﻿FN Thomson Reuters Web of Science™
VR 1.0
PT J
AU Horstmann, Helen M.
   Hosalkar, Harish
   Keenan, Mary Ann
TI Orthopaedic issues in the musculoskeletal care of adults with cerebral
   palsy
SO DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY
VL 51
BP 99
EP 105
DI 10.1111/j.1469-8749.2009.03417.x
PD OCT 2009
PY 2009
AB Aims
   Orthopaedic care of adults with cerebral palsy (CP) has not been well
   documented in orthopaedic literature. This paper focuses on some of the
   common problems which present themselves when adults with CP seek
   orthopaedic intervention. In particular, we review the most common
   orthopaedic issues which present to the Penn Neuro-Orthopaedics Program.
   Method
   A formal review of consecutive surgeries performed by the senior author
   on adults with CP was previously conducted. This paper focuses on the
   health delivery care for the adult with orthopaedic problems related to
   cerebral palsy. Ninety-two percent of these patients required lower
   extremity surgery. Forty percent had procedures performed on the upper
   extremities.
   Results
   The majority of problems seen in the Penn Neuro-Orthopaedics Program are
   associated with the residuals of childhood issues, particularly
   deformities associated with contractures. Patients are also referred for
   treatment of acquired musculoskeletal problems such as degenerative
   arthritis of the hip or knee. A combination of problems contribute most
   frequently to foot deformities and pain with weight-bearing, shoewear or
   both, most often due to equinovarus. The surgical correction of this is
   most often facilitated through a split anterior tibial tendon transfer.
   Posterior tibial transfers are rarely indicated. Residual equinus
   deformities contribute to a pes planus deformity. The split anterior
   tibial tendon transfer is usually combined with gastrocnemius-soleus
   recession and plantar release. Transfer of the flexor digitorum longus
   to the os calcis is done to augment the plantar flexor power. Rigid pes
   planus deformity is treated with a triple arthrodesis. Resolution of
   deformity allows for a good base for standing, improved ability to
   tolerate shoewear, and/or braces. Other recurrent or unresolved issues
   involve hip and knee contractures. Issues of lever arm dysfunction
   create problems with mechanical inefficiency. Upper extremity
   intervention is principally to correct contractures. Internal rotation
   and adductor tightness at the shoulder makes for difficult underarm
   hygiene and predispose a patient to a spiral fracture of the humerus. A
   tight flexor, pronation pattern is frequently noted through the elbow
   and forearm with further flexion contractures through the wrist and
   fingers. Lengthenings are more frequently performed than tendon
   transfers in the upper extremity. Arthrodesis of the wrist or on rare
   occasions of the metacarpal-phalangeal joints supplement the
   lengthenings when needed.
   Conclusions
   The Penn Neuro-Orthopaedics Program has successfully treated adults with
   both residual and acquired musculoskeletal deformities. These
   deformities become more critical when combined with degenerative
   changes, a relative increase in body mass, fatigue, and weakness
   associated with the aging process.
CT 62nd Annual Meeting of the
   American-Academy-for-Cerebral-Palsy-and-Developmental-Medicine
CY SEP 17-20, 2008
CL Atlanta, GA
SP Amer Acad Cerebral Palsy & Dev Med
TC 10
ZB 2
Z8 1
ZS 1
Z9 12
SN 0012-1622
UT WOS:000269539400014
PM 19740216
ER

PT J
AU Singh, J.
   Sinha, S. K.
   Alsop, E.
   Gupta, S.
   Mishra, A.
   Donn, S. M.
TI Long term follow-up of very low birthweight infants from a neonatal
   volume versus pressure mechanical ventilation trial
SO ARCHIVES OF DISEASE IN CHILDHOOD-FETAL AND NEONATAL EDITION
VL 94
IS 5
BP F360
EP F362
DI 10.1136/adc.2008.150938
PD SEP 2009
PY 2009
AB Background: A previous randomised trial showed volume controlled
   ventilation (VCV) was efficacious in ventilating very preterm and
   extremely low birthweight babies.
   Objective: To compare long term survival, pulmonary morbidities and
   gross neurodevelopmental outcomes of babies randomised to either VCV or
   pressure limited ventilation (PLV) for treatment of respiratory distress
   syndrome.
   Design/Methods: Masked evaluation of health status, including frequency
   of respiratory illness, use of medications, hospital admissions, and
   gross neurodevelopmental status were obtained using a structured
   parental questionnaire and verification from medical records.
   Results: 94 of 109 children (86%) survived to discharge. Three died
   after discharge (2 VCV, 1 PLV). Modality of ventilation did not affect
   overall mortality; seven VCV children died (12%) versus 11 PLV (21%) (OR
   0.5 (95% CI 0.1 to 1.4), p = 0.13). Respiratory abnormalities were
   present in 32 (37%), and 26 (30%) required hospital readmission. There
   was no significant difference in readmission rates between the two
   groups: VC 13/45 (29%) and PLV 19/40 (47%) (OR 0.4 (0.1 to 1.1), p =
   0.07). Modality of ventilation did not affect frequency of respiratory
   illness: VC 12 (27%) and PLV 14 (35%) (OR 0.46 (0.1 to 1.1), p = 0.09).
   However, significantly fewer VCV children (13%, n = 6) compared to PLV
   children (32%, n = 13) required treatment with inhaled
   steroids/bronchodilators (OR 0.3 (0.1 to 0.9), p = 0.04). Nine children
   had severe neurodevelopmental disability (cerebral palsy, blindness,
   deafness) (9.8%; 3 VCV, 6 PLV 6) (OR 0.4 (0.09 to 1.7)).
   Conclusions: The efficacy of VCV in very preterm and low birth babies
   appears to be maintained on longer term evaluation.
TC 6
ZB 1
Z8 0
ZS 0
Z9 6
SN 1359-2998
UT WOS:000270495600012
PM 19321507
ER

PT J
AU Burtin, Chris
   Clerckx, Beatrix
   Robbeets, Christophe
   Ferdinande, Patrick
   Langer, Daniel
   Troosters, Thierry
   Hermans, Greet
   Decramer, Marc
   Gosselink, Rik
TI Early exercise in critically ill patients enhances short-term functional
   recovery
SO CRITICAL CARE MEDICINE
VL 37
IS 9
BP 2499
EP 2505
DI 10.1097/CCM.0b013e3181a38937
PD SEP 2009
PY 2009
AB Objectives. To investigate whether a daily exercise session, using a
   bedside cycle ergometer, is a safe and effective intervention in
   preventing or attenuating the decrease in functional exercise capacity,
   functional status, and quadriceps force that is associated with
   prolonged intensive care unit stay. A prolonged stay in the intensive
   care unit is associated with muscle dysfunction, which may contribute to
   an impaired functional status up to 1 yr after hospital discharge. No
   evidence is available concerning the effectiveness of an early exercise
   training intervention to prevent these detrimental complications.
   Design. Randomized controlled trial.
   Setting: Medical and surgical intensive care unit at University Hospital
   Gasthuisberg.
   Patients: Ninety critically ill patients were included as soon as their
   cardiorespiratory condition allowed bedside cycling exercise (starting
   from day 5), given they still had an expected prolonged intensive care
   unit stay of at least 7 more days.
   Interventions. Both groups received respiratory physiotherapy and a
   daily standardized passive or active motion session of upper and lower
   limbs. In addition, the treatment group performed a passive or active
   exercise training session for 20 mins/day, using a bedside ergometer.
   Measurements and Main Results., All outcome data are reflective for
   survivors. Quadriceps force and functional status were assessed at
   intensive care unit discharge and hospital discharge. Six-minute walking
   distance was measured at hospital discharge. No adverse events were
   identified during and immediately after the exercise training. At
   intensive care unit discharge, quadriceps force and functional status
   were not different between groups. At hospital discharge, 6-min walking
   distance, isometric quadriceps force, and the subjective feeling of
   functional well-being (as measured with "Physical Functioning" item of
   the Short Form 36 Health Survey questionnaire) were significantly higher
   in the treatment group (p < .05).
   Conclusions: Early exercise training in critically ill intensive care
   unit survivors enhanced recovery of functional exercise capacity,
   self-perceived functional status, and muscle force at hospital
   discharge. (Crit Care Med 2009; 37:2499-2505)
RI burtin, chris/F-8813-2013; burtin, chris/B-3343-2015
TC 184
ZB 30
Z8 2
ZS 5
Z9 193
SN 0090-3493
UT WOS:000269191900001
PM 19623052
ER

PT J
AU Weber-Carstens, Steffen
   Koch, Susanne
   Spuler, Simone
   Spies, Claudia D.
   Bubser, Florian
   Wernecke, Klaus D.
   Deja, Maria
TI Nonexcitable muscle membrane predicts intensive care unit-acquired
   paresis in mechanically ventilated, sedated patients
SO CRITICAL CARE MEDICINE
VL 37
IS 9
BP 2632
EP 2637
DI 10.1097/CCM.0b013e3181a92f28
PD SEP 2009
PY 2009
AB Objectives. To investigate the predictive value of electrophysiological
   measurements including validation of muscle membrane excitability on the
   development of intensive care unit (ICU)-aquired paresis.
   Design: Prospective observational study.
   Setting. University ICU.
   Patients: Surgical ICU patients selected upon a simplified acute
   physiology score >= 20 on three successive days within 1 wk after ICU
   admission.
   Interventions: We performed serial electrophysiological measurements
   with onset of critical illness including conventional
   electrophysiological parameters and compound muscle action potentials
   after direct muscle stimulation (dmCMAP). Patients' awareness and muscle
   strength were measured sequentially by Ramsay sedation scale and an
   additional questionnaire and by Medical Research Council score,
   respectively.
   Measurements and Main Results: Among 56 sedated patients 34 patients
   revealed reduced dmCMAP values <3 mV indicating a myopathic process
   within 7.5 (5 of 11) days after admission to the ICU. Abnormal dmCMAP
   anticipated ICU-acquired paresis upon emergence from sedation with a
   sensitivity and specificity of 83.3% and 88.8%, respectively (positive
   predictive value of 0.91). Multivariate logistic regression analyses
   revealed that validating dmCMAP during early course of critical illness
   had significant diagnostic utility to anticipate ICU-acquired paresis (p
   = .004; odds ratio = .47; 95% confidence interval = .28-.79).
   Conclusions. Abnormal dmCMAP occurred within the first week after
   admission to the ICU and pointed towards a myopathic process as the
   primary cause of ICU-acquired paresis. Validation of dmCMAP with onset
   of critical illness allows an early prediction of ICU-acquired paresis
   and adds important information to clinical estimation of the patients'
   motor function. (Crit Care Med 2009; 37:2632-2637)
TC 34
ZB 11
Z8 0
ZS 0
Z9 34
SN 0090-3493
UT WOS:000269191900020
PM 19623045
ER

PT J
AU Garnacho-Montero, Jose
   Amaya Villar, Rosario
TI Better sooner than later?
SO CRITICAL CARE MEDICINE
VL 37
IS 9
BP 2672
EP 2673
DI 10.1097/CCM.0b013e3181abfbe5
PD SEP 2009
PY 2009
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 0090-3493
UT WOS:000269191900038
PM 19687648
ER

PT J
AU DiMarco, Anthony F.
   Kowalski, Krzysztof E.
TI High-frequency spinal cord stimulation of inspiratory muscles in dogs: a
   new method of inspiratory muscle pacing
SO JOURNAL OF APPLIED PHYSIOLOGY
VL 107
IS 3
BP 662
EP 669
DI 10.1152/japplphysiol.00252.2009
PD SEP 2009
PY 2009
AB DiMarco AF, Kowalski KE. High-frequency spinal cord stimulation of
   inspiratory muscles in dogs: a new method of inspiratory muscle pacing.
   J Appl Physiol 107: 662-669, 2009. First published June 11, 2009; doi:
   10.1152/japplphysiol.00252.2009.-Despite clinically available methods of
   diaphragm pacing, most patients with ventilator-dependent tetraplegia
   are still dependent on mechanical ventilation. Given the significant
   disadvantages of these devices, additional pacing options are needed.
   The objective of this study was to evaluate a novel and potentially more
   physiological method of inspiratory muscle activation, which involves
   the application of high-frequency (>200 Hz) stimulation to the ventral
   surface of the spinal cord in the high thoracic region. Studies were
   performed in 13 anesthetized dogs. High-frequency spinal cord
   stimulation (HF-SCS) results in the activation of both the diaphragm and
   inspiratory intercostal muscles, in concert, at physiological firing
   frequencies and the generation of large inspired volumes. Mean maximum
   firing frequencies of motor units in the parasternal (2nd interspace),
   the external intercostal (3rd interspace), and the diaphragm muscles
   were 10.6 +/- 0.4, 11.7 +/- 0.4, and 10.4 +/- 0.3 Hz, respectively.
   These values were not significantly different from those occurring
   during spontaneous breathing at comparable inspired volumes. Maximum
   inspired volume was 0.93 +/- 0.01 liter, which approximates the
   inspiratory capacity of these animals. Moreover, ventilation can be
   maintained on a chronic basis by this method (6 h) without evidence of
   system fatigue. Our results suggest that HF-SCS results in activation of
   spinal cord tracts that synapse with the inspiratory motoneuron pools,
   allowing processing of the stimulus and consequent physiological
   activation of the inspiratory muscles. HF-SCS has the potential to
   provide an effective method of inspiratory muscle pacing.
TC 22
ZB 20
Z8 0
ZS 0
Z9 22
SN 8750-7587
UT WOS:000269370700006
PM 19520839
ER

PT J
AU Tobin, Martin J.
   Laghi, Franco
   Brochard, Laurent
TI Role of the respiratory muscles in acute respiratory failure of COPD:
   lessons from weaning failure
SO JOURNAL OF APPLIED PHYSIOLOGY
VL 107
IS 3
BP 962
EP 970
DI 10.1152/japplphysiol.00165.2009
PD SEP 2009
PY 2009
AB Tobin MJ, Laghi F, Brochard L. Role of the respiratory muscles in acute
   respiratory failure of COPD:lessons from weaning failure. J Appl Physiol
   107: 962-970, 2009. First published April 30, 2009;
   doi:10.1152/japplphysiol.00165.2009.-It is problematic to withhold
   therapy in a patient with chronic obstructive pulmonary disease (COPD)
   who presents with acute respiratory failure so that detailed
   physiological measurements can be obtained. Accordingly, most
   information on respiratory muscle activity in patients experiencing
   acute respiratory failure has been acquired by studying patients who
   fail a trial of weaning after a period of mechanical ventilation. Such
   patients experience marked increases in inspiratory muscle load
   consequent to increases in resistance, elastance, and intrinsic positive
   end-expiratory pressure. Inspiratory muscle strength is reduced
   secondary to hyperinflation and possibly direct muscle damage and the
   release of inflammatory mediators. Most patients recruit both their
   sternomastoid and expiratory muscles, even though airflow limitation
   prevents the expiratory muscles from lowering lung volume. Even when
   acute hypercapnia is present, patients do not exhibit respiratory center
   depression; indeed, voluntary activation of the diaphragm, in absolute
   terms, is greater in hypercapnic patients than in normocapnic patients.
   Instead, the major mechanism of acute hypercapnia is the development of
   rapid shallow breathing. Despite the marked increase in mechanical load
   and decreased force-generating capacity of the inspiratory muscles,
   patients do not develop long-lasting muscle fatigue, at least over the
   period of a failed weaning trial. Although the disease originates within
   the lung parenchyma, much of the distress faced by patients with COPD,
   especially during acute respiratory failure, is caused by the burdens
   imposed on the respiratory muscles.
TC 31
ZB 12
Z8 2
ZS 0
Z9 34
SN 8750-7587
UT WOS:000269370700043
PM 19407256
ER

PT J
AU Malmivaara, Kirsi
   Hernesniemi, Juha
   Salmenpera, Ritva
   Ohman, Juha
   Roine, Risto P.
   Siironen, Jari
TI SURVIVAL AND OUTCOME OF NEUROSURGICAL PATIENTS REQUIRING VENTILATORY
   SUPPORT AFTER INTENSIVE CARE UNIT STAY
SO NEUROSURGERY
VL 65
IS 3
BP 530
EP 538
DI 10.1227/01.NEU.0000350861.97585.CE
PD SEP 2009
PY 2009
AB OBJECTIVE: The aim of this study was to analyze the clinical outcome of
   severely ill neurosurgical patients whose need for artificial life
   support was extended. We sought to determine whether these patients
   benefit from extended treatment both in life expectancy and quality of
   life. Furthermore, we evaluated the direct cost of the neurosurgical
   treatment.
   METHODS: The study group comprised a consecutive series of 346
   neurosurgical patients in poor condition who were discharged from the
   intensive care unit but still in need of artificial respiratory support.
   The patients had various neurosurgical diagnoses and were treated
   between 2000 and 2003 at the Department of Neurosurgery, Helsinki
   University Central Hospital. We followed the outcome of these patients
   by specially formatted questionnaires 6 months and 1, 2, and 5 years
   after treatment. Their health-related quality of life was evaluated with
   EuroQol EQ-5D; quality-adjusted life years (QALY) gained with the
   treatment and the costs of a QALY were calculated.
   RESULTS: The median follow-up time was 5 years. The mortality rate was
   27% at 30 days, 45% at 1 year, and 59% at 5 years after treatment. Of
   the patients, 20% had a good recovery (Glasgow Outcome Scale [GOS]
   scores 4 and 5), 18% had severe disability (GOS score 3), none was in a
   vegetative state (GOS score 2), 59% were dead (GOS score 1), and 3% were
   lost to follow-up. Of the survivors, 69% lived at home, 22% in a nursing
   home, 2% were in a hospital, and 7% were lost to follow-up. The median
   EQ-5D index value was lower than the median index value for the general
   population: 0.71 (25th percentile [Q1] 0.38 and 75th percentile [Q3]
   0.85) versus 0.85 (Q1 0.73 and Q3 1.00). The median cost of the direct
   neurosurgical treatment per patient was 15 000 (sic) (25th percentile,
   10 000 (sic) 75th percentile, 22 000 (sic)). Surviving patients gained a
   mean of 17 +/- 13 QALYs. The cost of 1 QALY was 2521 (sic).
   CONCLUSION: Prolonged intensive care unit and step-down unit treatment
   of critically ill neurosurgical patients seems to be clinically
   justified. Moreover, direct costs of neurosurgical treatment were
   reasonably low.
TC 7
ZB 4
Z8 0
ZS 0
Z9 7
SN 0148-396X
UT WOS:000269325600013
PM 19687698
ER

PT J
AU Chakkarapani, Ela
   Thoresen, Marianne
   Hobbs, Catherine E.
   Aquilina, Kristian
   Liu, Xun
   Dingley, John
TI A Closed-Circuit Neonatal Xenon Delivery System: A Technical and
   Practical Neuroprotection Feasibility Study in Newborn Pigs
SO ANESTHESIA AND ANALGESIA
VL 109
IS 2
BP 451
EP 460
DI 10.1213/ane.0b013e3181aa9550
PD AUG 2009
PY 2009
AB BACKGROUND: Asphyxia accounts for 23% of the 4 million annual global
   neonatal deaths. In developed Countries, the incidence of death or
   severe disability after hypoxic-ischemic (HI) encephalopathy is 1-2/1000
   infants born at term. Hypothermia (HT) benefits newborns post-HI and is
   rapidly entering clinical use. Xenon (Xe), a scarce and expensive
   anesthetic, combined with HT markedly increases neuroprotection in small
   animal HI models. The low-Xe uptake of the patient favors the use of
   closed-circuit breathing system for efficiency and economy. We developed
   a system for delivering Xe to mechanically ventilated neonates, then
   investigated its technical and practical feasibility in a previously
   described neonatal pig model approximating the clinical scenario of
   global HI injury, prolonged Xe delivery with and without HT as a
   potential therapy, subsequent neonatal intensive care unit management,
   and tracheal extubation.
   METHODS: Sixteen newborn pigs underwent a global 45 min HI insult (4%-6%
   0 inspired oxygen reducing the electroencephalogram amplitude to <7 mu
   V), the]) received 16 h 50% inspired Xe during normothermia (39.0
   degrees C) or HT (33.5 degrees C). A conventional neonatal ventilator
   provided breaths of oxygen to a lower chamber compressing a hanging bag
   within. This bag communicated with the upper closed part of the
   breathing system containing soda lime, unidirectional valves, Xe/oxygen
   analyzers, and a tracheal tube connection. At each end-inspiration, this
   bag emptied fully and a bolus of oxygen, the driving gas, crossed from
   the lower to upper chamber via an additional valve. This Mechanically
   Substituted the gas uptake from the circle during the previous breath
   cycle (oxygen + small volume of Xe) with an equivalent volume of oxygen
   creating a slow-rising inspired oxygen concentration. This was offset by
   manual injection of Xe boluses, infrequently at steady state, due to the
   low-Xe uptake of the patient.
   RESULTS: Total mean Xe usage was 0.18 (0.16-0.21) L/h with no
   differences between Xe-HT and Xe-NT groups, which had weights of 1767
   (1657-1877) g and 1818 (1662-1974) g, respectively (95%, Cl). HT reduced
   heart rate in the cooled animals; 180 (165-195) vs 148 (142-155) bpm (P
   < 0.0001) with no differences in arterial blood pressure, oxygen
   saturation, arterial carbon dioxide tension, or weaning times between
   these groups.
   CONCLUSION: We describe a closed-circuit Xe delivery system with
   automatic mechanical oxygen replenishment, which Could be developed as a
   single use device. Gas exchange was maintained while Xe comsumption was
   minimal (<$2/h at $10/L*). We have shown it is both feasible and
   cost-efficient to use this Xe delivery method in newborn pigs for up to
   16 h with or without Concurrent cooling after a severe HI insult.
   (Anesth Analg 2009;109:451-60)
TC 17
ZB 11
Z8 1
ZS 0
Z9 18
SN 0003-2999
UT WOS:000268298600026
PM 19608817
ER

PT J
AU Vohra, Hunaid A
   Modi, Amit
   Ohri, Sunil K
TI Does use of intra-operative cerebral regional oxygen saturation
   monitoring during cardiac surgery lead to improved clinical outcomes?
SO Interactive cardiovascular and thoracic surgery
VL 9
IS 2
BP 318
EP 22
DI 10.1510/icvts.2009.206367
PD 2009-Aug
PY 2009
AB A best evidence topic in cardiac surgery was written according to a
   structured protocol. The question addressed was whether the use of
   cerebral regional oxygen saturation (rSO(2)) monitoring during cardiac
   surgery can lead to improved clinical outcomes. Altogether 488 papers
   were found using the reported search, of which eight presented the best
   evidence to answer the clinical question. The author, year, journal,
   country of study, study type, patient group studied, relevant outcomes,
   results and study weaknesses were tabulated. Four prospective and
   another four retrospective studies involving adult and paediatric
   patients undergoing various cardiac surgical procedures were selected.
   These have demonstrated that prolonged intra-operative cerebral
   desaturations are associated with adverse neurological outcomes and
   prolonged hospital stay. Further, interventions carried out by
   thoughtful use of the cerebral oximeter are associated with significant
   reduction in neurologic injury, major organ morbidity and mortality
   (MOMM) and duration of hospital stay. Some studies have indicated
   decreased ventilation and intensive care unit (ICU) stay times as well.
   Clinical benefit and the lack of use-associated risk of injury at a
   modest expense support the use of this device routinely in patients
   undergoing cardiac surgery.
TC 19
ZB 5
Z8 0
ZS 0
Z9 19
UT MEDLINE:19447799
PM 19447799
ER

PT J
AU Sinclair, Joanna L.
   Reed, Peter W.
TI Risk factors for perioperative adverse events in children with myotonic
   dystrophy
SO PEDIATRIC ANESTHESIA
VL 19
IS 8
BP 740
EP 747
DI 10.1111/j.1460-9592.2009.03079.x
PD AUG 2009
PY 2009
AB Background:
   This study was conducted to identify patient-related, surgical, and
   anesthetic factors that would help predict adverse events and allow for
   better planning of perioperative care in children with myotonic
   dystrophy.
   Methods:
   This is a retrospective chart review from a large tertiary pediatric
   hospital. Data were collected on demographics, disease severity,
   surgical procedure, and anesthetic technique. Perioperative adverse
   events were recorded.
   Results:
   Records on 27 patients having 78 anesthetics over a 17.5-year period
   were reviewed. The overall frequency of postoperative respiratory
   complications was 10%. Significant risk factors were high muscular
   impairment rating scale (MIRS) grade (P = 0.007), at least 2300
   cytosine, thymine, guanine (CTG) repeats on the protein kinase gene of
   chromosome 19q (P = 0.009), a longer duration of surgery (RR = 14.0 for
   surgery lasting at least 1 h; P = 0.002), perioperative morphine use (RR
   = 7.7, 95% CI 2.2-12.8; P = 0.005), intubation (P = 0.02), and the use
   of muscle relaxant without reversal (RR = 15.5, P = 0.0002). Using a
   multivariate risk model, only MIRS grade and the use of muscle relaxant
   without reversal were shown to be significant independent risk factors
   (RR = 24.9, P < 0.0001).
   Conclusions:
   The MIRS is a statistically significant and clinically useful tool for
   predicting high perioperative risk. Patients with a high MIRS grade
   should therefore be considered for postoperative intensive care. The use
   of muscle relaxant without reversal was also shown to be a significant
   risk factor. Patients who require morphine infusions postoperatively
   might also be most safely managed in a high dependency unit.
TC 7
ZB 1
Z8 0
ZS 0
Z9 7
SN 1155-5645
UT WOS:000267884600003
PM 19624361
ER

PT J
AU Marn Pernat, Andreja
   Buturovic-Ponikvar, Jadranka
   Svigelj, Viktor
   Ponikvar, Rafael
TI Guillain-Barre syndrome treated by membrane plasma exchange and/or
   immunoadsorption.
SO Therapeutic apheresis and dialysis : official peer-reviewed journal of
   the International Society for Apheresis, the Japanese Society for
   Apheresis, the Japanese Society for Dialysis Therapy
VL 13
IS 4
BP 310
EP 3
DI 10.1111/j.1744-9987.2009.00730.x
PD 2009-Aug
PY 2009
AB In this report, we evaluate the success of immunoadsorption and plasma
   membrane exchange treatment in patients with severe Guillain-Barre
   syndrome (GBS), and describe one case successfully treated by
   immunoadsorption after failure of plasma exchange therapy. Nineteen
   severely paralyzed GBS patients, aged 14-76 years, who were treated
   between 1998 and 2008, were retrospectively studied. They underwent 161
   immunoadsorption and 119 plasma exchange procedures. In severe GBS, 4-30
   immunoadsorption and 5-31 plasma exchange sessions were needed. Among 16
   patients on mechanical ventilation, 11 recovered from disability
   completely, while in one patient mild muscle weakness persisted after
   one year. One patient suffered from ischemic stroke, two patients died
   after weaning from mechanical ventilation. One death was believed to be
   procedure-unrelated, the other patient died from sepsis. Four patients
   were lost to follow-up. We treated a 14-year-old,
   mechanically-ventilated patient using two different apheresis methods.
   After failure of 31 membrane plasma exchanges over 34 days, the patient
   was then switched to the immunoadsorption apheresis method, receiving
   seven sessions in 15 days. He no longer required assisted ventilation
   and recovered from the disability completely. A high number of
   immunoadsorption as well as membrane plasma exchange treatments can be
   safely and effectively applied in severe GBS patients. Our patients
   often needed, and were provided with, more than the currently
   arbitrarily accepted four apheresis sessions before good clinical
   recovery was achieved. For non-responders to plasma exchange treatment,
   immunoadsorption may be the first-line therapy.
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
UT MEDLINE:19695065
PM 19695065
ER

PT J
AU Fan, Eddy
   Zanni, Jennifer M
   Dennison, Cheryl R
   Lepre, Scott J
   Needham, Dale M
TI Critical illness neuromyopathy and muscle weakness in patients in the
   intensive care unit.
SO AACN advanced critical care
VL 20
IS 3
BP 243
EP 53
DI 10.1097/NCI.0b013e3181ac2551
PD 2009 Jul-Sep
PY 2009
AB Neuromuscular complications of critical illness are common and can be
   severe and persistent in some patients. Neuromyopathy from critical
   illness and disuse atrophy from prolonged immobility contribute to
   muscle weakness acquired while in the intensive care unit. Although
   various risk factors (eg, severity of illness, corticosteroids,
   neuromuscular blocking agents) have been implicated in critical illness
   neuromyopathy (CINM), the evidence supporting these associations is
   inconsistent. Hyperglycemia may be an important risk factor for CINM,
   with tight glycemic control through intensive insulin therapy reducing
   the incidence of CINM. Early mobility in the intensive care unit may
   minimize disuse atrophy and possibly CINM, through exercise training and
   its anti-inflammatory effects. Although emerging data have demonstrated
   the safety, feasibility, and benefit of early mobility in critically ill
   patients, randomized controlled trials are needed to thoroughly evaluate
   its potential benefits on patients' muscle strength, physical function,
   and quality of life. Future studies are needed to elucidate the multiple
   mechanisms by which immobility, CINM, and other aspects of critical
   illness lead to muscle loss and neuromuscular dysfunction.
TC 22
ZB 3
Z8 0
ZS 0
Z9 22
UT MEDLINE:19638746
PM 19638746
ER

PT J
AU Hopkins, Ramona O
   Spuhler, Vicki J
TI Strategies for promoting early activity in critically ill mechanically
   ventilated patients.
SO AACN advanced critical care
VL 20
IS 3
BP 277
EP 89
DI 10.1097/NCI.0b013e3181acaef0
PD 2009 Jul-Sep
PY 2009
AB Prolonged immobilization plays a significant role in neuromuscular
   abnormalities and complicates the clinical course of a majority of
   critically ill patients. Immobilization in critically ill patients is
   associated with significant morbidity and impaired physical function.
   Overuse of sedation, sleep deprivation, immobility, and the development
   of delirium are all intensive care unit (ICU) factors that may
   negatively impact patient outcomes. Ambulation of critically ill
   patients is difficult with risk for adverse events. However, with a
   dedicated and trained team and culture change, early ICU mobility can be
   a feasible and safe process. Early mobility has potential as a therapy
   to prevent or treat the neuromuscular complications of critical illness.
   ICU culture can be transformed in a way that leads to improved and more
   reliable treatments and care, including early activity and mobility.
TC 24
ZB 0
Z8 0
ZS 0
Z9 22
UT MEDLINE:19638749
PM 19638749
ER

PT J
AU Zink, Wolfgang
   Kollmar, Rainer
   Schwab, Stefan
TI Critical illness polyneuropathy and myopathy in the intensive care unit
SO NATURE REVIEWS NEUROLOGY
VL 5
IS 7
BP 372
EP 379
DI 10.1038/nrneurol.2009.75
PD JUL 2009
PY 2009
AB Critical illness polyneuropathy (CIP) and critical illness myopathy
   (CIM) are major complications that occur in severely ill patients who
   require intensive care treatment. CIP and CIM affect the limb and
   respiratory muscles, and, as a consequence, they characteristically
   complicate weaning from the ventilator, increase the length of stay on
   the intensive care unit, and prolong physical rehabilitation. The basic
   pathophysiology of both disorders is complex and involves metabolic,
   inflammatory and bioenergetic alterations. it is unclear at present
   whether CIP and CIM are distinct entities, or whether they just
   represent different 'organ' manifestations of a common
   pathophysiological mechanism. This article provides an overview of the
   clinical and diagnostic features of CIP and CIM and discusses current
   pathophysiological and therapeutic concepts relating to these
   neuromuscular disorders.
TC 23
ZB 12
Z8 2
ZS 0
Z9 24
SN 1759-4758
UT WOS:000267621600007
PM 19578344
ER

PT J
AU Anjari, Mustafa
   Counsell, Serena J.
   Srinivasan, Latha
   Allsop, Joanna M.
   Hajnal, Joseph V.
   Rutherford, Mary A.
   Edwards, A. David
TI The Association of Lung Disease With Cerebral White Matter Abnormalities
   in Preterm Infants
SO PEDIATRICS
VL 124
IS 1
BP 268
EP 276
DI 10.1542/peds.2008-1294
PD JUL 2009
PY 2009
AB OBJECTIVE: Preterm infants have a high incidence of neurodevelopmental
   impairment associated with diffuse cerebral white matter abnormalities
   and also a high incidence of serious respiratory disease. However, it is
   unclear if lung disease and brain injury are related, and previous
   research has been impeded by confounding effects, including prematurity
   and infection. Using a new approach that permits multivariate
   statistical analysis, we tested the hypothesis that lung disease is
   associated with specific white matter abnormalities, detected as reduced
   fractional anisotropy ( FA) in diffusion tensor imaging data.
   METHODS: Fifty-three preterm infants with no evidence of focal
   abnormality on conventional MRI were studied at term-equivalent age by
   using tract-based spatial statistics, an automated observer-independent
   method for voxelwise analysis of major white matter pathways.
   RESULTS: In several white matter tracts, FA decreased with a linear
   relation to the gestational age at birth. Independent of the confounding
   effects of prematurity and age at scan, respiratory disease was
   associated with specific white matter abnormalities in preterm infants;
   those infants receiving mechanical ventilation for >2 days in the
   perinatal period (n = 10) showed reduced FA in the genu of the corpus
   callosum, whereas subjects with chronic lung disease (n = 15) displayed
   a reduction in FA in the left inferior longitudinal fasciculus.
   CONCLUSION: Independent of the degree of prematurity, respiratory
   disease is associated with cerebral white matter abnormalities.
   Pediatrics 2009; 124: 268-276
RI counsell, serena/I-9012-2014
TC 32
ZB 21
Z8 2
ZS 0
Z9 34
SN 0031-4005
UT WOS:000267448100034
PM 19564309
ER

PT J
AU Schuetz, Philipp
   Christ-Crain, Mirjam
   Mueller, Beat
TI Procalcitonin and other biomarkers to improve assessment and antibiotic
   stewardship in infections - hope for hype?
SO SWISS MEDICAL WEEKLY
VL 139
IS 23-24
BP 318
EP 326
PD JUN 13 2009
PY 2009
AB This review aims to provide physicians with an overview of the potential
   of procalcitonin to guide antibiotic therapy in respiratory tract
   infections and in sepsis. Knowledge of the strengths and weaknesses of
   procalcitonin are prerequisites for a rational and safe use in clinical
   routine. In most infections a true gold standard for diagnosis does not
   exist, therefore physicians must remain sceptical towards observational
   studies evaluating procalcitonin. Interpretation of procalcitonin levels
   must always include the clinical setting and knowledge of assay
   characteristics, particularly the setting of specific cut-off ranges and
   functional assay sensitivities. Highly sensitive procalcitonin
   measurements, embedded in a clearly defined setting and prospectively
   validated with clinical algorithms were repeatedly effective in markedly
   reducing the (over)-utilisation of antimicrobial therapy. Today, this
   concept has been proven for lower respiratory tract infections and in
   pilot studies for meningitis and critically ill patients with sepsis.
   The higher the absolute risk for adverse outcome of a patient, the more
   cautious physicians must remain and empirical antibiotic therapies must
   be considered despite initial low procalcitonin levels at the initial
   presentation. In these patients a procalcitonin-guided shortening of
   antibiotic courses seems appropriate. The prognostic utility of initial
   procalcitonin measurement in respiratory tract infections is suboptimal.
   Other biomarkers including cortisol, human growth hormone and
   prohormones from adrenomedullin and vasopressin ("copeptin") have a
   superior predictive potential to estimate the risk for short and long
   term mortality and other adverse outcomes in different diseases. An
   accurate prognostic assessment has the potential to optimise the
   management of patients and the allocation of our limited health care
   resources by lowering unnecessary hospitalisations and associated cost.
   Future intervention studies must prove if these biomarkers indeed
   improve clinical decision making and thus the overall medical management
   of patients.
TC 61
ZB 25
Z8 7
ZS 1
Z9 69
SN 1424-7860
UT WOS:000267174200001
PM 19529989
ER

PT J
AU Annane, Djillali
   Bellissant, Eric
   Bollaert, Pierre-Edouard
   Briegel, Josef
   Confalonieri, Marco
   De Gaudio, Raffaele
   Keh, Didier
   Kupfer, Yizhak
   Oppert, Michael
   Meduri, G. Umberto
TI Corticosteroids in the Treatment of Severe Sepsis and Septic Shock in
   Adults A Systematic Review
SO JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION
VL 301
IS 22
BP 2362
EP 2375
PD JUN 10 2009
PY 2009
AB Context The benefit of corticosteroids in severe sepsis and septic shock
   remains controversial.
   Objective We examined the benefits and risks of corticosteroid treatment
   in severe sepsis and septic shock and the influence of dose and
   duration.
   Data Sources We searched the CENTRAL, MEDLINE, EMBASE, and LILACS
   (through March 2009) databases as well as reference lists of articles
   and proceedings of major meetings, and we contacted trial authors.
   Study Selection Randomized and quasi-randomized trials of
   corticosteroids vs placebo or supportive treatment in adult patients
   with severe sepsis/septic shock per the American College of Chest
   Physicians/Society of Critical Care Medicine consensus definition were
   included.
   Data Extraction All reviewers agreed on trial eligibility. One reviewer
   extracted data, which were checked by the other reviewers and by the
   trials' authors whenever possible. Some unpublished data were obtained
   from the trials' authors. The primary outcome for this review was 28-day
   mortality.
   Results We identified 17 randomized trials (n=2138) and 3
   quasi-randomized trials (n=246) that had acceptable methodological
   quality to pool in a meta-analysis. Twenty-eight-day mortality for
   treated vs control patients was 388/1099 (35.3%) vs 400/1039 (38.5%) in
   randomized trials (risk ratio [RR], 0.84; 95% confidence interval [CI],
   0.71-1.00; P=.05; I(2)=53% by random-effects model) and 28/121 (23.1%)
   vs 24/125 (19.2%) in quasi-randomized trials (RR, 1.05, 95% CI,
   0.69-1.58; P=.83). In 12 trials investigating prolonged low-dose
   corticosteroid treatment, 28-day mortality for treated vs control
   patients was 236/629 (37.5%) vs 264/599 (44%) ( RR, 0.84; 95% CI,
   0.72-0.97; P=.02). This treatment increased 28-day shock reversal ( 6
   trials; 322/481 [66.9%] vs 276/471 [58.6%]; RR, 1.12; 95% CI, 1.02-1.23;
   P=.02; I(2)=4%) and reduced intensive care unit length of stay by 4.49
   days (8 trials; 95% CI, -7.04 to -1.94; P<.001; I(2)=0%) without
   increasing the risk of gastroduodenal bleeding (13 trials; 65/800 [8.1%]
   vs 56/764 [7.3%]; P=.50; I(2)=0%), superinfection (14 trials; 184/998
   [18.4%] vs 170/950 [17.9%]; P=.92; I(2)=8%), or neuromuscular weakness
   (3 trials; 4/407 [1%] vs 7/404 [1.7%]; P=.58; I(2)=30%). Corticosteroids
   increased the risk of hyperglycemia (9 trials; 363/703 [51.6%] vs
   308/670 [46%]; P<.001; I(2)=0%) and hypernatremia (3 trials; 127/404
   [31.4%] vs 77/401 [ 19.2%]; P<.001; I(2)=0%).
   Conclusions Corticosteroid therapy has been used in varied doses for
   sepsis and related syndromes for more than 50 years, with no clear
   benefit on mortality. Since 1998, studies have consistently used
   prolonged low-dose corticosteroid therapy, and analysis of this subgroup
   suggests a beneficial drug effect on short-term mortality. JAMA.
   2009;301(22):2362-2375 www.jama.com
TC 204
ZB 80
Z8 20
ZS 2
Z9 226
SN 0098-7484
UT WOS:000266773400029
PM 19509383
ER

PT J
AU Gauld, Leanne Maree
TI Airway clearance in neuromuscular weakness
SO DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY
VL 51
IS 5
BP 350
EP 355
DI 10.1111/j.1469-8749.2008.03260.x
PD MAY 2009
PY 2009
AB Impaired airway clearance leads to recurrent chest infections and
   respiratory deterioration in neuromuscular weakness. It is frequently
   the cause of death. Cough is the major mechanism of airway clearance.
   Cough has several components, and assessment tools are available to
   measure the different components of cough. These include measuring peak
   cough flow, respiratory muscle strength, and inspiratory capacity. Each
   is useful in assessing the ability to generate an effective cough, and
   can be used to guide when techniques of assisting airway clearance may
   be effective for the individual and which are most effective. Techniques
   to assist airway clearance include augmenting inspiration by air
   stacking, augmenting expiration by assisting the cough, and augmenting
   both inspiration and expiration with the mechanical
   insufflator-exsufflator or by direct suctioning via a tracheostomy.
   Physiotherapists are invaluable in assisting airway clearance, and in
   teaching patients and their families how to use these techniques. Use of
   the mechanical insufflator-exsufflator has gained popularity in recent
   times, but several simpler, more economical methods are available to
   assist airway clearance that can be used effectively alone or in
   combination. This review examines the literature available on the
   assessment and management of impaired airway clearance in neuromuscular
   weakness.
RI Gauld, Leanne/D-8299-2011
TC 8
ZB 1
Z8 1
ZS 0
Z9 9
SN 0012-1622
UT WOS:000264955200006
PM 19379290
ER

PT J
AU Novak, Kevin R.
   Nardelli, Paul
   Cope, Tim C.
   Filatov, Gregory
   Glass, Jonathan D.
   Khan, Jaffar
   Rich, Mark M.
TI Inactivation of sodium channels underlies reversible neuropathy during
   critical illness in rats
SO JOURNAL OF CLINICAL INVESTIGATION
VL 119
IS 5
BP 1150
EP 1158
DI 10.1172/JCI36570
PD MAY 2009
PY 2009
AB Neuropathy and myopathy can cause weakness during critical illness. To
   determine whether reduced excitability of peripheral nerves, rather than
   degeneration, is the mechanism underlying acute neuropathy in critically
   ill patients, we prospectively followed patients during the acute phase
   of critical illness and early recovery and assessed nerve conduction.
   During the period of early recovery from critical illness, patients
   recovered from neuropathy within days. This rapidly reversible
   neuropathy has not to our knowledge been previously described in
   critically ill patients and may be a novel type of neuropathy. In vivo
   intracellular recordings from dorsal root axons in septic rats revealed
   reduced action potential amplitude, demonstrating that reduced
   excitability of nerve was the mechanism underlying neuropathy. When
   action potentials were triggered by hyperpolarizing pulses, their
   amplitudes largely recovered, indicating that inactivation of sodium
   channels was an important contributor to reduced excitability. There was
   no depolarization of axon resting potential in septic rats, which ruled
   out a contribution of resting potential to the increased inactivation of
   sodium channels. Our data suggest that a hyperpolarized shift in the
   voltage dependence of sodium channel inactivation causes increased
   sodium inactivation and reduced excitability. Acquired sodium
   channelopathy may be the mechanism underlying acute neuropathy in
   critically ill patients.
TC 32
ZB 18
Z8 0
ZS 0
Z9 33
SN 0021-9738
UT WOS:000265843400016
PM 19425168
ER

PT J
AU Schweickert, William D.
   Pohlman, Mark C.
   Pohlman, Anne S.
   Nigos, Celerina
   Pawlik, Amy J.
   Esbrook, Cheryl L.
   Spears, Linda
   Miller, Megan
   Franczyk, Mietka
   Deprizio, Deanna
   Schmidt, Gregory A.
   Bowman, Amy
   Barr, Rhonda
   McCallister, Kathryn E.
   Hall, Jesse B.
   Kress, John P.
TI Early physical and occupational therapy in mechanically ventilated,
   critically ill patients: a randomised controlled trial
SO LANCET
VL 373
IS 9678
BP 1874
EP 1882
DI 10.1016/S0140-6736(09)60658-9
PD MAY-JUN 2009
PY 2009
AB Background Long-term complications of critical illness include intensive
   care unit (ICU)-acquired weakness and neuropsychiatric disease.
   Immobilisation secondary to sedation might potentiate these problems. We
   assessed the efficacy of combining daily interruption of sedation with
   physical and occupational therapy on functional outcomes in patients
   receiving mechanical ventilation in intensive care.
   Methods Sedated adults (a:18 years of age) in the ICU who had been on
   mechanical ventilation for less than 72 h, were expected to continue for
   at least 24 h, and who met criteria for baseline functional independence
   were eligible for enrolment in this randomised controlled trial at two
   university hospitals. We randomly assigned 104 patients by
   computer-generated, permuted block randomisation to early exercise and
   mobilisation (physical and occupational therapy) during periods of daily
   interruption of sedation (intervention; n=49) or to daily interruption
   of sedation with therapy as ordered by the primary care team (control;
   n=55). The primary endpoint-the number of patients returning to
   independent functional status at hospital discharge-was defined as the
   ability to perform six activities of daily living and the ability to
   walk independently. Therapists who undertook patient assessments were
   blinded to treatment assignment. Secondary endpoints included duration
   of delirium and ventilator-free days during the first 28 days of
   hospital stay. Analysis was by intention to treat. This trial is
   registered with ClinicalTrials.gov, number NCT00322010.
   Findings All 104 patients were included in the analysis. Return to
   independent functional status at hospital discharge occurred in 29 (59%)
   patients in the intervention group compared with 19 (35%) patients in
   the control group (p=0.02; odds ratio 2.7 [95% CI 1.2-6.1]). Patients in
   the intervention group had shorter duration of delirium (median 2.0
   days, IQR 0.0-6.0 vs 4.0 days, 2.0-8.0; p=0.02), and more
   ventilator-free days (23.5 days, 7.4-25.6 vs 21.1 days, 0.0-23.8;
   p=0.05) during the 28-day follow-up period than did controls. There was
   one serious adverse event in 498 therapy sessions (desaturation less
   than 80%). Discontinuation of therapy as a result of patient instability
   occurred in 19 (4%) of all sessions, most commonly for perceived
   patient-ventilator asynchrony.
   Interpretation A strategy for whole-body rehabilitation-consisting of
   interruption of sedation and physical and occupational therapy in the
   earliest days of critical illness-was safe and well tolerated, and
   resulted in better functional outcomes at hospital discharge, a shorter
   duration of delirium, and more ventilator-free days compared with
   standard care.
   Funding None.
TC 576
ZB 104
Z8 12
ZS 13
Z9 604
SN 0140-6736
UT WOS:000266616400030
PM 19446324
ER

PT J
AU Plant, Nina
   Walker, Rob
TI Immediate extubation to noninvasive ventilation can reduce postoperative
   morbidity and need for PICU in children with neuromuscular disorders
SO PEDIATRIC ANESTHESIA
VL 19
IS 5
BP 549
EP 550
DI 10.1111/j.1460-9592.2009.02941.x
PD MAY 2009
PY 2009
TC 3
ZB 1
Z8 0
ZS 0
Z9 3
SN 1155-5645
UT WOS:000265511700025
PM 19453594
ER

PT J
AU Hung, Ha Tran
   Hojer, Jonas
   Du, Nguyen Thi
TI Clinical features of 60 consecutive ICU-treated patients envenomed by
   Bungarus multicinctus.
SO The Southeast Asian journal of tropical medicine and public health
VL 40
IS 3
BP 518
EP 24
PD 2009-May
PY 2009
AB In northern Vietnam, Bungarus multicinctus is the only krait of medical
   importance. We report 60 consecutive patients admitted to an ICU in
   Hanoi during 2000-2003 because of envenoming by B. multicinctus. Their
   mean age was 33 years (range 12-67), 77% were male. The majority were
   agricultural workers, 69% of the snakebites occurred during the night.
   The mean length of time until the first symptom developed was 3 hours
   (range 0.5-24 hours). The only sign at the site of the bite was fang
   marks, which were noted in 90%. The most common neuromuscular symptoms
   were ptosis and mydriasis (93%), ophthalmoplegia (82%), jaw weakness
   (90%), pharyngeal pain (83%), palatal palsy (90%), neck muscle paralysis
   (85%), limb paralysis (85%), and paralysis of the respiratory muscles
   (87%). No antivenom was available. Fifty-two patients (87%) needed
   mechanical ventilation for a mean of 8 days. The most surprising
   laboratory finding was a high rate of significant hyponatremia (42%).
   The mean duration of the ICU stay was 12 days and the hospital mortality
   was 7%. According to the Poisoning Severity Score criteria, 54 patients
   (90%) were classified as severe or lethal envenoming.
TC 7
ZB 7
Z8 1
ZS 0
Z9 8
SN 0125-1562
UT MEDLINE:19842438
PM 19842438
ER

PT J
AU Bott, J.
   Blumenthal, S.
   Buxton, M.
   Ellum, S.
   Falconer, C.
   Garrod, R.
   Harvey, A.
   Hughes, T.
   Lincoln, M.
   Mikelsons, C.
   Potter, C.
   Pryor, J.
   Rimington, L.
   Sinfield, F.
   Thompson, C.
   Vaughn, P.
   White, J.
CA British Thoracic Soc Physiotherapy
TI Guidelines for the physiotherapy management of the adult, medical,
   spontaneously breathing patient
SO THORAX
VL 64
BP 1
EP 51
DI 10.1136/thx.2008.110726
SU 1
PD MAY 2009
PY 2009
TC 61
ZB 7
Z8 0
ZS 5
Z9 65
SN 0040-6376
UT WOS:000265901800001
PM 19406863
ER

PT J
AU Murphy, Patrick
   Hart, Nicholas
TI Who benefits from home mechanical ventilation?
SO CLINICAL MEDICINE
VL 9
IS 2
BP 160
EP 163
PD APR 2009
PY 2009
TC 1
ZB 0
Z8 0
ZS 0
Z9 1
SN 1470-2118
UT WOS:000265125200019
PM 19435126
ER

PT J
AU McClung, Joseph M.
   Van Gammeren, Darin
   Whidden, Melissa A.
   Falk, Darin J.
   Kavazis, Andreas N.
   Hudson, Matt B.
   Gayan-Ramirez, Ghislaine
   Decramer, Marc
   DeRuisseau, Keith C.
   Powers, Scott K.
TI Apocynin attenuates diaphragm oxidative stress and protease activation
   during prolonged mechanical ventilation
SO CRITICAL CARE MEDICINE
VL 37
IS 4
BP 1373
EP 1379
DI 10.1097/CCM.0b013e31819cef63
PD APR 2009
PY 2009
AB Objective: To investigate whether apocynin protects the diaphragm from
   wasting and oxidative stress during mechanical ventilation (MV).
   Design: Prospective, randomized, controlled study.
   Setting: Research laboratory.
   Subjects: Adult female Sprague-Dawley rats.
   Interventions: Rats were randomly assigned to one of five experimental
   groups: 1) acutely anesthetized control, 2) spontaneous breathing
   control, 3) spontaneously breathing control with administration of the
   nicotinamide adenine dinucleotide phosphate oxidase inhibitor, apocynin,
   4) mechanically ventilated, and 5) mechanically ventilated with
   apocynin.
   Measurements and Main Results. Apocynin attenuated MV-induced
   diaphragmatic oxidative stress, contractile dysfunction, and type I,
   type IIa, and type IIb/IIx myofiber atrophy. The apocynin-induced
   attenuation of MV-induced diaphragmatic atrophy and contractile
   dysfunction occurred In conjunction with a reduction In the small
   increase in nicotinamide adenine dinucleotide phosphate oxidase activity
   as well as the preservation of total glutathione levels, glutathione
   peroxidase protein abundance, and a decrease in the activation of the
   cysteine proteases, calpain-1 and caspase-3. Interestingly, independent
   of MV, apocynin increased diaphragmatic levels of calpastatin, an
   endogenous calpain Inhibitor. Furthermore, treatment of skeletal muscle
   cells in culture (C2C12 myotubes) with apocynin resulted in an increase
   in both calpastatin mRNA levels and protein abundance.
   Conclusions. Our results suggest that the protective effects of apocynin
   on the diaphragm during prolonged MV seem to be linked to both Its
   functions as an antioxidant and role in cellular signaling regulating
   the cysteine protease inhibitor calpastatin. (Crit Care Med 2009;
   37:1373-1379)
RI Hudson, Matthew/E-4246-2010
TC 30
ZB 18
Z8 0
ZS 1
Z9 31
SN 0090-3493
UT WOS:000264699000028
PM 19242334
ER

PT J
AU Kavazis, Andreas N.
   Talbert, Erin E.
   Smuder, Ashley J.
   Hudson, Matthew B.
   Nelson, W. Bradley
   Powers, Scott K.
TI Mechanical ventilation induces diaphragmatic mitochondrial dysfunction
   and increased oxidant production
SO FREE RADICAL BIOLOGY AND MEDICINE
VL 46
IS 6
BP 842
EP 850
DI 10.1016/j.freeradbiomed.2009.01.002
PD MAR 15 2009
PY 2009
AB Mechanical ventilation (MV) is a life-saving intervention used in
   patients with acute respiratory failure. Unfortunately, prolonged MV
   results in diaphragmatic weakness, which is an important contributor to
   the failure to wean patients from MV. Our laboratory has previously
   shown that reactive oxygen species (ROS) play a critical role in
   mediating diaphragmatic weakness after MV. However, the pathways
   responsible for MV-induced diaphragmatic ROS production remain unknown.
   These experiments tested the hypothesis that prolonged MV results in an
   increase in mitochondrial ROS release, mitochondrial oxidative damage,
   and mitochondrial dysfunction. To test this hypothesis, adult (3-4
   months of age) female Sprague-Dawley rats were assigned to either a
   control or a 12-h MV group. After treatment, diaphragms were removed and
   mitochondria were isolated for subsequent respiratory and biochemical
   measurements. Compared to control, prolonged MV resulted in a lower
   respiratory control ratio in diaphragmatic mitochondria. Furthermore,
   diaphragmatic mitochondria from MV animals released higher rates of ROS
   in both State 3 and State 4 respiration. Prolonged MV was also
   associated with diaphragmatic mitochondrial oxidative damage as
   indicated by increased lipid peroxidation and protein oxidation.
   Finally, our data also reveal that the activities of the electron
   transport chain complexes II, III, and IV are depressed in mitochondria
   isolated from diaphragms of MV animals. In conclusion, these results are
   consistent with the concept that diaphragmatic inactivity promotes an
   increase in mitochondrial ROS emission, mitochondrial oxidative damage,
   and mitochondrial respiratory dysfunction. (c) 2009 Elsevier Inc. All
   rights reserved.
RI Hudson, Matthew/E-4246-2010
TC 54
ZB 39
Z8 1
ZS 0
Z9 55
SN 0891-5849
UT WOS:000264061400017
PM 19185055
ER

PT J
AU Lee, Yang Deok
TI Can Hand Dynamometry Serve as a Simple Test to Identify ICU-acquired
   Paresis?
SO AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE
VL 179
IS 4
BP 329
EP 329
PD FEB 15 2009
PY 2009
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 1073-449X
UT WOS:000263280300012
PM 19201931
ER

PT J
AU Thorburn, K.
TI Pre-existing disease is associated with a significantly higher risk of
   death in severe respiratory syncytial virus infection
SO ARCHIVES OF DISEASE IN CHILDHOOD
VL 94
IS 2
BP 99
EP 103
DI 10.1136/adc.2008.139188
PD FEB 2009
PY 2009
AB Background: 600 000 deaths worldwide are estimated to be directly or
   indirectly attributable to respiratory syncytial virus (RSV).
   Objectives: To determine: ( 1) the mortality rate; and ( 2) risk factors
   for death in children with severe RSV infection.
   Setting: 20-bed, regional, multidisciplinary, tertiary, paediatric
   intensive care unit (PICU) in a university-affiliated children's
   hospital.
   Methods: Cohort study of all children with severe RSV infection covering
   eight consecutive RSV seasons (1999-2007), using PICU admission as a
   marker of severity. Results: Of the 406 RSV-positive patients that were
   admitted to PICU: 98.5% required mechanical ventilation; 35 children
   died-median age 5.1 months (interquartile range (IQR) 2.4-13.6), length
   of PICU stay 16 days ( IQR 8-31) and 371 survived-median age 2.5 months
   ( IQR 1.2-9), length of PICU stay 5 days ( IQR 4-9). The overall PICU
   RSV mortality was 8.6% with a standardised mortality ratio of 0.76.
   During the study period 2009 RSV-positive patients were admitted to the
   children's hospital, giving a hospital RSV mortality rate of 1.7%. Of
   the deaths, 18 were directly RSV related ( RSV bronchiolitis-related
   mortality PICU 4.4% and hospital 0.9%) as the patients were still RSV
   positive when they died and 17 children died from non-pneumonitis causes
   after becoming RSV negative. All of the RSV deaths had pre-existing
   medical conditions -chromosomal abnormalities 29%, cardiac lesions 27%,
   neuromuscular 15%, chronic lung disease 12%, large airway abnormality
   9%, and immunodeficiency 9%. Nineteen children (56%) had pre-existing
   disease in two or more organ systems ( relative risk (RR) 4.38).
   Predisposing risk factors for death were pre-existing disease ( RR
   2.36), cardiac anomaly ( RR 2.98) and nosocomial/hospital-acquired RSV
   infection ( RR 2.89). There is an interaction effect between
   pre-existing disease, nosocomial/hospital-acquired RSV infection and
   mortality ( p < 0.001).
   Conclusions: Pre-existing disease/comorbidity, in particular multiple
   pre-existing diseases and cardiac anomaly, is associated with a
   significantly higher risk of death from severe RSV infection.
   Nosocomial/hospital-acquired RSV infection is an additional major risk
   factor for death in children with severe RSV infection.
TC 68
ZB 32
Z8 1
ZS 0
Z9 71
SN 0003-9888
UT WOS:000263079100005
PM 18653625
ER

PT J
AU Callahan, Leigh A.
TI Invited editorial on "Acquired respiratory muscle weakness in critically
   ill patients: what is the role of mechanical ventilation-induced
   diaphragm dysfunction?"
SO JOURNAL OF APPLIED PHYSIOLOGY
VL 106
IS 2
BP 360
EP 361
DI 10.1152/japplphysiol.91486.2008
PD FEB 2009
PY 2009
TC 2
ZB 2
Z8 2
ZS 0
Z9 4
SN 8750-7587
UT WOS:000263120400004
PM 19023013
ER

PT J
AU Hood, Brian
   Levene, Howard B.
   Levi, Allan D.
TI Transplantation of autologous Schwann cells for the repair of segmental
   peripheral nerve defects
SO NEUROSURGICAL FOCUS
VL 26
IS 2
AR E4
DI 10.3171/FOC.2009.26.2.E4
PD FEB 2009
PY 2009
AB Peripheral nerve injuries are a source of chronic disability. Incomplete
   recovery from such injuries results in motor and sensory dysfunction and
   the potential for the development of chronic pain. The repair of human
   peripheral nerve injuries with traditional surgical techniques has
   limited success, particularly when a damaged nerve segment needs to be
   replaced. An injury to a long segment of peripheral nerve is often
   repaired using autologous grafting of "noncritical" sensory nerve.
   Although extensive axonal regeneration can be observed extending into
   these grafts, recovery of function may be absent or incomplete if the
   axons fail to reach their intended target. The goal of this review was
   to summarize the progress that has occurred in developing an artificial
   neural prosthesis consisting of autologous Schwann cells (SCs), and to
   detail future directions required in translating this promising therapy
   to the clinic.
   In the authors' laboratory, methods are being explored to combine
   autologous SCs isolated using cell culture techniques with axon guidance
   channel (AGC) technology to develop the potential to repair critical gap
   length lesions within the peripheral nervous system. To test the
   clinical efficacy of such constructs, it is critically important to
   characterize the fate of the transplanted SCs with regard to cell
   survival, migration, differentiation, and myelin production. The authors
   sought to determine whether the use of SC-filled channels is superior or
   equivalent to strategies that are currently used clinically ( for
   example, autologous nerve grafts). Finally, although many nerve repair
   paradigms demonstrate evidence of regeneration within the AGC, the
   authors further sought to determine if the regeneration observed was
   physiologically relevant by including electrophysiological, behavioral,
   and pain assessments. If successful, the development of this reparative
   approach will bring together techniques that are readily available for
   clinical use and should rapidly accelerate the process of bringing an
   effective nerve repair strategy to patients with peripheral nerve injury
   prior to the development of pain and chronic disability. (DOI:
   10.3171/FOC.2009.26.2.E4)
TC 34
ZB 28
Z8 10
ZS 0
Z9 44
SN 1092-0684
UT WOS:000263024300003
PM 19435444
ER

PT J
AU Hershman, Eli
   Halberthal, Michael
   Goldsher, Dorit
   Golz, Avishai
   Bar-Joseph, Gad
TI Life threatening medullary injury following adenoidectomy and local
   anesthetic infiltration of the operative bed
SO PEDIATRIC ANESTHESIA
VL 19
IS 2
BP 164
EP 167
DI 10.1111/j.1460-9592.2008.02892.x
PD FEB 2009
PY 2009
AB To draw attention to a rare, life threatening complication of a rather
   common procedure, namely medullary injury following adenoidectomy and
   local anesthetic infiltration of the operative bed.
   Case report.
   A tertiary pediatric critical care unit.
   A healthy 7-year-old girl underwent adenoidectomy and local anesthetic
   infiltration of the adenoid bed with lidocaine and adrenaline. In the
   recovery room, nystagmus, dysarthria, dyspnea, inability to cough and
   right hemiparesis were noticed. Because of her inability to remove
   secretions tracheal intubation was performed, followed by severe, life
   threatening respiratory failure.
   Tracheal intubation, hemodynamic support, prolonged mechanical
   ventilation, nitric oxide, and tracheostomy.
   In children, local anesthetic infiltration of the adenoid bed may cause
   life-threatening medullary injury and its routine use should be
   re-considered.
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 1155-5645
UT WOS:000262689800012
PM 19143959
ER

PT J
AU Kennedy, J. Declan
   Martin, A. James
TI Chronic Respiratory Failure and Neuromuscular Disease
SO PEDIATRIC CLINICS OF NORTH AMERICA
VL 56
IS 1
BP 261
EP +
DI 10.1016/j.pcl.2008.10.011
PD FEB 2009
PY 2009
AB The outlook for children with respiratory complications of neuromuscular
   disease has improved significantly in the past 15 years. This has been
   the result of many advances in clinical care, including improved
   monitoring of lung function and hypoventilation during sleep;
   coordinated respiratory care by experienced physicians with access to
   specialized respiratory services, especially physiotherapy; and, most
   importantly, the widespread introduction of noninvasive ventilation.
TC 7
ZB 0
Z8 0
ZS 0
Z9 7
SN 0031-3955
UT WOS:000263234700015
PM 19135591
ER

PT J
AU Yan, Xi-xin
   Song, Bei-bei
   Ding, Li-jun
   Si, Ling
   Guan, Ji-tao
TI [The effect of controlled mechanical ventilation on the diaphragm of
   rats].
SO Zhonghua jie he he hu xi za zhi = Zhonghua jiehe he huxi zazhi = Chinese
   journal of tuberculosis and respiratory diseases
VL 32
IS 2
BP 103
EP 6
PD 2009-Feb
PY 2009
AB OBJECTIVE: To investigate the effect of controlled mechanical
   ventilation (CMV) on the diaphragm of rats, and therefore to understand
   the theoretic basis of difficulty weaning due to dysfunction and
   morphology in diaphragm induced by inappropriate mechanical ventilation.
   METHODS: Twenty-four adult male SD rats were randomly assigned into 3
   experimental groups: a control group, a 18 h CMV group, and a 24 h CMV
   group. Trans-diaphragmatic pressure (Pdi), maximal trans-diaphragmatic
   pressure (Pdimax), diaphragm electromyogram (EMGdi), and diaphragm
   muscle force were measured during CMV at various stimulation
   frequencies. Morphological changes of the diaphragm myofibril were
   observed by transmission electron microscopy. Myosin heavy chain (MHC)
   isoform expression were analyzed with SDS-glycerol PAGE and Western
   blotting.
   RESULTS: The Pdimax in the 18 h CMV group and the 24 h CMV group
   [(8.98+/-0.55, 6.12+/-0.53) cm H2O, 1 cm H2O=0.098 kPa] was
   significantly reduced (F=82.35, P<0.01) compared with the control group
   [(14.92+/-0.16) cm H2O]. The Fc and the H/L decreased significantly. At
   the stimulation frequency of 100 Hz, the diaphragm muscle force in the
   18 h CMV group and 24 h CMV group [(84.11+/-0.43) N, (52.65+/-0.64) N,
   respectively] decreased compare with the control [(98.13+/-0.50) N,
   F=15.02, P<0.01]. The proportion of MHC2A decreased in the 24 h group
   compared with control. The ultrastructural changes of the diaphragm was
   observed in the 24 h CMV group, such as disrupted myofibrils, increased
   numbers of lipid vacuoles in the sarcoplasm, and abnormally small
   mitochondria containing focal membrane disruptions.
   CONCLUSION: Short-term CMV induced diaphragm fatigue and altered the
   function and morphology of diaphragm in SD rats. Diaphragmatic
   dysfunction induced by CMV maybe one of the important reasons for
   difficult weaning.
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 1001-0939
UT MEDLINE:19567180
PM 19567180
ER

PT J
AU Beecham, Jennifer
   Perkins, Margaret
   Snell, Tom
   Knapp, Martin
TI Treatment paths and costs for young adults with acquired brain injury in
   the United Kingdom
SO BRAIN INJURY
VL 23
IS 1
BP 30
EP 38
AR PII 906986183
DI 10.1080/02699050802590338
PD 2009
PY 2009
AB Primary objectives: To identify the health and social care services used
   by young adults aged 18-25 years with acquired brain injury (ABI) and
   the costs of these supports. Research methods: A review of existing
   literature and databases and contact with academics and stakeholders
   working with people with ABI. Main outcomes and results: The likely care
   pathways of young adults with ABI were mapped over a notional 1-year
   period after presentation at hospital accident and emergency
   departments. Most young adults with ABI will use minimal health and
   social care support following injury but those with subsequent
   disabilities may cost the health and social care budget in excess of
   47.2 million per year. Conclusion: Lack of available data mean the
   service use and cost estimates draw from a range of sources. However,
   the costs may under-estimate the true impact on budgets as incidence
   rates may be higher than identified and conservative values were
   selected for unit costs. The model estimates the cost of treatment and
   support as provided today, but high levels of unmet need remain.
RI Beecham, Jennifer/E-7836-2010
OI Beecham, Jennifer/0000-0001-5147-3383
TC 5
ZB 1
Z8 0
ZS 0
Z9 5
SN 0269-9052
UT WOS:000262787000007
PM 19096972
ER

PT J
AU Jones, C.
   Mulleague, L.
   Jankowski, S.
TI The use of neuromuscular blockers to facilitate mechanical ventilation
   in severe asthma
SO BRITISH JOURNAL OF HOSPITAL MEDICINE
VL 70
IS 1
BP 57
EP 57
PD JAN 2009
PY 2009
RI Jones, Chris/B-2481-2013
TC 0
ZB 0
Z8 1
ZS 0
Z9 1
SN 1750-8460
UT WOS:000262712100027
PM 19357585
ER

PT J
AU Ghose, Aniruddha
   Sayeed, Absullah Abu
   Hossain, Amir
   Rahman, Ridwanur
   Faiz, Abul
   Haque, Gofranul
TI Mass barium carbonate poisoning with fatal outcome, lessons learned: a
   case series.
SO Cases journal
VL 2
BP 9069
EP 9069
DI 10.1186/1757-1626-0002-0000009069
PD 2009 Sep 01
PY 2009
AB INTRODUCTION: Barium, a heavy divalent alkaline metal, has long been
   known to cause human toxicity. The common mode is accidental ingestion
   and the common compound is Barium carbonate. Here we report an incident
   of food poisoning in 27 law enforcement personnel with rapidly
   developing sequelae and a high mortality due to ingestion of Barium
   carbonate contaminated flour.
   CASE PRESENTATION: One midnight, 27 adult males were rushed to emergency
   department of Chittagong Medical College Hospital with abdominal pain,
   vomiting, loose motion, cramps and generalized paraesthesia. The ailment
   started 1-2 hours after Iftar (evening meal to break day long fast
   during Ramadan) which included fried vegetables coated with a flour
   paste. On admission, twenty of them were restless, agitated. 22 reported
   weakness of limbs and were unable to walk. 10 had hypotension. 22 had
   rapid and shallow respiration. 5 had carpopedal spasm. Different grades
   of limb weakness were noted with loss of tendon jerks. Ten (N12)
   patients had hypokalaemia, three had hypoglycaemia, 4 patients had high
   creatine kinase. ECG showed flat ST with U waves in 4 patients.
   Potassium containing intravenous fluid and Oxygen was administered. Due
   to limited availability of mechanical ventilators patients were put on
   artificial respiration using Ambu bag; manually maintained by doctors,
   paramedics and attendants. Four patients were transferred to another
   hospital for mechanical ventilation. A total of 12 patients died over
   next 16 hours, 4 within 3 hrs. Other patients gradually improved.
   Chemical analysis of the vomitus, blood and flour used for preparation
   of meal revealed the presence of Barium. It was assumed that the flour
   was contaminated with the similar looking Barium carbonate powder which
   was kept in the kitchen as a rodenticide.
   CONCLUSION: This event exemplifies the weakness of usual health care
   facility in resource poor settings to cope with this kind of massive
   poisoning event. The multiple reported incidences of accidental barium
   poisoning due to unintentional mixing with food signifies the fact that
   the use and availability of barium carbonate should be restricted. We
   hope to draw attention to this relatively uncommon poisoning and to the
   need for development of poison information centre in resource poor
   countries.
TC 2
ZB 0
Z8 0
ZS 0
Z9 2
UT MEDLINE:20184709
PM 20184709
ER

PT J
AU Ghose, Aniruddha
   Sayeed, Abdullah Abu
   Hossain, Amir
   Rahman, Ridwanur
   Faiz, Abul
   Haque, Gofranul
TI Mass barium carbonate poisoning with fatal outcome, lessons learned: a
   case series.
SO Cases journal
VL 2
BP 9327
EP 9327
DI 10.1186/1757-1626-2-9327
PD 2009 Dec 16
PY 2009
AB INTRODUCTION: Barium, a heavy divalent alkaline metal, has long been
   known to cause human toxicity. The common mode is accidental ingestion
   and the common compound is Barium carbonate. Here we report an incident
   of food poisoning in 27 law enforcement personnel with rapidly
   developing sequelae and a high mortality due to ingestion of Barium
   carbonate contaminated flour.
   CASE PRESENTATION: One midnight, 27 adult males were rushed to emergency
   department of Chittagong Medical College Hospital with abdominal pain,
   vomiting, loose motion, cramps and generalized paraesthesia. The ailment
   started 1-2 hours after Iftar (evening meal to break day long fast
   during Ramadan) which included fried vegetables coated with a flour
   paste. On admission, twenty of them were restless, agitated. 22 reported
   weakness of limbs and were unable to walk. 10 had hypotension. 22 had
   rapid and shallow respiration. 5 had carpopedal spasm. Different grades
   of limb weakness were noted with loss of tendon jerks. Ten (N12)
   patients had hypokalaemia, three had hypoglycaemia, 4 patients had high
   creatine kinase. Electrocardiogram showed flat ST with U waves in 4
   patients. Potassium containing intravenous fluid and Oxygen was
   administered. Due to limited availability of mechanical ventilators
   patients were put on artificial respiration using Ambu bag; manually
   maintained by doctors, paramedics and attendants. Four patients were
   transferred to another hospital for mechanical ventilation. A total of
   12 patients died over next 16 hours, 4 within 3 hrs. Other patients
   gradually improved. Chemical analysis of the vomitus, blood and flour
   used for preparation of meal revealed the presence of Barium. It was
   assumed that the flour was contaminated with the similar looking Barium
   carbonate powder which was kept in the kitchen as a rodenticide.
   CONCLUSION: This event exemplifies the weakness of usual health care
   facility in resource poor settings to cope with this kind of massive
   poisoning event. The multiple reported incidences of accidental Barium
   poisoning due to unintentional mixing with food signifies the fact that
   the use and availability of Barium carbonate should be restricted. We
   hope to draw attention to this relatively uncommon poisoning and to the
   need for development of poison information centre in resource poor
   countries.
TC 2
ZB 2
Z8 0
ZS 0
Z9 2
UT MEDLINE:20066057
PM 20066057
ER

PT J
AU LI Cui-jun
   ZHANG Li-qiang
   ZHU Hong
   HE Bei
   YAO Wan-zhen
   ZHAO Ming-wu
Z2 李翠君
   张立强
   朱红
   贺蓓
   姚婉贞
   赵鸣武
TI Comparison of Chinese predictive rule with three international ones for
   assessing severity of community-acquired pneumonia
Z1 我国社区获得性肺炎病情评估标准与3种国际标准效能比较研究
Z3 中国实用内科杂志
SO Chinese Journal of Practical Internal Medicine
VL 29
IS 2
BP 128
EP 131
AR 1005-2194(2009)29:2<128:WGSQHD>2.0.TX;2-J
PD 2009
PY 2009
AB Objective To compare the performances of three foreign prediction rules
   with the severity criteria of the Chinese guidelines for CAP in
   identifying low-risk patients and evaluating severe pneumonia. Methods
   We retrospectively analyzed data from patients admitted with CAP to the
   respiratory department of Peking University Third Hospital from January
   of 2000 to April of 2007. Patients were stratified according to the
   Pneumonia Severity Index ( PSI), CURB and CURB65 severity scores and the
   severity criteria of the Chinese guidelines. Furthermore, patients were
   classified into three risk groups(low, moderate and high) in the light
   of each rule. Distribution of patients, hospital mortality and intensive
   care unit(ICU) admission rate in each group of the predictive rules were
   analyzed. Sensitivity, specificity, positive predictive values, negative
   predictive values and the areas under the receiver operating
   characteristic curves ( AUC) for predicting hospital mortality and ICU
   admission rate in each rule were compared too. Results In the light of
   PSJ( class Ⅰ～Ⅲ ), CURB(score 0)and CURB65(score 0 ～ 1) .greater
   proportions of patients were classified as low-risk(73.9% ,61.2% and
   69.1% .respectively) .while smaller proportions of patients were classed
   as moderate and high risk(20.0% ,28.5% , 21.8% ;6.1% ,10.3% ,9.1%
   respectively). Both low and moderate risk patients identified by these
   three rules had mortality( 1.6% ,2.0% ,1.8% ;9.1% ,6.4% ,8.3%
   .respectively). However, according to the severity criteria of the
   Chinese guidelines, smaller proportions of patients(7.3% )was identified
   as low-risk, while greater proportions of patients were defined as
   moderate and high risk (44.8% ,47.9% ) .nevertheless, no death or ICU
   admission occurred in the low-risk group and ICU admission rate were
   1.4% in moderate-risk group. The severity criteria of the Chinese
   guidelines had high sensitivity( 100.0% ,95.5% ) and low
   specificity(55.5% , 59.4% ) for predicting hospital mortality and
   admission to ICU. On the contrary, The PSI Ⅴ , CURB score 2 ～ 4 and
   CURB65 score 3 ～ 5 all had high specificity but low sensitivity for the
   two outcomes. The severity criteria of the Chinese guidelines had a
   greater discriminatory power to predict mortality and admission to ICU (
   AUC: 0.777,0.774). All these rules had low positive predictive values
   but high negative predictive values for the two outcomes. Conclusion The
   severity criteria of the Chinese guidelines and three foreign prediction
   rules have different strengths and weaknesses as prediction tools.
   Further research to identify better prediction tools is required.
Z4 目的
   比较我国社区获得性肺炎(CAP)病情评估标准(简称我国标准)与国外肺炎严重指数(PSI)、CURB和CURB65评估标准对CAP患者病情评估的效
   能.方法
   选取2000年1月至2007年4月北京大学第三医院呼吸科住院的CAP患者165例作为研究对象,通过回顾性研究,将所有患者分别按PSI、CURB、
   CURB65评分和我国标准分组,并进一步分成低、中、高危组,比较各组病死率和重症监护病房(ICU)住院率,各评估系统预测死亡和ICU住院的敏感度
   、特异度、阳性预测值、阴性预测值、ROC曲线下面积(AUC).结果
   PSI、CURB评分、CURB65评分3个标准均将较大一部分患者划分为低危组(分别为73.9%、61.2%、69.1%),较小部分患者划为中危组
   和高危组(分别为20.0%、28.5%、21.8%;6.1%、10.3%、9.1%).低危组和中危组均有死亡病例(病死率分别为1.6%、2.0%
   、1.8%;9.1%、6.4%、8.3%);而我国标准仅将较小部分患者划为低危组(7.3%),将较大部分患者划为中危组和高危组(44.8%、47
   .9%),但是低危组和中危组病死率为0,中危组ICU住院率仅为1.4%;我国标准预测死亡及入住ICU的敏感度高(100.0%、95.5%),而特
   异度较低(55.5%、59.4%),PSI、CURB、CURB65预测死亡及入住ICU的特异度均较高(均>90.0%),而敏感度均较低(预测死亡
   均为50.0%,预测入住ICU为22.7%～31.8%);根据AUC我国标准对死亡和ICU住院的总体识别力最好(AUC分别为0.777,0.77
   4);各评估标准预测死亡及入住ICU的阳性预测值均较低(预测死亡12.7%～50.0%;预测入住ICU
   26.6%～50.0%),阴性预测值均较高(预测死亡96.6%～100.0%;预测入住ICU 89.0%～98.8%).结论
   在筛选低风险CAP患者、预测死亡和入住ICU方面,PSI、CURB、CURB65'评分标准和我国标准各有优势与不足,需建立更为有效的CAP评估系
   统.
TC 0
ZB 0
Z8 4
ZS 0
Z9 4
SN 1005-2194
UT CSCD:3632440
ER

PT J
AU YAN Xi-xin
   SONG Bei-bei
   DING li-jun
   SI Ling
   GUAN Ji-tao
Z2 阎锡新
   宋贝贝
   丁立君
   司靓
   关继涛
TI The effect of controlled mechanical ventilation on the diaphragm of rats
Z1 控制性机械通气对大鼠膈肌功能的影响
Z3 中华结核和呼吸杂志
SO Chinese Journal of Tuberculosis and Respiratiory Diseases
VL 32
IS 2
BP 103
EP 106
AR 1001-0939(2009)32:2<103:KZXJXT>2.0.TX;2-1
PD 2009
PY 2009
AB Objective To investigate the effect of controlled mechanical ventilation
   (CMV) on the diaphragm of rats, and therefore to understand the
   theoretic basis of difficulty weaning due to dysfunction and morphology
   in diaphragm induced by inappropriate mechanical ventilation. Methods
   Twenty-four adult male SD rats were randomly assigned into 3
   experimental groups: a control group, a 18 h CMV group, and a 24 h CMV
   group. Trans-diaphragmatic pressure ( Pdi ) , maximal
   trans-diaphragmatic pressure ( Pdi_(max)) , diaphragm electromyogram (
   EMGdi) , and diaphragm muscle force were measured during CMV at various
   stimulation frequencies. Morphological changes of the diaphragm
   myofibril were observed by transmission electron microscopy. Myosin
   heavy chain ( MHC) isoform expression were analyzed with SDS-glycerol
   PAGE and Western blotting. Results The Pdimax in the 18 h CMV group and
   the 24 h CMV group [ (8. 98  0.55, 6. 12 0.53) cm H_2O, 1 cm H_2O=0.098
   kPa] was significantly reduced (F = 82. 35,P <0. 01) compared with the
   control group [ (14. 92 0. 16) cm H_2O]. The Fc and the H/L decreased
   significantly. At the stimulation frequency of 100 Hz, the diaphragm
   muscle force in the 18 h CMV group and 24 h CMV group [ (84. 11 0. 43)
   N, (52. 65 0. 64) N, respectively] decreased compare with the control[
   (98. 13  0. 50) N, F = 15. 02, P < 0.01 ]. The proportion of MHC2A
   decreased in the 24 h group compared with control. The ultrastructural
   changes of the diaphragm was observed in the 24 h CMV group, such as
   disrupted myofibrils, increased numbers of lipid vacuoles in the
   sarcoplasm, and abnormally small mitochondria containing focal membrane
   disruptions. Conclusion Short-term CMV induced diaphragm fatigue and
   altered the function and morphology of diaphragm in SD rats.
   Diaphragmatic dysfunction induced by CMV maybe one of the important
   reasons for difficult weaning.
Z4 目的 探讨控制性机械通气(CMV)对大鼠膈肌功能的影响,了解不适当控制性机械通气与膈肌功能不全和脱机困难的关系.方法
   将24只雄性SD大鼠按随机数字表法分为3组:正常对照组、18 h CMV组和24 h CMV组.后两组分别给予18 h和24 h
   CMV,并测定膈肌跨膈压(Pdi)、最大跨膈压(Pdi_(max))、膈肌肌电图(EMGdi)等指标和膈肌肌球蛋白重链(MHC)表型的改变.两样
   本组间均数比较用t检验,多组间均数差异性比较采用单因素方差分析.结果 与对照组比较,18、24
   Hcmv组Pdi_(max)分别为[(8.980.55、6.120.53、14.920.16)cm H_2O,1 cm H_2O=0.098
   kPa],实验组均低于对照组,差异有统计学意义(F=82.35,P<0.01);实验组EMGdi的中心频率和高低频比值均低于对照组;在最大刺激频
   率(100 Hz)下18、24 h
   CMV组的膈肌肌张力[(84.110.43、52.650.64)N]较对照组[(98.130.50)N]低,差异有统计学意义(F=15.02,P
   <0.01);同时MHC_(2A)比例下降;24 h
   CMV组大鼠膈肌肌纤维的电镜下病理改变为:膈肌出现肌原纤维排列疏松、脂肪滴和空泡增多,个别出现线粒体肿胀、空化,嵴减少.结论
   短期CMV即可导致膈肌功能失调和形态改变;机械通气,特别是CMV诱导的膈肌功能障碍可能是引起临床上一些患者脱机困难的重要原因之一.
TC 0
ZB 0
Z8 1
ZS 0
Z9 1
SN 1001-0939
UT CSCD:3620079
ER

PT J
AU Hermans, Greet
   De Jonghe, Bernard
   Bruyninckx, Frans
   Van den Berghe, Greet
TI Interventions for preventing critical illness polyneuropathy and
   critical illness myopathy
SO COCHRANE DATABASE OF SYSTEMATIC REVIEWS
IS 1
AR CD006832
DI 10.1002/14651858.CD006832.pub2
PD 2009
PY 2009
AB Background
   Critical illness polyneuro-and/or myopathy (CIP/CIM) is an important and
   frequent complication in the intensive care unit (ICU), causing delayed
   weaning from mechanical ventilation. It may increase ICU stay and
   mortality.
   Objectives
   To examine the ability of any intervention to prevent the occurrence of
   CIP/CIM.
   Search strategy
   We searched the Cochrane Neuromuscular Disease Group Trials Register
   (October 2007), MEDLINE (January 1950 to April 2008), EMBASE (January
   1980 to October 2007), checked bibliographies and contacted trial
   authors and experts in the field.
   Selection criteria
   All randomised controlled trials (RCTs), examining the effect of any
   intervention on the incidence of CIP/CIM in adult medical or surgical
   ICU patients. The primary outcome measure was the incidence of CIP/CIM
   after at least seven days in ICU, based on electrophysiological or
   clinical examination.
   Data collection and analysis
   Two authors independently extracted the data.
   Main results
   Three out of nine identified trials, provided data on our primary
   outcome measure. Two trials examined the effects of intensive insulin
   therapy versus conventional insulin therapy. Eight hundred and
   twenty-five out of 2748 patients randomised, were included in the
   analysis. The incidence of CIP/CIM was significantly reduced with
   intensive insulin therapy in the population screened for CIP/CIM
   (relative risk (RR) 0.65, 95% confidence interval (CI) 0.55 to 0.78) and
   in the total population randomised (RR 0.60, 95% CI 0.49 to 0.74).
   Duration of mechanical ventilation, duration of ICU stay and 180-day
   mortality but not 30-day mortality, were significantly reduced with
   intensive insulin therapy, in both the total and the screened
   population. Intensive insulin therapy significantly increased
   hypoglycaemic events and recurrent hypoglycaemia. Death within 24 hours
   of the hypoglycaemic event was not different between groups. The third
   trial examined the effects of corticosteroids versus placebo in 180
   patients with prolonged acute respiratory distress syndrome. No
   significant effect of corticosteroids on CIP/CIM was found (RR 1.09, 95%
   CI 0.53 to 2.26). No effect on 180-day mortality, new serious infections
   and glycaemia at day seven was found. A trend towards fewer episodes of
   pneumonia and reduction of new events of shock was shown.
   Authors' conclusions
   Substantial evidence shows that intensive insulin therapy reduces the
   incidence of CIP/CIM, the duration of mechanical ventilation, duration
   of ICU stay and 180-day mortality. There was a significant associated
   increase in hypoglycaemia. Further research needs to identify the
   clinical impact of this and strategies need to be developed to reduce
   the risk of hypoglycaemia. Limited evidence shows no significant effect
   of corticosteroids on the incidence of CIP/CIM, or on any of the other
   secondary outcome measures, except for a significant reduction of new
   episodes of shock. Strict diagnostic criteria for the purpose of
   research should be defined. Other interventions should be investigated
   in randomised controlled trials.
TC 29
ZB 9
Z8 1
ZS 0
Z9 30
SN 1469-493X
UT WOS:000262591900038
PM 19160304
ER

PT J
AU Radunovic, Aleksandar
   Annane, Djillali
   Jewitt, Kate
   Mustfa, Naveed
TI Mechanical ventilation for amyotrophic lateral sclerosis/motor neuron
   disease
SO COCHRANE DATABASE OF SYSTEMATIC REVIEWS
IS 4
AR CD004427
DI 10.1002/14651858.CD004427.pub2
PD 2009
PY 2009
AB Background
   Amyotrophic lateral sclerosis, also known as motor neuron disease, is a
   fatal neurodegenerative disease. Without mechanical ventilation, death
   from respiratory failure usually follows within two to five years of the
   onset of symptoms.
   Objectives
   To examine the efficacy of mechanical ventilation (tracheostomy and
   non-invasive ventilation) in improving survival, on disease progression
   and quality of life in amyotrophic lateral sclerosis.
   Search strategy
   We searched The Cochrane Neuromuscular Disease Group Trials Specialized
   Register (December 8 2008), The Cochrane Central Register of Controlled
   Trials (The Cochrane Library Issue 4, 2008), MEDLINE (January 1966 to
   December 2008), EMBASE (January 1947 to December 2008), CINAHL Plus
   (January 1937 to December 2008), and AMED (January 1985 to December
   2008). We also searched for ongoing studies on clinicaltrials.gov.
   Selection criteria
   Randomised and quasi-randomised controlled trials involving non-invasive
   or tracheostomy assisted ventilation in participants with a clinical
   diagnosis of amyotrophic lateral sclerosis.
   Data collection and analysis
   Four authors independently selected studies for assessment. All authors
   extracted data independently from the full text of selected studies and
   assessed the risk of bias in studies that met the inclusion criteria. We
   attempted to obtain missing data where possible.
   Main results
   Two randomised controlled trials involving 54 participants receiving
   non-invasive ventilation were identified and included. Incomplete data
   were published for one study and we contacted the trial authors who were
   not able to provide the missing data. Therefore the results of the
   review were based on a single study of 41 participants. The study showed
   that the overall median survival in the whole cohort after initiation of
   assisted ventilation was significantly different between the
   non-invasive ventilation and standard care groups (P = 0.0062) with a
   median survival for the non-invasive ventilation group patients of 48
   days longer than the standard care group participants. Non-invasive
   ventilation significantly improved survival and quality of life in the
   subgroup with normal to moderately impaired bulbar function.
   Non-invasive ventilation did not prolong survival in patients with poor
   bulbar function although it showed significant improvement in the mean
   symptoms domain of the sleep apnoea quality-of-life index but not in the
   Short Form-36 quality of life mental component summary score.
   Authors' conclusions
   Evidence from a single randomised trial of non-invasive ventilation in
   41 participants suggests that it significantly prolongs survival and
   improves or maintains quality of life in people with ALS. Survival and
   some measures of quality of life were significantly improved in the
   subgroup of people with better bulbar function, but not in those with
   severe bulbar impairment.
RI Radunovic, Aleksandar/D-2569-2012
TC 12
ZB 4
Z8 0
ZS 0
Z9 12
SN 1469-493X
UT WOS:000270686900022
PM 19821325
ER

PT J
AU Callahan, Leigh Ann
   Supinski, Gerald S.
TI Hyperglycemia and acquired weakness in critically ill patients:
   potential mechanisms
SO CRITICAL CARE
VL 13
IS 2
AR 125
DI 10.1186/cc7728
PD 2009
PY 2009
AB Critical illness polyneuropathy/critical illness myopathy (CIP/CIM) is a
   major cause of mortality and long-term morbidity in critically ill
   patients, but the true incidence and prevalence of these syndromes are
   not known. Hermans and colleagues show that when intensive insulin
   therapy is used as part of routine clinical practice in the intensive
   care unit, the incidence of CIP/CIM as determined by electrophysiologic
   testing is reduced. Our understanding of the mechanisms responsible for
   inducing prolonged weakness in intensive care unit patients is limited,
   and the role of hyperglycemia in modulating these processes is unknown.
   Intensive insulin therapy currently remains the only effective
   therapeutic intervention that has been shown to reduce the incidence of
   CIP/CIM.
TC 4
ZB 1
Z8 0
ZS 0
Z9 4
SN 1466-609X
UT WOS:000266638500037
PM 19439021
ER

PT J
AU Puthucheary, Zudin
   Hart, Nicholas
TI Intensive care unit acquired muscle weakness: when should we consider
   rehabilitation?
SO CRITICAL CARE
VL 13
IS 4
AR 167
DI 10.1186/cc7937
PD 2009
PY 2009
AB Muscle weakness is highly prevalent during acute critical illness, with
   the poor exercise performance that occurs after critical illness being
   recognized as a consequence of skeletal muscles weakness. Advanced
   techniques to measure peripheral muscle strength are available, but they
   have limited use in the clinical setting. Simple volitional methods to
   assess strength are limited because they rely on patient motivation,
   which can be problematic in the critical care setting. At present, the
   mechanisms that underlie skeletal muscle wasting and weakness are poorly
   understood, but use of rehabilitation early in critical illness appears
   to have beneficial effects on outcome. The future direction will be to
   determine the underlying mechanisms as well as developing rehabilitation
   programmes during both the acute and the post critical illness stages.
TC 7
ZB 2
Z8 0
ZS 0
Z9 8
SN 1466-609X
UT WOS:000272225600046
PM 19664190
ER

PT J
AU Truong, Alex D.
   Fan, Eddy
   Brower, Roy G.
   Needham, Dale M.
TI Bench-to-bedside review: Mobilizing patients in the intensive care unit
   - from pathophysiology to clinical trials
SO CRITICAL CARE
VL 13
IS 4
AR 216
DI 10.1186/cc7885
PD 2009
PY 2009
AB As the mortality from critical illness has improved in recent years,
   there has been increasing focus on patient outcomes after hospital
   discharge. Neuromuscular weakness acquired in the intensive care unit
   (ICU) is common, persistent, and often severe. Immobility due to
   prolonged bed rest in the ICU may play an important role in the
   development of ICU-acquired weakness. Studies in other patient
   populations have demonstrated that moderate exercise is beneficial in
   altering the inflammatory milieu associated with immobility, and in
   improving muscle strength and physical function. Recent studies have
   demonstrated that early mobility in the ICU is safe and feasible, with a
   potential reduction in short-term physical impairment. However, early
   mobility requires a significant change in ICU practice, with reductions
   in heavy sedation and bed rest. Further research is required to
   determine whether early mobility in the ICU can improve patients'
   short-term and long-term outcomes.
TC 45
ZB 10
Z8 1
ZS 2
Z9 48
SN 1466-609X
UT WOS:000272225600061
PM 19664166
ER

PT J
AU Ferguson, Alison
   Worrall, Linda
   Sherratt, Sue
TI The impact of communication disability on interdisciplinary discussion
   in rehabilitation case conferences
SO DISABILITY AND REHABILITATION
VL 31
IS 22
BP 1795
EP 1807
DI 10.1080/09638280902810984
PD 2009
PY 2009
AB Purpose. This article presents a descriptive research study that
   investigated the issues discussed in rehabilitation case conferences,
   with specific reference to patients with acquired communication
   disabilities of neurological origin.
   Method. A series of six routine rehabilitation case conferences of
   between 1 and 2 h, involving between 10 and 14 health professionals,
   were observed by a researcher who took detailed field notes. These data
   were analysed using a combination of apriori coding categories based on
   the International Classification of Functioning - WHO, 2001, and content
   and thematic analyses.
   Results. The rank order of frequency of contribution by each discipline
   reflected both distinct ('disciplinary') and overlapping
   ('interdisciplinary') areas of professional areas of expertise and
   responsibility. Although the speech pathologist was often alone in
   discussing communication goals, there was much interdisciplinary
   discussion for clients with impaired communication and/or cognitive
   capacity, and the presence of communication disability was associated
   with more conflict in the discussion.
   Conclusions. The findings of this research locate critical challenges in
   rehabilitation case conferences for interprofessional interaction,
   particularly in the team's shared responsibility for representing the
   'voice' of inpatients with communication disability.
RI Worrall, Linda/D-2579-2010
OI Worrall, Linda/0000-0002-3283-7038
TC 3
ZB 0
Z8 0
ZS 0
Z9 3
SN 0963-8288
UT WOS:000270937400001
PM 19479501
ER

PT J
AU Herridge, Margaret S.
TI Building consensus on ICU-acquired weakness
SO INTENSIVE CARE MEDICINE
VL 35
IS 1
BP 1
EP 3
DI 10.1007/s00134-008-1305-3
PD JAN 2009
PY 2009
TC 7
ZB 2
Z8 0
ZS 0
Z9 7
SN 0342-4642
UT WOS:000262549100001
PM 18946660
ER

PT J
AU Hough, Catherine L.
   Steinberg, Kenneth P.
   Thompson, B. Taylor
   Rubenfeld, Gordon D.
   Hudson, Leonard D.
TI Intensive care unit-acquired neuromyopathy and corticosteroids in
   survivors of persistent ARDS
SO INTENSIVE CARE MEDICINE
VL 35
IS 1
BP 63
EP 68
DI 10.1007/s00134-008-1304-4
PD JAN 2009
PY 2009
AB To determine the incidence and outcomes of intensive care unit-acquired
   neuromyopathy and to investigate the role of methylprednisolone in
   survivors of persistent acute lung injury.
   Secondary analysis of completed randomized placebo-controlled trial.
   Twenty-five hospitals in the NHLBI ARDS Network.
   Patients enrolled in the ARDS Network study of methylprednisolone versus
   placebo for persistent ARDS who survived 60 days or to hospital
   discharge.
   One hundred and twenty-eight study patients survived 60 days.
   Forty-three (34%) of these patients had evidence by chart review of
   ICU-acquired neuromyopathy, which was associated with prolonged
   mechanical ventilation, return to mechanical ventilation, and delayed
   return to home after critical illness. Treatment with methylprednisolone
   was not significantly associated with an increase in risk of
   neuromyopathy (OR 1.5; 95% CI 0.7-3.2).
   ICU-acquired-neuromyopathy is common among survivors of persistent ARDS
   and is associated with poorer clinical outcomes. We did not find a
   significant association between methylprednisolone treatment and
   neuromyopathy. Limitations of this study preclude definitive conclusions
   about the causal relationship between corticosteroids and ICU-acquired
   neuromuscular dysfunction.
TC 40
ZB 11
Z8 2
ZS 2
Z9 44
SN 0342-4642
UT WOS:000262549100008
PM 18946661
ER

PT J
AU Kesler, Sarah M.
   Sprenkle, Mark D.
   David, William S.
   Leatherman, James W.
TI Severe weakness complicating status asthmaticus despite minimal duration
   of neuromuscular paralysis
SO INTENSIVE CARE MEDICINE
VL 35
IS 1
BP 157
EP 160
DI 10.1007/s00134-008-1267-5
PD JAN 2009
PY 2009
AB Mechanically ventilated patients with status asthmaticus who undergo
   prolonged paralysis are at risk for severe weakness due to myopathy. In
   the mid-1990s, we changed our usual method of achieving tolerance of
   ventilatory support in asthmatic patients from continuous paralysis to
   deep sedation. This study examines the impact of this change in practice
   on the development of clinically significant weakness in status
   asthmaticus.
   Retrospective cohort study in university-affiliated county hospital.
   Mechanically ventilated asthmatic patients seen before (n = 96) and
   after (n = 74) a clinical practice change in 1995 that markedly
   restricted use of paralytics.
   The duration of neuromuscular paralysis declined sharply after 1995
   (23.7 +/- A 42.2 vs. 1.8 +/- A 4.0 h, P < 0.001), but this was not
   associated with a significant difference in the incidence of weakness
   (21 vs. 14%, P = 0.23). Within the post-1995 cohort, there was no
   significant difference in the duration of paralysis for weak and
   non-weak patients (3.5 +/- A 6.2 vs. 1.5 +/- A 3.5 h, P = 0.10).
   However, weak patients had a much longer duration of mechanical
   ventilation than did patients without weakness (11.9 +/- A 3.6 vs. 1.9
   +/- A 1.8 days, P < 0.001).
   Mechanically ventilated patients with status asthmaticus who are
   immobilized for prolonged periods of time by deep sedation remain at
   risk for clinically significant weakness.
TC 10
ZB 6
Z8 1
ZS 1
Z9 12
SN 0342-4642
UT WOS:000262549100021
PM 18807012
ER

PT J
AU Richardson, Lydia
   Dunning, Joel
   Hunter, Steven
TI Is intrathecal morphine of benefit to patients undergoing cardiac
   surgery.
SO Interactive cardiovascular and thoracic surgery
VL 8
IS 1
BP 117
EP 22
DI 10.1510/icvts.2008.190686
PD 2009-Jan
PY 2009
AB A best evidence topic in cardiac surgery was written according to a
   structured protocol. The question addressed is whether intrathecal
   morphine is of benefit to patients undergoing cardiac surgery? Using the
   reported search 850 papers were identified. Ten papers represented the
   best evidence on the subject. The author, journal, date and country of
   publication, patient group studied, study type, relevant outcomes,
   results and study comments and weaknesses were tabulated. The ten papers
   demonstrated that intrathecal morphine reduces postoperative pain
   scores, increases time to first IV morphine dose and reduces the overall
   postoperative IV morphine dose required, indicating its analgesic
   effect. Opioid-related complications remained comparable to controls,
   however, other benefits of reduced time to extubation, reduced ICU stay
   and improved postoperative lung function are variably reported with
   significant results found only in small retrospective studies. No spinal
   haematomas were reported, however, high-risk patients were excluded. We
   conclude that intrathecal morphine is an alternative method of
   pre-induction analgesia that benefits patients as less postoperative IV
   morphine is required, however, other benefits are less well reported.
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
UT MEDLINE:18755789
PM 18755789
ER

PT J
AU Wilson, F Colin
   Wheatley-Smith, Laura
   Downes, Ciara
TI Analysis of intensive outpatient neuro-rehabilitation outcomes using
   FIM+FAM(UK).
SO NeuroRehabilitation
VL 24
IS 4
BP 377
EP 82
DI 10.3233/NRE-2009-0492
PD 2009
PY 2009
AB OBJECTIVE: To analyse the functional outcomes of adults following
   acquired brain injury attending an intensive outpatient
   neuro-rehabilitation programme relative to a comprehensive TBI day
   programme service in the United States.
   METHOD: 
   DESIGN: Retrospective audit of all admissions over a two-year period
   (2001-2003) to an outpatient neuro-rehabilitation service utilising an
   interdisciplinary team model.
   SETTING: Outpatient neuro-rehabilitation service.
   PARTICIPANTS: 89 patients in receipt of 2+ therapies attending for
   intensive day neuro-rehabilitation programme.
   MAIN OUTCOME MEASURES: Routine FIM+FAM(UK) scores were compiled on
   admission and discharge. The FIM+FAM(UK) is a widely employed outcome
   measure of activity and participation comprising 30 items across a range
   of domains including self care, domestic skills, mobility,
   communication, cognitive and social abilities. The scale is divided into
   two broad domains of functioning (motor and cognitive).
   DATA ANALYSIS: Descriptive analysis of demographic, patient diagnosis,
   referral patterns and time since injury to attendance was undertaken.
   Analysis of FIM+FAM(UK) admission and discharge scores was performed.
   RESULTS: Complete admission and discharge scores were available for 65
   patients. Significant mean improvements in motor (12.0 point change),
   cognitive (7.3 point change) and composite FIM+FAM(UK) (19.3 point
   change) scores were observed indicating reduced functional dependence
   following an intensive period of outpatient neuro-rehabilitation.
   CONCLUSION: The FIM+FAM(UK) measure demonstrated sensitivity to change
   across functional domains relevant to goal directed intensive outpatient
   interdisciplinary neuro-rehabilitation.
TC 6
ZB 1
Z8 0
ZS 1
Z9 6
SN 1053-8135
UT MEDLINE:19597276
PM 19597276
ER

PT J
AU Donini, Lorenzo M.
   Savina, Claudia
   Ricciardi, Laura Maria
   Coletti, Cecilia
   Paolini, Maddalena
   Scavone, Luciano
   De Felice, Maria Rosaria
   Laviano, Alessandro
   Fanelli, Tilippo Rossi
   Cannella, Carlo
TI Predicting the outcome of artificial nutrition by clinical and
   functional indices
SO NUTRITION
VL 25
IS 1
BP 11
EP 19
DI 10.1016/j.nut.2008.07.001
PD JAN 2009
PY 2009
AB Objective: Artificial nutrition (AN) is now considered medical therapy
   and has progressively become one of the mainstays of the different
   therapeutic options available for home or hospitalized patients,
   including surgical, medical, and critically ill patients. The clinical
   relevance of any therapy is based on its efficacy and effectiveness and
   thus on the improvement of its cost efficiency, i.e., the ability to
   provide benefits to the patients with minimal wasting of human and
   financial resources. The aim of the present study was to identify those
   indices, clinical, functional, or nutritional, that may reliably
   predict, before the start of AN, those patients who are likely not to
   benefit from nutritional support.
   Methods: Three hundred twelve clinical charts of patients receiving AN
   between January 1999 and September 2006 were retrospectively examined.
   Data registered before starting AN were collected and analyzed: general
   data (age, sex), clinical conditions (comorbidity, quality of life,
   frailty), anthropometric and biochemical indices, type of AN treatment
   (total enteral nutrition, total parenteral nutrition, mixed AN), and
   outcome of treatment.
   Results: The percentage of negative outcomes (death or interruption of
   AN due to worsening clinical conditions within 10 d after starting AN)
   was meaningfully higher in subjects >80 y of age and with reduced social
   functions, higher comorbidity and/or frailty, reduced level of albumin,
   prealbumin, lymphocyte count, and cholinesterase and a higher level of
   C-reactive protein. The multivariate analysis showed that prealbumin and
   comorbidity were die best predictors of AN outcome. The logistic
   regression model with these variables showed a predictive value equal to
   84.2%.
   Conclusion: Proper prognostic instruments are necessary to perform
   optimal evaluations. The present study showed that a patient's general
   status (i.e., comorbidity, social quality of life, frailty) and
   nutritional and inflammatory statuses (i.e., lymphocyte count, albumin,
   prealbumin, C-reactive protein) have good predictive value on the
   effectiveness of AN. (C) 2009 Elsevier Inc. All rights reserved.
TC 17
ZB 3
Z8 0
ZS 0
Z9 18
SN 0899-9007
UT WOS:000261646000004
PM 18848432
ER

PT J
AU Carrera, Emmanuel
   Claassen, Jan
   Oddo, Mauro
   Emerson, Ronald G.
   Mayer, Stephan A.
   Hirsch, Lawrence J.
TI Continuous Electroencephalographic Monitoring in Critically Ill Patients
   With Central Nervous System Infections
SO ARCHIVES OF NEUROLOGY
VL 65
IS 12
BP 1612
EP 1618
DI 10.1001/archneur.65.12.1612
PD DEC 2008
PY 2008
AB Objectives: To determine the prevalence, predictors, and clinical
   significance of electrographic seizures (ESz) and other continuous
   electroencephalographic monitoring findings in critically ill patients
   with central nervous system infections.
   Design: Retrospective cohort study.
   Setting: Eighteen-bed neurocritical care unit.
   Patients: We identified 42 consecutive patients with primary central
   nervous system infection ( viral, 27 patients [64%]; bacterial, 8
   patients [18%]; and fungal or parasitic, 7 patients [17%]) who underwent
   continuous electroencephalographic monitoring between January 1, 1996,
   and February 28, 2007.
   Main Outcome Measures: Presence of ESz or periodic epileptiform
   discharges (PEDs).
   Results: Electrographic seizures were recorded in 14 patients (33%), and
   PEDs were recorded in 17 patients (40%). Twenty patients (48%) had
   either PEDs or ESz. Of the 14 patients with ESz, only 5 (36%) had a
   clinical correlate. Periodic epileptiform discharges ( odds ratio=13.4;
   P=.001) and viral cause ( odds ratio=13.0; P=.02) were independently
   associated with ESz. Both ESz ( odds ratio=5.9; P=.02) and PEDs ( odds
   ratio=6.1; P=.01) were independently associated with poor outcome at
   discharge ( severe disability, vegetative state, or death).
   Conclusions: In patients with central nervous system infections
   undergoing continuous electroencephalographic monitoring, ESz and/or
   PEDs were frequent, occurring in 48% of our cohort. More than half of
   the ESz had no clinical correlate. Both ESz and PEDs were independently
   associated with poor outcome. Additional studies are needed to determine
   whether prevention or treatment of these electrographic findings
   improves outcome.
TC 46
ZB 12
Z8 0
ZS 1
Z9 47
SN 0003-9942
UT WOS:000261483100008
PM 19064748
ER

PT J
AU Hong, Sang-Bum
   Oh, Bum Jin
   Kim, Young Sam
   Kang, Eun Hae
   Kim, Chang Ho
   Park, Yong Bum
   Han, Min Soo
   Shin, Cheungsoo
CA Korean-Study-Grp-Resp-Failure-KOSR
TI Characteristics of Mechanical Ventilation Employed in Intensive Care
   Units: A Multicenter Survey of Hospitals
SO JOURNAL OF KOREAN MEDICAL SCIENCE
VL 23
IS 6
BP 948
EP 953
DI 10.3346/jkms.2008.23.6.948
PD DEC 2008
PY 2008
AB A 1D point-prevalence study was performed to describe the
   characteristics of conventional mechanical ventilation in intensive care
   units (ICUs). In addition, a survey was conducted to determine the
   characteristics of ICUs. A prospective, multicenter study was performed
   in ICUs at 24 university hospitals. The study population consisted of
   223 patients who were receiving mechanical ventilation or had been
   weaned off mechanical ventilation within the past 24 hr. Common
   indications for the initiation of mechanical ventilation included acute
   respiratory failure (66%), acute exacerbation of chronic respiratory
   failure (15%) (including tuberculosis-destroyed lung [5%]), coma (13%),
   and neuromuscular disorders (6%). Mechanical ventilation was delivered
   via an endotracheal tube in 68% of the patients, tracheostomy in 28% and
   facial mask with noninvasive ventilation (NIV) in 4%. NIV was used in 2
   centers. In patients who had undergone tracheostomy, the procedure had
   been performed 16.9 +/- 8.1 days after intubation. Intensivists treated
   29% of the patients. A need for additional educational programs
   regarding clinical practice in the ICU was expressed by 62% of the staff
   and 42% of the nurses. Tuberculosis-destroyed lung is a common
   indication for mechanical ventilation in acute exacerbation of chronic
   respiratory failure, and noninvasive ventilation was used in a limited
   number of ICUs.
TC 5
ZB 2
Z8 0
ZS 0
Z9 5
SN 1011-8934
UT WOS:000262192100004
PM 19119434
ER

PT J
AU Beligere, N.
   Rao, R.
TI Neurodevelopmental outcome of infants with meconium aspiration syndrome:
   report of a study and literature review
SO JOURNAL OF PERINATOLOGY
VL 28
BP S93
EP S101
DI 10.1038/jp.2008.154
SU 3
PD DEC 2008
PY 2008
AB There is a paucity of information on long-term outcome of infants who
   have suffered from meconium aspiration syndrome (MAS) in the neonatal
   period. We analyzed long-term developmental outcome data of 35 infants
   who were admitted to the neonatal intensive care unit (NICU) at the
   University of Illinois Hospital at Chicago (UICMC) with a diagnosis of
   MAS, and we reviewed the literature pertinent to the subject. The
   objective of the study was to assess the neurodevelopment status of MAS
   infants and compare the possible effects of different variables that are
   known to affect the later developmental outcome. The variables included
   mode of delivery, APGAR score, cord pH, mode of treatment, and
   neurological findings during the course of NICU. The infants were
   enrolled in the developmental follow-up program (DFUP) after discharge
   from the nursery for assessment of long-term developmental status and
   neurodevelopmental outcome. In order to assess the impact of the
   treatment on long-term outcome and compare our findings with previously
   published reports, we also reviewed the previously published literature
   on neurodevelopment outcome of infants treated for MAS (with different
   modalities) during the last three decades. Total of 35 infants with a
   diagnosis of MAS admitted to the NICU at UICMC were followed in the DFUP
   clinic for 3 years during January 1999 to September 2001. The medical
   records of these infants were reviewed for the mode of delivery, APGAR
   score, birth weight (BW), gestational age, mode of treatment during the
   neonatal period, and neurodevelopment status. 19/35 (54%) infants were
   delivered vaginally, 16/ 35 (46%) by cesarean section (C-section). All
   were treated in the delivery room using the standard resuscitation
   protocol. Following initial resuscitation, all except three required
   intubation and ventilation for varying duration. One infant required
   inhaled nitric oxide therapy, and two required extracorporeal membrane
   oxygenation treatment. Subsequent to discharge, the infants were
   evaluated in the clinic at 2 months of age, and then every 4 months up
   to 3 years. The developmental assessment of mental development index
   (MDI), psychomotor development index (PDI), and behavior rating scale
   (BRS) were obtained using the Bayley II infant motor scale, and
   neurodevelopment evaluation was performed using the Amiel-Tison
   technique. Speech evaluation was performed in infants > 18 months using
   the Rossetti Infant-Toddler language scale. Infants were considered
   normal when MDI and PDI scores were > 85 to 110; mildly delayed when
   scores were > 70 to 84; and severely delayed if the scores were < 69. In
   addition, neurological evaluation also confirmed the disability. The
   report is based on the final analysis of 29 infants. Data of six infants
   were not included in the final analysis because of incomplete
   information. The mean BW of the infants was 3269 +/- 671 g; mean
   gestational age was 39.5 +/- 3.1 weeks. The median APGAR score at 1' was
   4, and at 5' was 6. Out of 29, 11 (38%) infants were normal. Out of 29,
   2 infants (7%) had cerebral palsy (CP) and 4 (14%) had severe delay at
   12 months of age. Out of 29, 2 who were neurologically disabled had PDI
   < 69. Out of 29, 12 (41%) had mild delay in speech. No statistical
   difference in neurodevelopment was found in infants born vaginally or by
   C-section. Our findings show poor outcome (CP and global delay) in 21%
   of infants who suffered MAS, even though the majority of the infants
   (26/29) responded to conventional ventilator support alone.
   No difference was found in the outcome of infants betwen NSVD vs
   C-section delivery. These findings suggest that infants with the
   diagnosis of MAS manifest later neurodevelopmental delays, even if they
   respond well to conventional treatment. This abstract was presented at
   the Society for Pediatric Research Annual Meeting, 2000.
CT 1st International Conference on Meconium Aspiration Syndrome and
   Meconium-Induced Lung Injury
CY MAR 23-24, 2007
CL Chicago, IL
TC 12
ZB 6
Z8 0
ZS 0
Z9 12
SN 0743-8346
UT WOS:000261417200016
PM 19057618
ER

PT J
AU Buysse, Corinne M. P.
   Raat, Hein
   Hazelzet, Jan A.
   Hulst, Jessie M.
   Cransberg, Karlien
   Hop, Wim C. J.
   Vermunt, Lindy C. A. C.
   Utens, Elisabeth M. W. J.
   Maliepaard, Marianne
   Joosten, Koen F. M.
TI Long-term Health Status in Childhood Survivors of Meningococcal Septic
   Shock
SO ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE
VL 162
IS 11
BP 1036
EP 1041
DI 10.1001/archpedi.162.11.1036
PD NOV 2008
PY 2008
AB Objective: To assess long-term health status in patients who survived
   meningococcal septic shock in childhood.
   Design: Medical and psychological follow-up of a cross-sectional cohort.
   Setting: Pediatric intensive care unit (PICU) of a tertiary care
   university hospital.
   Participants: All consecutive patients with septic shock and purpura who
   required intensive care between 1988 and 2001.
   Intervention: Patients and their parents were invited to our follow-up
   clinic 4 to 16 years after PICU discharge.
   Outcome Measures: Health status was assessed with a standard medical
   interview, physical examination, renal function test, and the Health
   Utilities Index Mark 2 (HUI2) and 3 (HUI3).
   Results: One hundred twenty patients (response rate 71%) participated in
   the follow-up (median age at PICU admission, 3.1 years; median follow-up
   interval, 9.8 years; median age at follow-up, 14.5 years). Thirty-five
   percent of patients had 1 or more of the following neurological
   impairments: severe mental retardation with epilepsy (3%), hearing loss
   (2%), chronic headache (28%), and focal neurological signs (6%), like
   paresis of 1 arm. One of the 16 patients with septic shock-associated
   acute renal failure at PICU admission showed signs of mild chronic renal
   failure (glomerular filtration rate, 62 mL/min/1.73 m(2); proteinuria;
   and hypertension). Scores were significantly lower on nearly all HUI2
   and HUI3 attributes compared with Dutch population data, indicating
   poorer health in these patients.
   Conclusions: In patients who survived meningococcal septic shock in
   childhood, one-third showed long-term neurological impairments, ranging
   from mild to severe and irreversible. Patients reported poorer general
   health as measured by HUI2 and HUI3.
TC 21
ZB 10
Z8 0
ZS 0
Z9 21
SN 1072-4710
UT WOS:000260600600005
PM 18981351
ER

PT J
AU Miller, Anton R.
   Armstrong, Robert W.
   Masse, Louise C.
   Klassen, Anne F.
   Shen, Jane
   O'Donnell, Maureen E.
TI Waiting for child developmental and rehabilitation services: an overview
   of issues and needs
SO DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY
VL 50
IS 11
BP 815
EP 821
DI 10.1111/j.1469-8749.2008.03113.x
PD NOV 2008
PY 2008
AB Concern about the length of time that children, young people, and
   families may have to wait to access assessment, diagnostic,
   interventional, therapeutic, and supportive child developmental and
   rehabilitation (CDR) services is widespread, but adequate data
   collection and research on this issue remain limited. We review key
   concepts and issues relevant to waiting for CDR services from the
   published literature, a national workshop devoted to this topic, and
   international experience. We conclude that gaps in data, evidence, and
   consensus challenge our ability to address the issue of waiting for CDR
   services in a systematic way. A program of research coupled with actions
   based on consensus-building is required. Research priorities include
   acquiring evidence of the appropriateness and effectiveness of different
   models of intervention and rehabilitation services, and documenting the
   experience and expectations of waiting families. Consensus-building
   processes are critical to identify, categorize, and prioritize
   'sentinel' components of CDR service pathways: (1) to reduce the
   inherent complexity of the field; (2) to create benchmarks for waiting
   for these respective services; and (3) to develop definitions for
   wait-time subcomponents in CDR services. Collection of accurate and
   replicable data on wait times for CDR services can be used to document
   baseline realities, to monitor and improve system performance, and to
   conduct comparative and analytic research in the field of CDR services.
TC 12
ZB 4
Z8 0
ZS 1
Z9 13
SN 0012-1622
UT WOS:000261118800007
PM 18811706
ER

PT J
AU Chatwin, Michelle
   Nickol, Annabel H.
   Morrell, Mary J.
   Polkey, Michael I.
   Simonds, Anita K.
TI Randomised trial of inpatient versus outpatient initiation of home
   mechanical ventilation in patients with nocturnal hypoventilation
SO RESPIRATORY MEDICINE
VL 102
IS 11
BP 1528
EP 1535
DI 10.1016/j.rmed.2008.07.019
PD NOV 2008
PY 2008
AB Background: Long-term home mechanical ventilation (HMV) is usually
   initiated in hospital. Admission to hospital has resource implications
   and may not be reimbursable in some healthcare systems.
   Methods: Twenty-eight stable neuromuscular and chest wall disease
   patients with nocturnal hypoventilation (transcutaneous carbon dioxide
   (TcCO(2) >6.5 kPa), were randomised to start HMV either as an outpatient
   (n = 14, age range 12-62 years) or inpatient (n = 14, age range 14-73
   years). We compared effects of HMV on nocturnal. and diurnal arterial
   blood gas tensions, ventilator compliance, healthcare professional (HCP)
   contact time, and time in hospital.
   Results: Improvements in nocturnal arterial oxygen saturation (SaO(2))
   and daytime PaO(2) were equivalent in both groups. Peak nocturnal
   TcCO(2), improved in both groups; % time TcCO(2) >6.5 kPa fell in the
   inpatient group and daytime PaCO(2) decreased significantly (p < 0.05)
   in the outpatient group. The mean (SD) inpatient stay was 3.8 (1.0)
   days, and the outpatient attendance sessions 1.2 (0.4). HCP contact time
   including telephone calls was: inpatient 177 (99) min; outpatient 188
   (60) min (p = not significant); 2 month ventilator compliance was:
   inpatient 4.32 (7); outpatient 3.92 (8) (p = not significant) hours per
   night.
   Conclusion: Outpatient initiation of HMV is feasible with equivalent
   outcome in the outpatient and the inpatient groups. (C) 2008 Elsevier
   Ltd. All rights reserved.
TC 26
ZB 5
Z8 0
ZS 0
Z9 26
SN 0954-6111
UT WOS:000261506700004
PM 18774702
ER

PT J
AU Needham, Dale M.
TI Mobilizing patients in the intensive care unit - Improving neuromuscular
   weakness and physical function
SO JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION
VL 300
IS 14
BP 1685
EP 1690
DI 10.1001/jama.300.14.1685
PD OCT 8 2008
PY 2008
AB Early mobilization of patients in the hospital and the intensive care
   unit has a strong historical precedent. However, in more recent times,
   deep sedation and bed rest have been part of routine medical care for
   many mechanically ventilated patients. A growing body of literature
   demonstrates that survivors of severe critical illness commonly have
   significant and prolonged neuromuscular complications that impair their
   physical function and quality of life after hospital discharge. Bed
   rest, and its associated mechanisms, may play an important role in the
   pathogenesis of neuromuscular weakness in critically ill patients. A new
   approach for managing mechanically ventilated patients includes reducing
   deep sedation and increasing rehabilitation therapy and mobilization
   soon after admission to the intensive care unit. Emerging research in
   this field provides preliminary evidence supporting the safety,
   feasibility, and potential benefits of early mobilization in critical
   care medicine.
CT 1st International Meeting of Physical Rehabilitation in the Critically
   Ill
CY MAY 17, 2008
CL Toronto, CANADA
TC 136
ZB 20
Z8 5
ZS 5
Z9 145
SN 0098-7484
UT WOS:000259812800030
PM 18840842
ER

PT J
AU Haim, Alon
   Zucker, Nili
   Levitas, Aviva
   Sofer, Shaul
   Katz, Amos
   Zalzstein, Eli
TI Cardiac manifestations following electrocution in children
SO CARDIOLOGY IN THE YOUNG
VL 18
IS 5
BP 458
EP 460
DI 10.1017/S1047951108002527
PD OCT 2008
PY 2008
AB Background: Electrical injury can result in a variety of cardiac
   abnormalities. We evaluate the cardiac effects in patients injured by
   electric shock and treated in our medical centre. Methods: We reviewed
   retrospectively the findings in 52 children, aged from 7 months to 17
   years, with a mean age of 10.1 +/- 5.1 years, all evaluated and treated
   for accidental electric shock from January, 1992, through July, 2004.
   Relevant data regarding clinical presentation, electrocardiogram
   recording and cardiac enzymes was compiled. We also evaluated the
   echocardiographic findings, clinical course, treatment, and outcome.
   Results: Syncope had been the presenting symptom In 17 children (33%),
   asystole in I patient, and ventricular fibrillation or tachycardia in 2
   patients. Characteristic changes of acute ischaemia of the anterior wall
   on the basis of changes in the ST segments were noted in 2 patients.
   Total creatine phosphokinase was measured in 33 children (63%), and was
   elevated in 20. Creatine phosphokinase-MB was measured in 11 patients,
   and was abnormal in six (54%). Troponin was measured in three children,
   and was significantly high in one (33%). Cardiopulmonary resuscitation
   and mechanical ventilation for a significant period was necessary in 5
   patients, of whom 4 (80%) survived. None of the survivors was left with
   any cardiac disability following the acute event. Conclusions:
   Significant cardiac damage and complications are rare in children and
   young adults who survive incidental electrocution. Most of the cardiac
   events are observed during the acute phase and immediately subsequent to
   electrocution. No delayed complications are anticipated.
RI Katz, Amos/E-6261-2011
TC 4
ZB 2
Z8 0
ZS 0
Z9 4
SN 1047-9511
UT WOS:000260521000003
PM 18706131
ER

PT J
AU Cleland, James C.
   Griggs, Robert C.
TI Treatment of neuromuscular channelopathies: Current concepts and future
   prospects
SO NEUROTHERAPEUTICS
VL 5
IS 4
BP 607
EP 612
DI 10.1016/j.nurt.2008.09.001
PD OCT 2008
PY 2008
AB Our understanding of the molecular pathogenesis of the neuromuscular ion
   channelopathies has increased rapidly over the past two decades due to
   the identification of many of the genes whose mutation causes these
   diseases. These molecular discoveries have facilitated identification
   and classification of the hereditary periodic paralyses and the
   myotonias, and are likely to shed light on acquired ion channelopathies
   as well. Despite our better understanding of the pathogenesis of these
   disorders, current treatments are largely empirical and the evidence in
   favor of specific therapy largely anecdotal. For periodic paralysis,
   dichlorphenamide-a carbonic anhydrase inhibitor-has been shown in a
   controlled trial to prevent attacks for many patients with both
   hypokalemic and hypokalemic periodic paralysis. A second trial,
   comparing dichlorphenamide with acetazolamide versus placebo, is
   currently in progress. For myotonia, there is only anecdotal evidence
   for treatment, but a controlled trial of mexiletine versus placebo is
   currently being funded by a Food and Drug Administration-orphan products
   grant and is scheduled to begin in late 2008. In the future,
   mechanism-based approaches are likely to be developed. For example,
   exciting advances have already been made in one disorder, myotonic
   dystrophy-1 (DM-1). In a mouse model of DM-1, a morpholino antisense
   oligonucleuotide targeting the 3' splice site of CLCN1 exon 7a repaired
   the RNA splicing defect by promoting the production of full-length
   chloride channel transcripts. Abnormal chloride conductance was
   restored, and myotonia was abolished. Similar strategies hold potential
   for DM-2. The era of molecularly-based treatments is about to begin.
TC 10
ZB 5
Z8 1
ZS 0
Z9 11
SN 1933-7213
UT WOS:000259727800015
PM 19019313
ER

PT J
AU Nanas, S.
   Kritikos, K.
   Angelopoulos, E.
   Siafaka, A.
   Tsikriki, S.
   Poriazi, M.
   Kanaloupiti, D.
   Kontogeorgi, M.
   Pratikaki, M.
   Zervakis, D.
   Routsi, C.
   Roussos, C.
TI Predisposing factors for critical illness polyneuromyopathy in a
   multidisciplinary intensive care unit
SO ACTA NEUROLOGICA SCANDINAVICA
VL 118
IS 3
BP 175
EP 181
DI 10.1111/j.1600-0404.2008.00996.x
PD SEP 2008
PY 2008
AB Objective - To investigate risk factors of critical illness
   polyneuromyopathy (CIPM) in a general multidisciplinary intensive care
   unit (ICU). Patients and methods - Prospective observational study in a
   28-bed university multidisciplinary ICU. Four hundred and seventy-four
   (323 M/151 F, age 55 +/- 19) consecutive patients were prospectively
   evaluated. All patients were assigned admission Acute Physiology and
   Chronic Health Evaluation (APACHE II; 15 +/- 7) and Sequential Organ
   Failure Assessment (SOFA; 6 +/- 3) scores and were subsequently
   evaluated for newly developed neuromuscular weakness. Other potential
   causes of new-onset weakness after ICU admission were excluded before
   CIPM was diagnosed. Results - Forty-four (23.8%) of 185 patients
   developed generalized weakness that met the criteria for CIPM. Patients
   with CIPM had higher APACHE II (18.9 +/- 6.6 vs 15.6 +/- 6.4, P = 0.004)
   and SOFA scores (8.4 +/- 2.9 vs 7.1 +/- 2.9, P = 0.013). According to
   multivariate logistic regression analysis, the following risk factors
   were independently associated with the development of CIPM: severity of
   illness at the time of ICU admission, administration of aminoglycoside
   antibiotics and high blood glucose levels. Analysis according to
   severity of illness stratification revealed the emergence of Gram (-)
   bacteremia as the most important independent predisposing factor for
   CIPM development in less severely ill patients. Conclusions - CIPM has a
   high incidence in the ICU setting. Our study revealed the association of
   aminoglycosides, hyperglycemia and illness severity with CIPM
   development, as well as the association between Gram (-) bacteremia and
   development of CIPM in less severely ill patient population.
TC 28
ZB 8
Z8 0
ZS 0
Z9 28
SN 0001-6314
UT WOS:000258376100006
PM 18355395
ER

PT J
AU Gutierrez-Gonzalez, Raquel
   Boto, Gregorio R.
   Perez-Zamarron, Alvaro
   Rivero-Garvia, Monica
TI Retropharyngeal pseudomeningocele formation as a traumatic
   atlanto-occipital dislocation complication: case report and review
SO EUROPEAN SPINE JOURNAL
VL 17
BP S253
EP S256
DI 10.1007/s00586-007-0531-7
SU 2
PD SEP 2008
PY 2008
AB Retropharyngeal pseudomeningocele after atlanto-occipital dislocation is
   a rare complication, with only five cases described in the literature.
   It develops when a traumatic dural tear occurs allowing cerebrospinal
   fluid outflow, and it often appears associated with hydrocephalus. We
   present a case of a 29-year-old female who suffered a motor vehicle
   accident causing severe brain trauma and spinal cord injury. At hospital
   arrival the patient scored three points in the Glasgow Coma Scale.
   Admission computed tomography of the head and neck demonstrated
   subarachnoid hemorrhage and atlanto-occipital dislocation. Three weeks
   later, when impossibility to disconnect her from mechanical ventilation
   was noticed, a magnetic resonance imaging of the neck showed a large
   retropharyngeal pseudomeningocele. No radiological evidence of
   hydrocephalus was documented. Given the poor neurological status of the
   patient, with spastic quadriplegia and disability to breathe
   spontaneously due to bulbar-medullar injury, no invasive measure was
   performed to treat the pseudomeningocele. Retropharyngeal
   pseudomeningocele after atlanto-occipital dislocation should be managed
   by means of radiological brain study in order to assess for the presence
   of hydrocephalus, since these two pathologies often appear associated.
   If allowed by neurological condition of the patient, shunting procedures
   such as ventriculo-peritoneal or lumbo-peritoneal shunt placement may be
   helpful for the treatment of the pseudomeningocele, regardless of
   craniocervical junction management.
RI Rivero-Garvia, Monica/F-1567-2015
OI Rivero-Garvia, Monica/0000-0001-5125-6151
TC 2
ZB 1
Z8 0
ZS 0
Z9 2
SN 0940-6719
UT WOS:000261115200008
PM 17973127
ER

PT J
AU Skinner, Elizabeth H.
   Berney, Susan
   Warrillow, Stephen
   Denehy, Linda
TI Rehabilitation and exercise prescription in Australian intensive care
   units
SO PHYSIOTHERAPY
VL 94
IS 3
BP 220
EP 229
DI 10.1016/j.physio.2007.11.004
PD SEP 2008
PY 2008
AB Objectives To identify methods of exercise prescription by
   physiotherapists across Australian intensive care units (ICU's),
   including the most commonly used activities for both mechanically
   ventilated and spontaneously breathing patients; and to determine the
   outcome measures used for the evaluation of exercise intervention.
   Design Postal questionnaire.
   Setting One hundred and sixty-seven adult ICUs across all Australian
   states and territories.
   Participants Australian intensive care physiotherapists.
   Results In total, 126 questionnaires were returned from all states and
   territories of Australia except the Northern Territory. Almost half of
   the ICUs (49%, 20/41) that did not return a questionnaire lacked a
   permanent physiotherapy service. Seventy-eight percent (87/111) of
   respondents were senior staff, and 49% (54/111) of respondents had
   worked in TCUs for longer than 5 years. Almost all (94%, 104/111)
   physiotherapists prescribed exercise routinely for ICU patients, with
   active and active-assisted exercise techniques along with mobilisation
   being the most common activities utilised. Heart rate, oxygen saturation
   and respiratory rate were the most important factors used in
   modification of exercise prescription. Seventy-one percent (79/111) of
   respondents prescribed exercise routinely for mechanically ventilated
   patients, but altered the type of exercise prescription for these
   patients compared with spontaneously breathing patients. Only one-third
   (34%, 38/111) of physiotherapists used outcome measures routinely in ICU
   exercise prescription.
   Conclusions Although a large majority of ICU physiotherapists prescribed
   exercise routinely in ICU patients (including those on mechanical
   ventilation), practice varies widely throughout Australia. No validated,
   functional exercise outcome measures were used, highlighting that
   further research is required to enable adequate evaluation of exercise
   prescription and rehabilitation in ICUs. Crown Copyright (C) 2008
   Published by Elsevier Ltd on behalf of Chartered Society of
   Physiotherapy. All rights reserved.
TC 22
ZB 1
Z8 0
ZS 1
Z9 23
SN 0031-9406
UT WOS:000259537200006
ER

PT J
AU Ali, Naeem A.
   O'Brien, James M., Jr.
   Hoffmann, Stephen P.
   Phillips, Gary
   Garland, Allan
   Finley, James C. W.
   Almoosa, Khalid
   Hejal, Rana
   Wolf, Karen M.
   Lemeshow, Stanley
   Connors, Alfred F., Jr.
   Marsh, Clay B.
CA Midwest Critical Care Consortium
TI Acquired weakness, handgrip strength, and mortality in critically ill
   patients
SO AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE
VL 178
IS 3
BP 261
EP 268
DI 10.1164/rccm.200712-18290C
PD AUG 1 2008
PY 2008
AB Rationale: ICU-acquired paresis (ICUAP) is common in survivors of
   critical illness. There is significant associated morbidity, including
   prolonged time on the ventilator and longer hospital stay. However, it
   is unclear whether ICUAP is independently associated with mortality, as
   sicker patients are more prone and existing studies have not adjusted
   for this.
   Objectives: To test the hypothesis that ICUAP is independently
   associated with increased mortality. Secondarily, to determine if
   handgrip dynamometry is a concise measure of global strength and is
   independently associated with mortality.
   Methods: A prospective multicenter cohort study was conducted in
   intensive care units (ICU) of five academic medical centers. Adults
   requiring at least 5 days of mechanical ventilation without evidence of
   preexisting neuromuscular disease were followed until awakening and were
   then examined for strength.
   Measurements and Main Results: We measured global strength and handgrip
   dynamometry. The primary outcome was in-hospital mortality and secondary
   outcomes were hospital and ICU-free days, ICU readmission, and recurrent
   respiratory failure. Subjects with ICUAP (average MRC score of < 4) had
   longer hospital stays and required mechanical ventilation longer.
   Handgrip strength was lower in subjects with ICUAP and had good test
   performance for diagnosing ICUAP. After adjustment for severity of
   illness, ICUAP was independently associated with hospital mortality
   (odds ratio [OR], 7.8; 95% confidence interval [CI], 2.4-25.3; P =
   0.001). Separately, handgrip strength was independently associated with
   hospital mortality (OR, 4.5; 95% Cl, 1.5-13.6; P = 0.007).
   Conclusions: ICUAP is independently associated with increased hospital
   mortality. Handgrip strength is also independently associated with
   poorhospital outcomeand mayserveasa simpletestto identify ICUAP.
   Clinical trial registered with www.clinicaltrials.gov (NCT00106665).
RI O'Brien, James/A-2624-2009; Crouser, Elliott/E-2933-2011
TC 137
ZB 35
Z8 3
ZS 3
Z9 144
SN 1073-449X
UT WOS:000258162000008
PM 18511703
ER

PT J
AU Roze, Jean-Christophe
   Denizot, Sophie
   Carbajal, Ricardo
   Ancel, Pierre-Yves
   Kaminski, Monique
   Arnaud, Catherine
   Truffert, Patrick
   Marret, Stephane
   Matis, Jaqueline
   Thiriez, Gerard
   Cambonie, Gilles
   Andre, Monique
   Larroque, Beatrice
   Breart, Gerard
TI Prolonged sedation and/or analgesia and 5-year neurodevelopment outcome
   in very preterm infants - Results from the EPIPAGE cohort
SO ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE
VL 162
IS 8
BP 728
EP 733
DI 10.1001/archpedi.162.8.728
PD AUG 2008
PY 2008
AB Objective: To describe the long-term outcome of very preterm infants
   receiving prolonged sedation and/or analgesia and examine the
   relationship between prolonged sedation and/or analgesia and this
   long-term outcome.
   Design: A prospective population-based study (Etude EPI-demiologique sur
   les Petits Ages GEstationnels[EPIPAGE]). To reduce bias, the propensity
   score method was used.
   Setting: Nine regions of France.
   Participants: The study population included very preterm infants of
   fewer than 33 weeks' gestational age, born in 1997, who received
   mechanical ventilation and/or surgery.
   Main Exposure: Prolonged exposure to sedative and/or analgesic drugs in
   the neonatal period, defined as exposure of more than 7 days to sedative
   and/or opioid drugs.
   Main Outcome Measure: Presence of moderate or severe disability at 5
   years of age.
   Results: The analysis concerns 1572 premature infants who received
   mechanical ventilation for whom information about exposure to prolonged
   sedation and/or analgesia in the neonatal period was available. A total
   of 115 were exposed and 1457 were not exposed. There was no significant
   difference between the number of patients lost to follow-up from the
   group of very preterm infants who were exposed to prolonged sedation
   and/or analgesia and the group who were not. Exposed very preterm
   infants had severe or moderate disability at 5 years (41/97; 42%) more
   often than those who were not exposed (324/1248; 26%). After adjustment
   for gestational age and propensity score, this association was no longer
   statistically significant (adjusted relative risk, 1.0; 95% confidence
   interval, 0.8-1.2).
   Conclusion: Prolonged sedation and/or analgesia is not associated with a
   poor 5-year neurological outcome after adjustment for the propensity
   score.
TC 43
ZB 19
Z8 2
ZS 0
Z9 45
SN 1072-4710
UT WOS:000258225200003
PM 18678804
ER

PT J
AU Morris, Peter E.
   Goad, Amanda
   Thompson, Clifton
   Taylor, Karen
   Harry, Bethany
   Passmore, Leah
   Ross, Amelia
   Anderson, Laura
   Baker, Shirley
   Sanchez, Mary
   Penley, Lauretta
   Howard, April
   Dixon, Luz
   Leach, Susan
   Small, Ronald
   Hite, R. Duncan
   Haponik, Edward
TI Early intensive care unit mobility therapy in the treatment of acute
   respiratory failure
SO CRITICAL CARE MEDICINE
VL 36
IS 8
BP 2238
EP 2243
DI 10.1097/CCM.0b013e318180b90e
PD AUG 2008
PY 2008
AB Objective. Immobilizabon and subsequent weakness are consequences of
   critical illness. Despite the theoretical advantages of physical therapy
   to address this problem, it has not been shown that physical therapy
   initiated in the intensive care unit offers benefit.
   Design and Setting: Prospective cohort study in a university medical
   intensive care unit that assessed whether a mobility protocol increased
   the proportion of intensive care unit patients receiving physical
   therapy vs. usual care.
   Patients. Medical intensive care unit patients with acute respiratory
   failure requiring mechanical ventilation on admission: Protocol, n =
   165; Usual Care, n = 165.
   Interventions: An intensive care unit Mobility Team (critical care
   nurse, nursing assistant, physical therapist) initiated the protocol
   within 48 hrs of mechanical ventilation.
   Measurements and Main Results. The primary outcome was the proportion of
   patients receiving physical therapy in patients surviving to hospital
   discharge. Baseline characteristics were similar between groups. Outcome
   data are reflective of survivors. More Protocol patients received at
   least one physical therapy session than did Usual Care (80% vs. 47%, p
   <= .001). Protocol patients were out of bed earlier (5 vs. 11 days, p
   <=.001), had therapy initiated more frequently in the intensive care
   unit (91% vs. 13%, p <= .001), and had similar low complication rates
   compared with Usual Care. For Protocol patients, intensive care unit
   length of stay was 5.5 vs. 6.9 days for Usual Care (p = .025); hospital
   length of stay for Protocol patients was 11.2 vs. 14.5 days for Usual
   Care (p =.006) (intensive care unit/hospitall length of stay adjusted
   for body mass index, Acute Physiology and Chronic Health Evaluation 11,
   vasopressor). There were no untoward events during an intensive care
   unit Mobility session and no cost difference (survivors + nonsurvivors)
   between the two arms, including Mobility Team costs.
   Conclusions: A Mobility Team using a mobility protocol initiated earlier
   physical therapy that was feasible, safe, did not increase costs, and
   was associated with decreased intensive care unit and hospital length of
   stay in survivors who received physical therapy during intensive care
   unit treatment compared with patents who received usual care.
TC 262
ZB 49
Z8 7
ZS 9
Z9 279
SN 0090-3493
UT WOS:000258271100003
PM 18596631
ER

PT J
AU Vohra, Hunaid A
   Adamson, Louise
   Haw, Marcus P
TI Is early primary repair for correction of tetralogy of Fallot comparable
   to surgery after 6 months of age?
SO Interactive cardiovascular and thoracic surgery
VL 7
IS 4
BP 698
EP 701
DI 10.1510/icvts.2008.180083
PD 2008-Aug
PY 2008
AB A best evidence topic in cardiac surgery was written according to a
   structured protocol. The question addressed was whether early primary
   repair for correction of tetralogy of Fallot (TOF) resulted in better
   outcomes than surgery after 6 months of age. Altogether 650 relevant
   papers were identified using the below mentioned search, eight papers
   represented the best evidence to answer the specific question. The
   author, journal, date and country of publication, patient group studied,
   study type, relevant outcomes, results and study weaknesses were
   tabulated. We conclude that early primary repair of TOF has been shown
   to be comparable to later repair, with several retrospective series
   concluding that there is no increase in mortality with children under 6
   months of age. Freedom from reintervention has also been shown to be
   similar irrespective of the age primary repair is undertaken. However,
   it has been observed that length of intensive care unit stay, period of
   mechanical ventilation and the need for inotropes is increased in
   patients undergoing primary repair at <3 months of age.
TC 10
ZB 1
Z8 2
ZS 1
Z9 13
UT MEDLINE:18490365
PM 18490365
ER

PT J
AU Hutchinson, David
   Whyte, Ken
TI Neuromuscular disease and respiratory failure.
SO Practical neurology
VL 8
IS 4
BP 229
EP 37
DI 10.1136/pn.2008.152611
PD 2008-Aug
PY 2008
AB Neurologists should be able to anticipate and recognise the onset of
   respiratory failure in patients with neuromuscular disorders. Symptoms
   will differ depending on the speed of onset of the respiratory muscle
   weakness. Careful monitoring of respiratory function is particularly
   important in acute disorders such as Guillain-Barre syndrome. Patients
   with an unrecognised neuromuscular disorder may occasionally present
   with respiratory failure. Important investigations include vital
   capacity, mouth pressures, arterial blood gases, chest x ray and
   sometimes overnight respiratory monitoring. Patients with Guillain-Barre
   and other acute conditions may require short-term ventilatory support in
   the intensive care unit. Patients with some chronic disorders, such as
   motor neuron disease and Duchenne dystrophy, can be successfully treated
   with non-invasive ventilation, usually in collaboration with a
   respiratory physician. New-onset weakness of limb and respiratory
   muscles in the intensive care unit is usually due to critical illness
   myopathy or critical illness polyneuropathy, and treatment is
   supportive.
TC 15
ZB 4
Z8 2
ZS 0
Z9 17
UT MEDLINE:18644909
PM 18644909
ER

PT J
AU Choi, JiYeon
   Tasota, Frederick J.
   Hoffman, Leslie A.
TI Mobility interventions to improve outcomes in patients undergoing
   prolonged mechanical ventilation: A review of the literature
SO BIOLOGICAL RESEARCH FOR NURSING
VL 10
IS 1
BP 21
EP 33
DI 10.1177/1099800408319055
PD JUL 2008
PY 2008
AB Survivors of critical illness often undergo an extended recovery
   trajectory. Reduced functional ability is one of several adverse
   outcomes of prolonged bed rest and mechanical ventilation during
   critical illness. Skeletal muscle weakness is known to be one of the
   major phenomena that account for reduced functional ability. Although
   skeletal muscle weakness is evident after prolonged mechanical
   ventilation (PMV), few studies have tested the benefits of various types
   of mobility interventions in this population. The purpose of this
   article is to review the published research on improving mobility
   outcomes in patients undergoing PMV. For this review, published studies
   were retrieved from MEDLINE, PubMed, CINAHL, and the Cochrane Database
   of Systematic Reviews from January 1990 to July 2007. A total of 10
   relevant articles were selected that examined the effect of whole body
   physical therapy, electrical stimulation (ES), arm exercise, and
   inspiratory muscle training (IMT). Overall, there is support for the
   ability of mobility interventions to improve outcomes in patients on PMV
   but limited evidence of how to best accomplish this goal. Generating
   more data from multicenter studies and randomized controlled trials is
   recommended.
TC 13
ZB 1
Z8 2
ZS 2
Z9 17
SN 1099-8004
UT WOS:000257930900003
PM 18647758
ER

PT J
AU Simon, Arne
   Mueller, Andreas
   Khurana, Karun
   Engelhart, Steffen
   Exner, Martin
   Schildgen, Oliver
   Eis-Huebinger, Anna M.
   Kamin, Wolfgang
   Schaible, Thomas
   Wadas, Karoline
   Ammann, Roland A.
   Wilkesmann, Anja
CA DSM RSV Paed Study Grp
TI Nosocomial infection: A risk factor for a complicated course in children
   with respiratory syncytial virus infection - Results from a prospective
   multicenter German surveillance study
SO INTERNATIONAL JOURNAL OF HYGIENE AND ENVIRONMENTAL HEALTH
VL 211
IS 3-4
BP 241
EP 250
DI 10.1016/j.ijheh.2007.07.020
PD JUL 2008
PY 2008
AB Background: Nosocomially acquired respiratory syncytial virus infections
   (RSV-NI) may cause serious problems in hospitalized paediatric patients.
   Hitherto, prospectively collected representative data on RSV-NI from
   multicenter studies in Germany are limited.
   Methods: The DMS RSV Ped database was designed for the prospective
   multicenter documentation and analysis of clinically relevant aspects of
   the management of inpatients with RSV-infection. The study covered six
   consecutive seasons (1999-2005); the surveillance took place in 14
   paediatric hospitals in Germany.
   Results: Of the 1568 prospectively documented RSV-infections, 6% (n =
   90) were NI and 94% (n = 1478) were community acquired (CA). A
   significantly higher proportion in the NI group displayed additional
   risk factors like prematurity, chronic lung disease, mechanical
   ventilation (med. history), congenital heart disease, and neuromuscular
   impairment. Of all NI, 55% occurred in preterms (30.6% of all
   RSV-infections in preterms with severe chronic lung disease of
   prematurity were NI). Illness severity as well as the total mortality,
   but not the attributable mortality was significantly higher in the NI
   group. In the multivariate analysis, NI was significantly associated
   with the combined outcome 'complicated course of disease'.
   Conclusion: This is the first prospective multicenter study from
   Germany, which confirms the increased risk of a severe clinical course
   in nosocomially acquired RSV-infection. Of great concern is the high
   rate of (preventable) NI in preterms, in particular in those with severe
   chronic lung disease or with mechanical ventilation due to other
   reasons. (C) 2007 Elsevier GmbH. All rights reserved.
RI Schildgen, Oliver/D-5327-2014
OI Schildgen, Oliver/0000-0003-4297-9627
TC 21
ZB 12
Z8 3
ZS 0
Z9 24
SN 1438-4639
UT WOS:000258180600003
PM 17869579
ER

PT J
AU Udink ten Cate, Floris E A
   van Royen, Barend J
   van Heerde, Marc
   Roerdink, Dianne
   Plotz, Frans B
TI Incidence and risk factors of prolonged mechanical ventilation in
   neuromuscular scoliosis surgery.
SO Journal of pediatric orthopedics. Part B
VL 17
IS 4
BP 203
EP 6
DI 10.1097/BPB.0b013e328301e962
PD 2008-Jul
PY 2008
AB Patients with neuromuscular scoliosis (NMS) are frequently considered at
   high risk for postoperative complications based on their underlying
   disease and comorbidities. Postoperative complications include prolonged
   mechanical ventilation (MV), defined longer than 72 h, at the paediatric
   intensive care unit. The objectives of this retrospective study were to
   assess the incidence of prolonged MV in patients with NMS following
   scoliosis surgery and to identify predictive risk factors. A total of 46
   consecutive patients underwent surgical spinal fusion and
   instrumentation for progressive NMS. Prolonged MV was required in seven
   of 46 patients (15%). The only risk factor for prolonged MV was a
   decreased preoperative pulmonary function. Forced expired volume in 1 s
   and vital capacity were significantly decreased in patients with MV >72
   h compared with patients with MV <72 h. Routine preoperative pulmonary
   function testing may reveal important information with regard to
   restrictive lung disease in the preoperative assessment of patients with
   NMS and predict the early postoperative clinical course.
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 1060-152X
UT MEDLINE:18525479
PM 18525479
ER

PT J
AU Pati, S.
   Goodfellow, J. A.
   Iyadurai, S.
   Hilton-Jones, D.
TI Approach to critical illness polyneuropathy and myopathy
SO POSTGRADUATE MEDICAL JOURNAL
VL 84
IS 993
BP 354
EP 360
DI 10.1136/pgmj.2007.064915
PD JUL 2008
PY 2008
AB A newly acquired neuromuscular cause of weakness has been found in
   25-85% of critically ill patients. Three distinct entities have been
   identified: (1) critical illness polyneuropathy (CIP); (2) acute
   myopathy of intensive care (itself with three subtypes); and (3) a
   syndrome with features of both 1 and 2 (called critical illness myopathy
   and/or neuropathy or CRIMYNE). CIP is primarily a distal axonopathy
   involving both sensory and motor nerves. Electroneurography and
   electromyography (ENG-EMG) is the gold standard for diagnosis. CIM is a
   proximal as well as distal muscle weakness affecting both types of
   muscle fibres. It is associated with high use of non-depolarising muscle
   blockers and corticosteroids. Avoidance of systemic inflammatory
   response syndrome (SIRS) is the most effective way to reduce the
   likelihood of developing CIP or CIM. Outcome is variable and depends
   largely on the underlying illness. Detailed history, careful physical
   examination, review of medication chart and analysis of initial
   investigations provides invaluable clues towards the diagnosis.
TC 7
ZB 3
Z8 0
ZS 0
Z9 7
SN 0032-5473
UT WOS:000258608200005
PM 18716014
ER

PT J
AU Lin, Vernon
   Hsiao, Ian N.
TI Functional neuromuscular stimulation of the respiratory muscles for
   patients with spinal cord injury
SO PROCEEDINGS OF THE IEEE
VL 96
IS 7
BP 1096
EP 1107
DI 10.1109/JPROC.2008.922572
PD JUL 2008
PY 2008
AB Respiratory complication is a major cause of morbidity and mortality in
   patients with spinal cord injury (SCI). These complications arise partly
   due to the loss of supraspinal control over expiratory and/or
   inspiratory muscles caused by SCL Functional neuromuscular stimulation
   of the respiratory muscles has been used to restore inspiratory and
   respiratory functions to these patients, helping them to reduce the
   incidence of respiratory complications and to have more normal lives.
   This paper covers three types of techniques for respiratory muscle
   stimulation: functional electric stimulation, functional magnetic
   stimulation, and semiconductor-based microstimulator stimulation.
   Functional electrical stimulation has been used to restore breathing to
   patients with spinal cord injury for several decades. it is a mature and
   reliable technology, and there are several commercial systems available.
   Functional magnetic stimulation of the respiratory muscles has been
   demonstrated to be an effective tool for producing cough in patients
   with SCI for nearly a decade. This is a safe and noninvasive technology
   that is well tolerated by most subjects. Semiconductor-based
   microstimulators have been widely publicized in recent years, and
   several clinical applications have been demonstrated, including the
   applications for restoring cough and breathing. This technology may
   eventually play a major role in respiratory muscle pacing.
TC 2
ZB 0
Z8 0
ZS 0
Z9 2
SN 0018-9219
UT WOS:000257073900005
ER

PT J
AU Nenadovic, Vera
   Hutchison, James S.
   Dominguez, Luis Garcia
   Otsubo, Hiroshi
   Gray, Martin P.
   Sharma, Rohit
   Belkas, Jason
   Velazquez, Jose Luis Perez
TI Fluctuations in cortical synchronization in pediatric traumatic brain
   injury
SO JOURNAL OF NEUROTRAUMA
VL 25
IS 6
BP 615
EP 627
DI 10.1089/neu.2007.0474
PD JUN 2008
PY 2008
AB Traumatic brain injury (TBI) is the leading cause of death and acquired
   disability in the pediatric population worldwide. We hypothesized that
   electroencephalography (EEG) synchrony and its temporal variability,
   analyzed during the acute phase following TBI, would be altered from
   that of normal children and as such would offer insights into TBI
   pathophysiology. Seventeen pediatric patients with mild to severe head
   injury admitted to a pediatric critical care unit were recruited along
   with 10 age- and gender-matched controls. Patients had two
   electroencephalographs performed 3 days apart. Outcome was measured at 1
   year post- TBI utilizing the Pediatric Cerebral Performance Category
   score (PCPC). Maximal synchrony between EEG channels correlated to areas
   of primary injury as seen on computed tomography (CT) scan. The temporal
   variability of phase synchronization among EEG electrodes increased as
   patients recovered and emerged from coma (p < 0.001). This temporal
   variability correlated with outcome (Pearson coefficient of 0.74) better
   than the worst Glasgow Coma Scale score, length of coma, or extent of
   injury on CT scan. This represents a novel approach in the evaluation of
   TBI in children.
TC 20
ZB 14
Z8 0
ZS 0
Z9 21
SN 0897-7151
UT WOS:000257633900005
PM 18578633
ER

PT J
AU Klang, Birgitta
   Markstrom, Agneta
   Sundell, Kerstin
   Barle, Hans
   Gillis-Haegerstrand, Caroline
TI Hypoventilation does not explain the impaired quality of sleep in
   postpolio patients ventilated noninvasively vs. invasively.
SO Scandinavian journal of caring sciences
VL 22
IS 2
BP 236
EP 40
DI 10.1111/j.1471-6712.2007.00520.x
PD 2008-Jun
PY 2008
AB In a previous study, it was found that patients treated with noninvasive
   ventilation (NIV) reported larger dysfunctions in sleep-related
   parameters as assessed with the Sickness Impact Profile (SIP) and Health
   Index questionnaires than those treated with tracheostomy. The aim of
   the current study was to further evaluate these sleep limitations and
   relate these limitations to blood gas analyses in the groups to
   investigate, if the differences could be related to differences in the
   efficacy of ventilation. We compared postpolio patients treated with
   tracheostomy (PPT, n = 17), NIV (PPN, n = 14) and patients with
   neuromuscular disorders treated with NIV (NMN, n = 15). Significantly
   fewer patients in the PPT group scored large dysfunctions in the SIP
   sleep (SIP score >10 points) compared with the PPN and NMN patients. The
   PPT patients scored significantly higher regarding quality of sleep and
   less sense of tiredness than the PPN and NMN patients. No differences
   were found between the groups regarding blood gas parameters neither
   before nor during or after the study period. In conclusion, postpolio
   patients treated with invasive home mechanical ventilation seem to
   experience better sleep and less sense of tiredness than patients on
   NIV. These differences cannot be explained by differences in alveolar
   ventilation as assessed with blood gas analyses.
TC 1
ZB 0
Z8 0
ZS 0
Z9 1
UT MEDLINE:18489694
PM 18489694
ER

PT J
AU Kellett, John
TI Prognostication - The lost skill of medicine
SO EUROPEAN JOURNAL OF INTERNAL MEDICINE
VL 19
IS 3
BP 155
EP 164
DI 10.1016/j.ejim.2007.09.002
PD MAY 2008
PY 2008
AB Making a prognosis is one of the primary functions of the medical
   profession. At the end of the nineteenth century prognostication took up
   approximately ten percent of medical textbooks, by 1970 this had fallen
   to nearly zero. Given medical technology's awesome ability to prolong
   the process and suffering of dying today's patients need to know their
   prognosis in order to make choices about their treatment options. Whilst
   precise predictions of the future are obviously not possible, relatively
   simple mathematical modelling techniques can make reasonable estimates
   of likely outcomes for individual patients. The life expectancy of a
   patient of any age with any illness can be estimated provided the
   disease-specific mortality of the illness is known. Decision analysis or
   logistic regression models can then be used to determine the risks and
   benefits of various treatment options. A patient's prognosis does not
   just depend on their age and primary diagnosis, but also on the severity
   of their illness, their functional capacity both prior to and during the
   illness and the number of co-morbidities also suffered from. Several
   predictive instruments have been developed to help simplify the
   prediction of the outcome of individual patients. There are conflicting
   reports on how these models compare with doctors' intuition - whatever
   their strengths and weaknesses it is unlikely that they worsen clinical
   judgement. Therefore, all doctors should become familiar with them and
   use them appropriately. (C) 2007 European Federation of Internal
   Medicine. Published by Elsevier B.V. All rights reserved.
TC 15
ZB 6
Z8 0
ZS 1
Z9 16
SN 0953-6205
UT WOS:000255674600002
PM 18395158
ER

PT J
AU Manrique, Dayse
   Sato, Juliana
   Anastacio, Erika M.
TI Postoperative acute respiratory insufficiency following
   adenotonsillectomy in children with neuropathy
SO INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY
VL 72
IS 5
BP 587
EP 591
DI 10.1016/j.ijporl.2008.01.005
PD MAY 2008
PY 2008
AB Objective: Evaluate the incidence of acute respiratory insufficiency
   (ARI) in the immediate postoperative period following adenotonsillectomy
   in children with neurological diseases.
   Methods: Medical records from all pediatric adenotonsillectomies
   performed from January 1997 through August 2003 at the Roberto de Abreu
   Sodre Hospital of the Association for the Welfare of Physically
   Handicapped Children (AACD) in Sao Paulo were reviewed. Data were
   collected for patient age, neurological diagnosis, associated
   comorbidities, index of respiratory insufficiency in the immediate
   postoperative period and period of hospitalization.
   Results: One hundred and nine patients charts had sufficient
   documentation to be included in this study. Of these, 15 (13.7%)
   developed ARI in the immediate postoperative period. Ages ranged from 1
   to 12 years old (average of 5). Of the 15 patients that presented ARI,
   10 (67%) were intubated in the first 3 h following extubation. The
   predominant neurological diagnosis was non-progressive chronic
   encephalopathy, observed in 84 children (77%), and, among that, 14 (17%)
   presented ARI. Other neurological diagnoses present in this study were
   Rett syndrome, neuromuscular disease and meningomyelocele. All. of the
   children that developed ARI presented quadriplegia. Among children that
   did not develop ARI, the predominant motor pattern was: 28 with
   quadriplegia, 38 diplegia, 10 hemiplegia, 12 with involuntary movement
   (choeroathethosis) and six without motor involvement. Children
   presenting ARI needed mechanical ventilation for an average of 37.87 h
   (1.5 days) in the intensive care unit. ARI increased the period of
   hospitalization; these children had an average length of stay of 7 days
   versus 1.5 days for those that did not develop complications.
   Conclusion: Children with neurological disorders, especially those with
   quadriplegic pattern of motor involvement and severe oropharyngeal
   dysphagia, are at higher risk for respiratory insufficiency in immediate
   postoperative period of adenotonsillectomy and should be observed in
   intensive care unit. (C) 2008 Elsevier Ireland Ltd. All rights reserved.
RI Sharp, Kath/A-4434-2012
TC 3
ZB 0
Z8 0
ZS 1
Z9 4
SN 0165-5876
UT WOS:000255321200007
PM 18295353
ER

PT J
AU Elsayegh, Dany
   Saito, Shigeki
   Eden, Edward
   Shapiro, Janet
TI Increasing severity of status asthmaticus in an urban medical intensive
   care unit
SO JOURNAL OF HOSPITAL MEDICINE
VL 3
IS 3
BP 206
EP 211
DI 10.1002/jhm.302
PD MAY-JUN 2008
PY 2008
AB BACKGROUND: Life-threatening status asthmaticus (SA) requiring intensive
   care is a major concern given the rising prevalence of asthma. We
   examined episodes of SA requiring admission to the medical intensive
   care unit (MICU) of an urban hospital center.
   METHODOLOGY: The charts of patients admitted to the MICU of an urban
   hospital center with a diagnosis of SA during the 5-year period
   2002-2006 were reviewed retrospectively. These results were compared
   with those of a previously published experience at our institution from
   1995 to 1999.
   RESULTS: The medical records of 84 MICU admissions for SA were reviewed.
   There were 61 women (5 pregnant). The mean age was 44 years. Use of
   cigarettes or illicit drugs was found in 51% and 30%, respectively.
   Mechanical ventilation (MV) was required in 76% of admissions.
   Noninvasive ventilation was used in 10 patients. Neuromuscular blockade
   (NMB) was needed in 9% of admissions. The highest average PaCO(2) during
   the first 24 hours was 67 mm Hg. Median duration of MV was 4.4 days. Six
   patients died, 3 of whom sustained prehospital cardiac arrest. Compared
   with the patients in the preceding 5-year period, the more recent
   patients had greater use of illicit drug and cigarettes. Patients
   presented with more severe asthma, as reflected by a higher PaCO(2) and
   an increased duration of MV
   CONCLUSIONS: During the recent 5-year period, we found a trend toward
   increasing severity of SA, as indicated by the degree of respiratory
   acidosis, need for NMB, and longer duration of MV Access to medical care
   and cigarette and illicit drug use remain potential targets of primary
   intervention.
TC 3
ZB 3
Z8 0
ZS 0
Z9 3
SN 1553-5592
UT WOS:000257229900006
PM 18571779
ER

PT J
AU MacIntyre, Neil
   Huang, Yuh Chin
TI Acute exacerbations and respiratory failure in chronic obstructive
   pulmonary disease.
SO Proceedings of the American Thoracic Society
VL 5
IS 4
BP 530
EP 5
DI 10.1513/pats.200707-088ET
PD 2008-May-1
PY 2008
AB Acute exacerbations of chronic obstructive pulmonary disease (AECOPD)
   describe the phenomenon of sudden worsening in airway function and
   respiratory symptoms in patients with COPD. These exacerbations can
   range from self-limited diseases to episodes of florid respiratory
   failure requiring mechanical ventilation. The average patient with COPD
   experiences two such episodes annually, and they account for significant
   consumption of health care resources. Although bacterial infections are
   the most common causes of AECOPD, viral infections and environmental
   stresses are also implicated. AECOPD episodes can be triggered or
   complicated by other comorbidities, such as heart disease, other lung
   diseases (e.g., pulmonary emboli, aspiration, pneumothorax), or systemic
   processes. Pharmacologic management includes bronchodilators,
   corticosteroids, and antibiotics in most patients. Oxygen, physical
   therapy, mucolytics, and airway clearance devices may be useful in
   selected patients. In hypercapneic respiratory failure, noninvasive
   positive pressure ventilation may allow time for other therapies to work
   and thus avoid endotracheal intubation. If the patient requires invasive
   mechanical ventilation, the focus should be on avoiding
   ventilator-induced lung injury and minimizing intrinsic positive
   end-expiratory pressure. These may require limiting ventilation and
   "permissive hypercapnia." Although mild episodes of AECOPD are generally
   reversible, more severe forms of respiratory failure are associated with
   a substantial mortality and a prolonged period of disability in
   survivors.
TC 21
ZB 7
Z8 0
ZS 2
Z9 22
SN 1546-3222
UT MEDLINE:18453367
PM 18453367
ER

PT J
AU Thalanany, Mariamma M.
   Mugford, Miranda
   Hibbert, Clare
   Cooper, Nicola J.
   Truesdale, Ann
   Robinson, Steven
   Tiruvoipati, Ravindranath
   Elbourne, Diana R.
   Peek, Giles J.
   Clemens, Felicity
   Hardy, Polly
   Wilson, Andrew
CA CESAR Trial Grp
TI Methods of data collection and analysis for the economic evaluation
   alongside a national, multi-centre trial in the UK: Conventional
   ventilation or ECMO for Severe Adult Respiratory Failure (CESAR)
SO BMC HEALTH SERVICES RESEARCH
VL 8
AR 94
DI 10.1186/1472-6963-8-94
PD APR 30 2008
PY 2008
AB Background: Extracorporeal Membrane Oxygenation (ECMO) is a technology
   used in treatment of patients with severe but potentially reversible
   respiratory failure. A multi-centre randomised controlled trial (CESAR)
   was funded in the UK to compare care including ECMO with conventional
   intensive care management. The protocol and funding for the CESAR trial
   included plans for economic data collection and analysis. Given the high
   cost of treatment, ECMO is considered an expensive technology for many
   funding systems. However, conventional treatment for severe respiratory
   failure is also one of the more costly forms of care in any health
   system.
   Methods/Design: The objectives of the economic evaluation are to compare
   the costs of a policy of referral for ECMO with those of conventional
   treatment; to assess cost-effectiveness and the cost-utility at 6 months
   follow-up; and to assess the cost-utility over a predicted lifetime.
   Resources used by patients in the trial are identified. Resource use
   data are collected from clinical report forms and through follow up
   interviews with patients. Unit costs of hospital intensive care
   resources are based on parallel research on cost functions in UK NHS
   intensive care units. Other unit costs are based on published NHS
   tariffs. Cost effectiveness analysis uses the outcome: survival without
   severe disability. Cost utility analysis is based on quality adjusted
   life years gained based on the Euroqol EQ-5D at 6 months. Sensitivity
   analysis is planned to vary assumptions about transport costs and method
   of costing intensive care. Uncertainty will also be expressed in
   analysis of individual patient data. Probabilities of cost effectiveness
   given different funding thresholds will be estimated.
   Discussion: In our view it is important to record our methods in detail
   and present them before publication of the results of the trial so that
   a record of detail not normally found in the final trial reports can be
   made available in the public domain.
   Trial Registrations: The CESAR trial registration number is
   ISRCTN47279827.
TC 9
ZB 6
Z8 0
ZS 0
Z9 9
SN 1472-6963
UT WOS:000256396700002
PM 18447931
ER

PT J
AU Tyson, Jon E.
   Parikh, Nehal A.
   Langer, John
   Green, Charles
   Higgins, Rosemary D.
CA Natl Inst Child Hlth
TI Intensive care for extreme prematurity - Moving beyond gestational age
SO NEW ENGLAND JOURNAL OF MEDICINE
VL 358
IS 16
BP 1672
EP 1681
DI 10.1056/NEJMoa073059
PD APR 17 2008
PY 2008
AB Background: Decisions regarding whether to administer intensive care to
   extremely premature infants are often based on gestational age alone.
   However, other factors also affect the prognosis for these patients.
   Methods: We prospectively studied a cohort of 4446 infants born at 22 to
   25 weeks' gestation (determined on the basis of the best obstetrical
   estimate) in the Neonatal Research Network of the National Institute of
   Child Health and Human Development to relate risk factors assessable at
   or before birth to the likelihood of survival, survival without profound
   neurodevelopmental impairment, and survival without neurodevelopmental
   impairment at a corrected age of 18 to 22 months.
   Results: Among study infants, 3702 (83%) received intensive care in the
   form of mechanical ventilation. Among the 4192 study infants (94%) for
   whom outcomes were determined at 18 to 22 months, 49% died, 61% died or
   had profound impairment, and 73% died or had impairment. In
   multivariable analyses of infants who received intensive care, exposure
   to antenatal corticosteroids, female sex, singleton birth, and higher
   birth weight (per each 100-g increment) were each associated with
   reductions in the risk of death and the risk of death or profound or any
   neurodevelopmental impairment; these reductions were similar to those
   associated with a 1-week increase in gestational age. At the same
   estimated likelihood of a favorable outcome, girls were less likely than
   boys to receive intensive care. The outcomes for infants who underwent
   ventilation were better predicted with the use of the above factors than
   with use of gestational age alone.
   Conclusions: The likelihood of a favorable outcome with intensive care
   can be better estimated by consideration of four factors in addition to
   gestational age: sex, exposure or nonexposure to antenatal
   corticosteroids, whether single or multiple birth, and birth weight.
   (ClinicalTrials.gov numbers, NCT00063063 and NCT00009633.).
RI Benneyworth, Brian/A-4667-2009
OI Benneyworth, Brian/0000-0002-4692-5303
TC 276
ZB 152
Z8 1
ZS 6
Z9 284
SN 0028-4793
UT WOS:000254966600005
PM 18420500
ER

PT J
AU Nunez-Cornejo, C.
   Borras-Blasco, J.
   Gracia-Perez, A.
   Rosique-Robles, J. D.
   Lopez-Camps, V.
   Castera, E.
   Abad, F. J.
TI Septic shock and community-acquired pneumonia associated with etanercept
   therapy
SO INTERNATIONAL JOURNAL OF CLINICAL PHARMACOLOGY AND THERAPEUTICS
VL 46
IS 4
BP 193
EP 197
PD APR 2008
PY 2008
AB Obiective: To report a case of septic shock and corrununity-acquired
   pneumonia in a patient with psoriatic arthritis receiving treatment with
   etanercept. Patient details: A 65-year-old woman diagnosed as having
   psoriatic arthritis had received treatment with etanercept. Chest X-ray
   studies were normal and the tuberculin skin test was negative. Two
   months after etanercept therapy, the patient presented to our emergency
   department with fever, cough, chest pain and generalized weakness. Chest
   radiography revealed a right pulmonary infiltrate. Her condition rapidly
   deteriorated and she went into shock with a further drop in her blood
   pressure, tachycardia and tachypnea. She was intubated, mechanically
   ventilated and was treated with fluids, cardioversion and amiodarone.
   Empiric therapy with levofloxacin, amikacin and cefepime were initiated.
   In the urinalysis, the result of a rapid test for Streptococcus
   pneumoniae was positive. Etanercept treatment was suspended due to a
   possible adverse reaction associated with this drug. At the start of
   therapy her clinical condition improved slowly. On Day 28, the patient
   was afebrile and she was discharged from the intensive care unit.
   Discussion: Most of the infections associated with etanercept therapy
   have been reported in patients with rheumatoid arthritis. Based on our
   observations, etanercept was the possible offender in the development of
   septic shock and respiratory failure in community-acquired pneumonia.
   There was a temporal relationship between exposure to the drug and onset
   of symptoms. Etanercept was the only drug administered before the septic
   shock developed. Based on the Naranjo algorithm, the adverse reaction
   could be considered possible. Conclusion: Patients initiated on
   etanercept should be counseled and receive appropriate screening before
   drug initiation. All febrile and newly occurring concomitant illnesses
   should be promptly evaluated. General practitioners should discontinue
   etanercept treatment and institute prompt and aggressive intervention if
   infection develops.
TC 6
ZB 3
Z8 0
ZS 0
Z9 6
SN 0946-1965
UT WOS:000255069200006
PM 18397693
ER

PT J
AU Meadow, William
   Lagatta, Joanne
   Andrews, Bree
   Caldarelli, Leslie
   Keiser, Amaris
   Laporte, Johanna
   Plesha-Troyke, Susan
   Subramanian, Madhu
   Wong, Sam
   Hron, Jon
   Golchin, Nima
   Schreiber, Michael
TI Just, in time: Ethical implications of serial predictions of death and
   morbidity for ventilated premature infants
SO PEDIATRICS
VL 121
IS 4
BP 732
EP 740
DI 10.1542/peds.2006-2797
PD APR 2008
PY 2008
AB OBJECTIVES. For a cohort of extremely premature, ventilated, newborn
   infants, we determined the power of either serial caretaker intuitions
   of "die before discharge" or serial illness severity scores to predict
   the outcomes of death in the NICU or neurologic performance at corrected
   age of 2 years.
   METHODS. We identified 268 premature infants who were admitted to our
   NICU in 1999-2004 and required mechanical ventilation. For each infant
   on each day of mechanical ventilation, we asked nurses, residents,
   fellows, and attending physicians the following question: "Do you think
   this child is going to live to go home or die before hospital
   discharge?" In addition, we calculated illness severity scores until
   either death or extubation.
   RESULTS. A total of 17 066 intuition profiles were obtained on 5609 days
   of mechanical ventilation in the NICU. One hundred (37%) of 268 profiled
   infants had >= 1 intuition of die before discharge. Only 33 infants
   (33%) with an intuition of die actually died in the NICU. Of 48 infants
   with even 1 day of corroborated intuition of die in the NICU, only 7
   (14%) were alive with both Mental Developmental Index and Psychomotor
   Developmental Index scores of >69, and only 2 (4%) were alive with both
   Mental Developmental Index and Psychomotor Developmental Index Scores of
   >79 at corrected age of 2 years. On day of life 1, the Score for
   Neonatal Acute Physiology II value for nonsurvivors (38.2 +/- 18.1) was
   significantly higher than that for survivors (26.3 +/- 12.7). However,
   this difference decreased steadily over time as scores improved for both
   groups.
   CONCLUSIONS. Illness severity scores become progressively less helpful
   over time in distinguishing infants who will either die in the NICU or
   survive with low Mental Developmental Index/Psychomotor Developmental
   Index scores. Serial caretaker intuitions of die before discharge also
   fail to identify prospective nonsurviving infants. However, corroborated
   intuitions of die before discharge identify a subset of infants whose
   likelihood of surviving to 2 years with both MDI and PDI > 80 is
   approximately 4%.
TC 32
ZB 17
Z8 0
ZS 1
Z9 32
SN 0031-4005
UT WOS:000254576800011
PM 18381538
ER

PT J
AU Sieck, Gary C.
   Mantilla, Carlos B.
TI Effect of mechanical ventilation on the diaphragm
SO NEW ENGLAND JOURNAL OF MEDICINE
VL 358
IS 13
BP 1392
EP 1394
DI 10.1056/NEJMe0801226
PD MAR 27 2008
PY 2008
RI Mantilla, Carlos/A-3562-2013
TC 17
ZB 9
Z8 2
ZS 0
Z9 19
SN 0028-4793
UT WOS:000254308400012
PM 18367743
ER

PT J
AU Budweiser, Stephan
   Joerres, Rudolf A.
   Pfeifer, Michael
TI Noninvasive home ventilation for chronic obstructive pulmonary disease:
   indications, utility and outcome
SO CURRENT OPINION IN PULMONARY MEDICINE
VL 14
IS 2
BP 128
EP 134
PD MAR 2008
PY 2008
AB Purpose of review Despite its widespread use, the role of noninvasive
   home mechanical ventilation for the management of severe chronic
   obstructive pulmonary disease and chronic hypercapnic respiratory
   failure is still controversial. The majority of randomized controlled
   trials show methodological weaknesses, including issues of patient
   selection, insufficient pressure support and poor adherence to therapy.
   Data from short-term trials, while assuring effective ventilation, are
   encouraging by demonstrating physiological improvements, in line with
   benefits regarding symptoms and quality of life. The role of home
   mechanical ventilation for long-term survival is, however, still
   unclear.
   Recent findings Possible indications of home mechanical ventilation,
   physiological concepts underlying the effects of noninvasive ventilation
   and their impact on clinically important long-term outcomes are
   reported.
   Summary Due to systemic involvement, the decision to undertake home
   mechanical ventilation should probably not be based on symptomatic
   chronic hypercapnia alone, but on a broader spectrum of factors. In
   particular, patients with repeated hypercapnic decompensation are at
   high risk for death and obvious candidates for home mechanical
   ventilation. Beyond restoration of chemosensitivity, changes in
   breathing pattern and a reduction of mechanical load are likely
   mechanisms of home mechanical ventilation, inducing symptom relief and
   improving functional reserve. To fully utilize its potential, high
   pressure levels are required. Future prospective controlled studies
   should take into account these experiences.
TC 7
ZB 0
Z8 0
ZS 0
Z9 7
SN 1070-5287
UT WOS:000253470400008
PM 18303422
ER

PT J
AU Pierce, Janet D.
   Goodyear-Bruch, Caryl
   Hall, Sandra
   Reed, Greg A.
   Clancy, Richard L.
TI Dopamine alleviation of diaphragm contractile dysfunction and reduction
   of deoxyribonucleic acid damage in rats
SO HEART & LUNG
VL 37
IS 2
BP 132
EP 143
DI 10.1016/j.hrtlng.2007.05.011
PD MAR-APR 2008
PY 2008
AB BACKGROUND: Weaning difficulties from mechanical ventilation are
   associated with diaphragm fatigue and reduced respiratory muscle
   endurance capacity. often the work of breathing is increased during the
   weaning process as a result of inspiratory resistance loading (IRL). IRL
   produces increased free radical formation that contributes to
   deoxyribonucleic acid (DNA) damage. The purpose of this study was to
   determine whether dopamine reduced nuclei DNA damage when the work of
   breathing was increased. We hypothesized that the administration of
   low-dose dopamine (2 mu g/kg/min) during IRL decreases myonuclei DNA
   damage associated with free radical formation.
   METHODS: In this in vivo study, 30 male Sprague-Dawley rats were divided
   into three groups: (1) the sham group receiving no IRL or no intravenous
   fluids, (2) IRL with administration intravenous saline, and (3) IRL with
   intravenous low-dose dopamine (2 mu g/kg/min). All rats from the same
   breed and similar colonies were purchased from one laboratory facility
   to ensure homogeneity. The animals were anesthetized and tracheotomized,
   and an ultrasonic sensor was attached to the right hemidiaphragm to
   measure diaphragm shortening. Diaphragm fatigue was produced by IRL.
   Dopamine (2 mu g/kg/min) was infused intravenously before and during
   loading. The diaphragms were excised, and myonuclei DNA damage was
   measured using the fluorescent dyes ethidium bromide and acridine orange
   and comet analyses as indices of free radical injury.
   RESULTS: In rats receiving saline, diaphragm shortening decreased by 37%
   after 45 minutes of IRL (P = .002) compared with baseline. In contrast,
   rats infused with dopamine exhibited a 31% increase in diaphragm
   shortening after 45 minutes of IRL (P = .037). With the use of
   differential dye uptake, in the saline group 59% of the nuclei were
   apoptotic, and 18% were necrotic. However, in the dopamine group there
   was significantly less apoptotic nuclei (16%, P < .001) and necrotic
   nuclei (7%, P = .005). Myonuclei DNA damage, measured by comet analyses,
   was associated with tail length and tail olive moment, which were 37%
   and 60% greater, respectively, in the saline group than in the dopamine
   group (P < .05).
   CONCLUSION: These data support the hypothesis that low-dose dopamine
   during IRL reduced myonuclei DNA damage as measured by the fluorescent
   dyes and comet analysis. In addition, diaphragm fatigue was prevented by
   the administration of dopamine during IRL.
TC 1
ZB 0
Z8 0
ZS 0
Z9 1
SN 0147-9563
UT WOS:000254637400006
PM 18371506
ER

PT J
AU Stocchetti, Nino
   Zanaboni, Clelia
   Colombo, Angelo
   Citerio, Giuseppe
   Beretta, Luigi
   Ghisoni, Laura
   Zanier, Elisa Roncati
   Canavesi, Katia
TI Refractory intracranial hypertension and "second-tier" therapies in
   traumatic brain injury
SO INTENSIVE CARE MEDICINE
VL 34
IS 3
BP 461
EP 467
DI 10.1007/s00134-007-0948-9
PD MAR 2008
PY 2008
AB Objective: To quantify the occurrence of high intracranial pressure
   (HICP) refractory to conventional medical therapy after traumatic brain
   injury (TBI) and to describe the use of more aggressive therapies
   (profound hyperventilation, barbiturates, decompressive craniectomy).
   Design: Prospective study of 407 consecutive TBI patients Setting: Three
   neurosurgical intensive care units (ICU). Measurements and results:
   Intracranial pressure (ICP) was studied during the first week after TBI;
   153 patients had at least 1 day of ICP>20mmHg. Early surgery was
   necessary for 221 cases, and standard medical therapy [sedation,
   mannitol, cerebrospinal fluid (CSF) withdrawal, PaCO2 30-35mmHg] was
   used in 135 patients. Reinforced treatment (PaCO2 25-29mmHg, induced
   arterial hypertension, muscle relaxants) was used in 179 cases (44%),
   and second-tier therapies in 80 (20%). Surgical decompression and/or
   barbiturates were used in 28 of 407 cases (7%). Six-month outcome was
   recorded in 367 cases using the Glasgow outcome scale (GOS). The outcome
   was favorable (good recovery or moderate disability) in 195 cases (53%)
   and unfavorable (all the other categories) in 172 (47%). HICP was
   associated with worse outcome. Outcome for cases who had received
   second-tier therapies was significantly worse (43% favorable at 6
   months, p=0.03). Conclusions: HICP is frequent and is associated with
   worse outcome. ICP was controlled by early surgery and first-tier
   therapies in the majority of cases. Profound hyperventilation, surgical
   decompression and barbiturates were used in various combinations in a
   minority of cases. The indications for surgical decompression and/or
   barbiturates seem restricted to less than 10% of severe TBI.
RI Citerio, Giuseppe/B-1839-2015
TC 36
ZB 9
Z8 3
ZS 1
Z9 39
SN 0342-4642
UT WOS:000253200800011
PM 18066523
ER

PT J
AU Ryan, Monique M.
TI The use of invasive ventilation is appropriate in children with
   genetically proven spinal muscular atrophy type I: the motion against
SO PAEDIATRIC RESPIRATORY REVIEWS
VL 9
IS 1
BP 51
EP 54
DI 10.1016/j.prrv.2007.10.002
PD MAR 2008
PY 2008
AB Spinal muscular atrophy (SMA) is a relatively common, profoundly
   disabling and incurable disease that presents in early childhood with
   hypotonia, weakness and decreased movement. Without ventilatory support,
   premature death from respiratory insufficiency is universal in children
   with spinal muscular atrophy type I (SMA I). With mechanical
   ventilation, however, long-term survival in SMA I has been reported from
   numerous international centres. Children kept alive by this means
   experience progressive paralysis and eventually become effectively
   'locked in' on the ventilator, with no useful movements of the
   extremities, progressive facial and bulbar weakness, and complete
   inability to communicate. Prolongation of life by invasive ventilation
   in such cases is futile given the absence of curative treatments for
   infants with SMA I, and overly burdensome given the unacceptable quality
   of life of such children. (c) 2007 Elsevier Ltd. All rights reserved.
TC 18
ZB 4
Z8 0
ZS 0
Z9 18
SN 1526-0542
UT WOS:000254172500008
PM 18280980
ER

PT J
AU van Aswegen, H
   Eales, C J
   Richards, G A
   Goosen, J
   Becker, P
   Mudzi, W
TI Effect of penetrating trunk trauma on the recovery of adult survivors: a
   pilot study.
SO Physiotherapy theory and practice
VL 24
IS 2
BP 95
EP 104
DI 10.1080/09593980701378231
PD 2008 Mar-Apr
PY 2008
AB Gunshot and/or stab wounds to the trunk are injuries seen in South
   African hospitals. Patients are managed in the intensive care unit.
   Prolonged mechanical ventilation with immobilization results in some
   degree of muscle dysfunction. Our goal was to determine if patients
   recover adequately spontaneously following critical illness. No formal
   rehabilitation programmes exist in South Africa for these patients
   following discharge. A prospective, observational study was conducted.
   Patients were recruited from three ICUs in Johannesburg. Lung function
   tests, dynamometry, quality of life, 6-minute-walk, and oxygen uptake
   tests were performed over 6 months following discharge from the
   hospital. The control group consisted of existing data for healthy
   volunteers. Distance walked during 6-minute-walk test was significantly
   reduced for the study group compared to the control group (1 month [p =
   0.00251]; 6 months [p = 0.0355]). At 1 month there was a significant
   reduction in quadriceps and triceps strength for the study group
   compared to the control group (p = 0.0089; p = 0.0246, respectively).
   Quadriceps strength remained significantly reduced for the study group
   (3 months [p = 0.0489]). No difference in muscle strength was detected
   between the groups at 6 months. Actual and predicted residual volumes
   differed significantly for the study group (1 month [p = 0.0034]; 6
   months [p = 0.0157]). A trend of muscle weakness (to 3 months), poor
   exercise capacity, and abnormal lung volumes was identified. A formal
   rehabilitation programme may be needed to address these disabilities.
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
UT MEDLINE:18432512
PM 18432512
ER

PT J
AU Marchese, Santino
   Lo Coco, Daniele
   Lo Coco, Albino
TI Outcome and attitudes toward home tracheostomy ventilation of
   consecutive patients: A 10-year experience
SO RESPIRATORY MEDICINE
VL 102
IS 3
BP 430
EP 436
DI 10.1016/j.rmed.2007.10.006
PD MAR 2008
PY 2008
AB Objectives: To describe survival, predictors of long-term outcome and
   attitudes in patients treated at home by tracheostomy-intermittent
   positive-pressure ventilation (TIPPV) for respiratory failure during a
   10-year period (1995-2004).
   Methods: Seventy-seven consecutive patients were treated by TIPPV at
   home. Patients were divided into three groups: neuromuscular, pulmonary,
   and non-pulmonary patients. Effects of TIPPV on survival, factors
   influencing outcome after TIPPV, and attitudes of patients and
   caregivers regarding mechanical ventilation were studied.
   Results: Forty-one patients (53%) were neuromuscular, 19 (25%) were
   affected by pulmonary diseases, and 17 (22%) by non-pulmonary diseases.
   The median survival time after TIPPV in the group was 49 months (range
   3-149 months). There was statistically significant longer survival in
   neuromuscular compared to pulmonary patients (p = 0.006), and a trend
   toward longer survival for non-pulmonary when compared to pulmonary
   patients (p = 0.048). Chronic obstructive pulmonary disease (COPD)
   patients (n = 14) showed the poorest outlook (median survival 26 months,
   range 3-45 months) and the highest number of emergency readmissions to
   hospital. The median survival in amyotrophic lateral sclerosis (ALS)
   patients was 49 months (range 30-61), tower than the whole group of
   neuromuscular patients. Major tracheostomy complications were low: 2.6%.
   Multivariate analysis showed that COPD and ALS patients had a three-fold
   higher risk of death than patients with other diagnoses. Lastly, 64
   patients (83%) were pleased they had chosen TIPPV and 69 (90%) would
   choose it again. Forty-two caregivers (55%) were pleased the patients
   had chosen home ventilation, but 29 (38%) reported major burdens.
   Conclusions: TIPPV is well-received by the patients, is safe, and
   provides survival for long periods of time. Underlying conditions (COPD
   and ALS) might represent important prognostic factors for survival. (C)
   2007 Elsevier Ltd. All rights reserved.
TC 19
ZB 3
Z8 0
ZS 1
Z9 19
SN 0954-6111
UT WOS:000253637500016
PM 18023334
ER

PT J
AU O'Laughlin, Daniel T.
   Hick, John L.
TI Ethical issues in resource triage
SO RESPIRATORY CARE
VL 53
IS 2
BP 190
EP 197
PD FEB 2008
PY 2008
AB Mass-care events, such as pandemic influenza, could reach such
   devastating proportions that there will be the need to make difficult
   triage decisions that will ultimately result in the deaths or severe
   disability of patients in large numbers. The method by which we
   determine how triage of scarce health care resources will be performed
   must be clearly defined prior to a disaster event. This paper will
   discuss several of the ethical principles that must be weighed in
   developing a mass-care triage plan, as well as steps to facilitate its
   implementation. Development of triage polices in such an event should be
   developed in an open and transparent manner, be reasonable in design,
   include the views of the critical stakeholders, and be responsive to and
   provide a mechanism for accountability, with a clearly defined goal of
   the just triage of limited health care resources. Planning failure will
   result in increased deaths from poor triage processes and substantial
   mistrust of the health care system and its practitioners.
CT 9th International Congress on Biotechnology in Animal Reproduction
CY DEC 02-04, 2002
CL Chennai, INDIA
TC 11
ZB 3
Z8 0
ZS 0
Z9 11
SN 0020-1324
UT WOS:000253055900003
PM 18218150
ER

PT J
AU Chiswick, Malcolm
TI Infants of borderline viability: Ethical and clinical considerations
SO SEMINARS IN FETAL & NEONATAL MEDICINE
VL 13
IS 1
BP 8
EP 15
DI 10.1016/j.siny.2007.09.007
PD FEB 2008
PY 2008
AB The burden of prolonged intensive care for infants of borderline
   viability and the relatively high disability rate among survivors pose
   ethical and clinical problems. Bioethicists have argued that clinical
   decisions should be based on the infant's 'best interests', balancing
   the burden of intensive care including 'pain and suffering' against the
   likely outcome. However, there are so many uncertainties that the 'best
   interest' argument is more helpful in defining problems than driving
   clinical solutions. The parents' interests are inextricably linked with
   those of their infant and have considerable weight. Parental complaints
   about delivery room care are rarely based on a conflict of ethical
   opinion. They are more likely due to misunderstanding, confusion and
   tension among staff and parents as a result of a failure to have in
   place or to implement agreed protocols. Information given during
   pre-delivery counselling can easily be misunderstood. The condition of
   the infant at birth and response to bag and mask ventilation have an
   important role in influencing whether to continue intensive care.
   Subsequent care in the neonatal intensive care unit (NICU) should be
   considered as a 'trial of life', with the option of withdrawing
   ventilatory assistance according to the nature and extent of neonatal
   complications. (C) 2007 Elsevier Ltd. All rights reserved.
TC 15
ZB 6
Z8 0
ZS 3
Z9 17
SN 1744-165X
UT WOS:000253065100003
PM 17993295
ER

PT J
AU Eikermann, M.
   Malhotra, A.
TI Predictive value of stimulated muscle force assessment in critically ill
   patients
SO ACTA ANAESTHESIOLOGICA SCANDINAVICA
VL 52
IS 1
BP 1
EP 2
DI 10.1111/j.1399-6576.2007.01536.x
PD JAN 2008
PY 2008
TC 2
ZB 0
Z8 0
ZS 0
Z9 2
SN 0001-5172
UT WOS:000251763800001
PM 18173429
ER

PT J
AU Cavazzoni, Elena
   Lister, Bruce
   Sargent, Phillip
   Schibler, Andreas
TI Blue-ringed octopus (Hapalochlaena sp.) envenomation of a 4-year-old
   boy: A case report
SO CLINICAL TOXICOLOGY
VL 46
IS 8
BP 760
EP 761
DI 10.1080/15563650701601790
PD 2008
PY 2008
AB Introduction. The blue-ringed octopus (Hapalochlaena sp.) is a small
   animal, which can inject a toxin that produces a respiratory arrest
   within minutes. This envenomation is a rare occurrence with very few
   reported outcomes in children. Case report. A 4-year-old boy was bitten
   by a blue-ringed octopus (Hapalochlaena sp.) whilst playing at a popular
   beach in Queensland, Australia. Within ten minutes of the bite, he had
   vomited three times, lost the ability to stand and complained of blurred
   vision. An ambulance was called by the time he presented to the local
   emergency department (20 minutes after the bite) he had acute and
   progressive skeletal muscle weakness. He was intubated, ventilated, and
   transferred to a pediatric intensive care unit for specialized
   supportive care. He was ventilated for a total of 17 hours with
   spontaneous muscular activity returning at around 15 hours from
   envenomation. Discussion. If not treated appropriately the bite of this
   small and innocuous looking animal could have lead to death within
   minutes. Conclusion. This case report serves as a reminder of how
   appropriate treatment can ensure discharge from hospital with no
   long-term consequences. It also highlights the importance of education
   for beach goers and in particular parents to prevent exposure of
   tetrodotoxin to children.
RI Schibler, Andreas/C-3503-2012; Schibler, Andreas/D-8876-2015
TC 10
ZB 6
Z8 0
ZS 0
Z9 10
SN 1556-3650
UT WOS:000259365400012
PM 19238736
ER

PT J
AU Powers, Scott K.
   DeCramer, Marc
   Gayan-Ramirez, Ghislaine
   Levine, Sanford
TI Pressure support ventilation attenuates ventilator-induced protein
   modifications in the diaphragm
SO CRITICAL CARE
VL 12
IS 6
AR 191
DI 10.1186/cc7095
PD 2008
PY 2008
AB Common medical conditions that require mechanical ventilation include
   chronic obstructive lung disease, acute lung injury, sepsis, heart
   failure, drug overdose, neuromuscular disorders, and surgery. Although
   mechanical ventilation can be a life saving measure, prolonged
   mechanical ventilation can also present clinical problems. Indeed,
   numerous well-controlled animal studies have demonstrated that prolonged
   mechanical ventilation results in diaphragmatic weakness due to both
   atrophy and contractile dysfunction. Importantly, a recent clinical
   investigation has confirmed that prolonged mechanical ventilation
   results in atrophy of the human diaphragm. This mechanical
   ventilation-induced diaphragmatic weakness is important because the most
   frequent cause of weaning difficulty is respiratory muscle failure due
   to inspiratory muscle weakness and/or a decline in inspiratory muscle
   endurance. Therefore, developing methods to protect against mechanical
   ventilation-induced diaphragmatic weakness is important.
TC 6
ZB 3
Z8 0
ZS 0
Z9 6
SN 1466-609X
UT WOS:000263949200035
PM 19040772
ER

PT J
AU Khan, Jaffar
   Harrison, Taylor B.
   Rich, Mark M.
TI Mechanisms of neuromuscular dysfunction in critical illness
SO CRITICAL CARE CLINICS
VL 24
IS 1
BP 165
EP +
DI 10.1016/j.ccc.2007.10.004
PD JAN 2008
PY 2008
AB The development of neuromuscular dysfunction (NMD) during critical
   illness is increasingly recognized as a cause of failure to wean from
   mechanical ventilation and is associated with significant morbidity and
   mortality. At times, it is difficult to identify the presence of NMD and
   distinguish the etiology of the weakness in patients with critical
   illness, but subtle clinical findings and bedside electrophysiologic
   testing are helpful in establishing the diagnosis. This article
   describes the clinical spectrum of acquired neuromuscular weakness in
   the setting of critical illness, provides an approach to diagnosis, and
   discusses its pathogenesis. Finally, a defective sodium channel
   regulation as a unifying mechanism underlying NMD in critically ill
   patients is proposed.
TC 24
ZB 11
Z8 0
ZS 1
Z9 25
SN 0749-0704
UT WOS:000253470700011
PM 18241784
ER

PT J
AU Demir, Sibel Oezbudak
   Koeseoglu, Fuesun
TI Factors associated with health-related quality of life in patients with
   severe Guillain-Barre syndrome
SO DISABILITY AND REHABILITATION
VL 30
IS 8
BP 593
EP 599
DI 10.1080/09638280701352626
PD 2008
PY 2008
AB Purpose. To compare the health-related quality of life (HRQOL) in
   control subjects and patients with severe Guillain-Barr syndrome (GBS) 6
   months after rehabilitation. To determine the relationship of several
   sociodemographic and medical factors with the HRQOL of the GBS
   survivors. Methods. Thirty-one patients with severe GBS and 31 control
   subjects were included in the study. Demographic and medical variables
   were recorded. The functional outcome was measured using the Functional
   Independence Measure (FIM), both at admission and discharge and also at
   the 6-month follow-up examination. The HRQOLs were assessed by the
   Nottingham Health Profile (NHP) at the 6-month follow-up examination.
   Results. There were significant improvements in functional status as
   measured by the FIM at discharge and also at 6 months. The scores of all
   of the NHP dimensions of the GBS patients were significantly higher than
   in the control subjects. Functional disability scores were highly
   related to the energy level, physical mobility and emotional reactions
   of the NHP domains. Education, gender, employment, mechanical
   ventilation and tendency to depression were the factors most related to
   the NHP domains. Age and marital status showed no significant
   correlation with the NHP scores. Conclusion. The HRQOL of the GBS
   patients remains lower than that of the control subjects. In addition to
   functional scores, several sociodemographic and medical variables, such
   as education, psychological factors, gender, mechanical ventilation and
   employment may play a crucial role in determining the quality of life in
   persons with GBS.
TC 12
ZB 3
Z8 0
ZS 0
Z9 12
SN 0963-8288
UT WOS:000254573900003
PM 17852306
ER

PT J
AU Friedrich, O.
TI Critical illness myopathy: sepsis-mediated failure of the peripheral
   nervous system
SO EUROPEAN JOURNAL OF ANAESTHESIOLOGY
VL 25
BP 73
EP 82
DI 10.1017/S0265021507003262
SU 42
PD 2008
PY 2008
AB With better survival of critically ill patients, 'de novo' arising
   neuromuscular complications like critical illness myopathy or
   polyneuropathy have been increasingly observed. Prolonged
   hospitalization not only imposes risks like pneumonia or thrombosis on
   patients but also represents a real budget threat to modern
   intensive-care medicine. Clinical symptoms like muscle weakness and
   weaning failure are common to critical illness myopathy and critical
   illness polyneuropathy and do not allow for distinction. Specific
   therapies are not yet available, and the quest for the pathomechanisms
   has proved more complicated than anticipated. Especially for critical
   illness myopathy, multiple sites of disturbances to the
   excitation-contraction coupling cascade are possible causes of muscle
   weakness. The present review summarizes the epidemiological, clinical
   and diagnostic features of critical illness myopathy and then focuses on
   current concepts of the presumed pathomechanisms of critical illness
   myopathy. Sepsis was shown to be a major cause of critical illness
   myopathy and special emphasis will be placed on how sepsis and
   inflammatory mediators influence (1) the membrane excitability at the
   level of voltage-gated ion channels and (ii) the intracellular protein
   signalling that results in selective loss of myosin protein content and
   muscle wasting. For (1), critical illness myopathy represents a new type
   of acquired channelopathy affecting the inactivation properties of Na(+)
   channels. For (ii), both protein proteolysis and protein build up at the
   transcriptional level seem to be involved. Findings from different
   studies are put into a common context to propose a model for
   cytokine-mediated failure of muscle in severe sepsis. This can open a
   series of new possible trials to test specific therapeutic strategies in
   the future.
CT Brain Annual Meeting
CY MAY 09-12, 2007
CL Brescia, ITALY
TC 6
ZB 5
Z8 1
ZS 0
Z9 7
SN 0265-0215
UT WOS:000254610100013
ER

PT J
AU Friedrich, O
TI Critical illness myopathy: sepsis-mediated failure of the peripheral
   nervous system.
SO European journal of anaesthesiology. Supplement
VL 42
BP 73
EP 82
DI 10.1017/S0265021507003262
PD 2008
PY 2008
AB With better survival of critically ill patients, 'de novo' arising
   neuromuscular complications like critical illness myopathy or
   polyneuropathy have been increasingly observed. Prolonged
   hospitalization not only imposes risks like pneumonia or thrombosis on
   patients but also represents a real budget threat to modern
   intensive-care medicine. Clinical symptoms like muscle weakness and
   weaning failure are common to critical illness myopathy and critical
   illness polyneuropathy and do not allow for distinction. Specific
   therapies are not yet available, and the quest for the pathomechanisms
   has proved more complicated than anticipated. Especially for critical
   illness myopathy, multiple sites of disturbances to the
   excitation-contraction coupling cascade are possible causes of muscle
   weakness. The present review summarizes the epidemiological, clinical
   and diagnostic features of critical illness myopathy and then focuses on
   current concepts of the presumed pathomechanisms of critical illness
   myopathy. Sepsis was shown to be a major cause of critical illness
   myopathy and special emphasis will be placed on how sepsis and
   inflammatory mediators influence (i) the membrane excitability at the
   level of voltage-gated ion channels and (ii) the intracellular protein
   signalling that results in selective loss of myosin protein content and
   muscle wasting. For (i), critical illness myopathy represents a new type
   of acquired channelopathy affecting the inactivation properties of Na+
   channels. For (ii), both protein proteolysis and protein build up at the
   transcriptional level seem to be involved. Findings from different
   studies are put into a common context to propose a model for
   cytokine-mediated failure of muscle in severe sepsis. This can open a
   series of new possible trials to test specific therapeutic strategies in
   the future.
TC 4
ZB 4
Z8 2
ZS 0
Z9 6
SN 0952-1941
UT MEDLINE:18289421
PM 18289421
ER

PT J
AU Shehu, I
   Peli, E
TI Phrenic nerve stimulation.
SO European journal of anaesthesiology. Supplement
VL 42
BP 186
EP 91
DI 10.1017/S0265021507003377
PD 2008
PY 2008
AB Weakness of the limbs and respiratory muscles has increasingly been
   found to be a frequent event that complicates the medical history of
   patients in Intensive Care. The problem normally affects more serious
   cases and presents as muscular weakness leading to flaccid paralysis and
   difficulty in weaning patients off mechanical ventilation. This latter
   sign leads the intensivist to suspect possible involvement of the
   neuromuscular respiratory system. Unfortunately, in-depth clinical
   assessment of the neuromuscular respiratory system is difficult with
   critically ill patients, and electrophysiological studies have been used
   instead to overcome this problem. Of these latter, electric and
   electromagnetic stimulation of the phrenic nerve have been successful
   (along with needle electromyography of the diaphragm) in identifying the
   causes of neuromuscular respiratory insufficiency, especially in
   Intensive Care. In this brief chapter, we will be discussing the
   technique of electric stimulation of the phrenic nerve and neuromuscular
   respiratory insufficiency within the field of critical illness
   polyneuropathy.
TC 1
ZB 2
Z8 0
ZS 0
Z9 2
SN 0952-1941
UT MEDLINE:18289440
PM 18289440
ER

PT J
AU Jakkula, V.
   Cook, D. J.
TI Anomaly detection using temporal data mining in a smart home environment
SO METHODS OF INFORMATION IN MEDICINE
VL 47
IS 1
BP 70
EP 75
DI 10.3414/ME9103
PD 2008
PY 2008
AB Objectives: To many people, home is a sanctuary. With the maturing of
   smart home technologies, many people with cognitive and physical
   disabilities can lead independent lives in their own homes for extended
   periods of time. In this paper, we investigate the design of machine
   learning algorithms that support this goal. We hypothesize that machine
   learning algorithms can be designed to automatically learn models of
   resident behavior in a smart home, and that the results can be used to
   perform automated health monitoring and to detect anomalies.
   Methods: Specifically, our algorithms draw upon the temporal nature of
   sensor data collected in a smart home to build a model of expected
   activities and to detect unexpected, and possibly health-critical,
   events in the home.
   Results: We validate our algorithms using synthetic data and real
   activity data collected from volunteers in an automated smart
   environment.
   Conclusions: The results from our experiments support our hypothesis
   that a model can be learned from observed smart home data and used to
   report anomalies, as they occur, in a smart home.
TC 14
ZB 2
Z8 0
ZS 0
Z9 14
SN 0026-1270
UT WOS:000252710800011
PM 18213431
ER

PT J
AU Allen, David C.
   Arunachalam, Ramamurthy
   Mills, Kerry R.
TI Critical illness myopathy: Further evidence from muscle-fiber
   excitability studies of an acquired channelopathy
SO MUSCLE & NERVE
VL 37
IS 1
BP 14
EP 22
DI 10.1002/mus.20884
PD JAN 2008
PY 2008
AB Recent studies have demonstrated acquired muscle inexcitability in
   critical illness myopathy (CIM) and have used direct muscle stimulation
   (DMS) techniques to distinguish neuropathy from myopathy as a cause of
   weakness in the critically ill. The mechanisms underlying weakness in
   CIM are incompletely understood and DIMS is only semiquantitative. We
   report results from a series of 32 patients with CIM and demonstrate
   significant slowing of muscle-fiber conduction velocity (MFCV) and
   muscle-fiber conduction block during the acute phase of CIM, which
   correlates with prolonged compound muscle action potential (CMAP)
   duration, clinical severity, and course. We also used a paired
   stimulation technique to explore the excitability of individual muscle
   fibers in vivo. We demonstrate altered muscle-fiber excitability in CIM
   patients. Serial studies help define the course of these
   pathophysiological changes. Parallels are made between CIM and
   hypokalemic periodic paralysis. Our findings provide further evidence
   for muscle membrane dysfunction being the principal underlying
   abnormality in CIM.
TC 30
ZB 13
Z8 1
ZS 0
Z9 30
SN 0148-639X
UT WOS:000252114200003
PM 17763454
ER

PT J
AU Graf, Jeanine M.
   Montagnino, Barbara A.
   Hueckel, Remi
   McPherson, Mona L.
TI Pediatric tracheostomies: A recent experience from one academic center
SO PEDIATRIC CRITICAL CARE MEDICINE
VL 9
IS 1
BP 96
EP 100
DI 10.1097/01.PCC.0000298641.84257.53
PD JAN 2008
PY 2008
AB Objectives. To describe the indications, surgical timing, length of
   stay, hospital charges, and discharge disposition of pediatric
   tracheostomy patients.
   Design: Retrospective case series. Setting. Large urban academic
   pediatric hospital.
   Patients: Seventy children and adolescents undergoing tracheostomy
   placement over a 24-month period.
   Interventions: None.
   Measurements and Main results: Hospital database records were used to
   determine demographics and readmission rates, tabulate charges, and
   confirm deaths. Indications for tracheostomies included airway
   obstruction, inadequate airway protection, chronic lung disease,
   neuromuscular weakness, and central hypoventilation. Surgical timing of
   the tracheostomy was grouped into three categories: prolonged mechanical
   ventilation, elective, or emergent. The overall median hospital stay was
   46 days (range 14-254) with a median hospital charge of $136,718 (range
   $36,237-$913,934). The prolonged mechanical ventilation group underwent
   a tracheostomy after a median of 26 days (mean 37.5 days) on the
   ventilator. Eighty-one percent of children were discharged home; 63% of
   children were readmitted within 6 months, with 11% requiring four or
   more admissions. The six-month mortality rate was 13%; no deaths were
   related to the tracheostomy.
   Conclusions: Children with tracheostomies are a heterogeneous
   population. Children who require tracheostomy for longterm mechanical
   ventilation have longer hospital stays than children who receive a
   tracheotomy on an elective or emergent basis. Hospital readmissions
   should be anticipated in this complex group of patients.
TC 26
ZB 9
Z8 1
ZS 1
Z9 28
SN 1529-7535
UT WOS:000252462200017
PM 18477921
ER

PT S
AU Larsson, Lars
BE Laing, NG
TI Acute Quadriplegic Myopathy: An Acquired "Myosinopathy"
SO SARCOMERE AND SKELETAL MUSCLE DISEASE
SE Advances in Experimental Medicine and Biology
VL 642
BP 92
EP 98
PD 2008
PY 2008
AB Acquired neuromuscular disorders have been shown to be very common in
   critically ill patients receiving prolonged mechanical ventilation in
   the intensive care unit (ICU). Acute Quadriplegic Myopathy (AQM) is a
   specific acquired myopathy in ICU patients. Patients with AQM are
   characterized by severe muscle weakness and atrophy of spinal nerve
   innervated limb and trunk muscles, while cranial nerve innervated
   craniofacial muscles, sensory and cognitive functions are spared or less
   affected. The muscle weakness is associated with altered muscle membrane
   properties and a preferential loss of the motor protein myosin and
   myosin-associated thick filament proteins. Prolonged mechanical
   ventilation, muscle unloading, postsynaptic block of neuromuscular
   transmission, sepsis and systemic corticosteroid hormone treatment have
   been suggested as important triggering factors in AQM. However, the
   exact mechanisms underlying the loss of thick filament proteins are not
   known, though enhanced myofibrillar protein degradation in combination
   with a downregulation of protein synthesis at the transcriptional level
   play important roles.
TC 13
ZB 9
Z8 0
ZS 0
Z9 13
SN 0065-2598
BN 978-0-387-84846-4
UT WOS:000261700300009
PM 19181096
ER

PT J
AU Bershad, Eric M.
   Feen, Eliahu S.
   Suarez, Jose I.
TI Myasthenia gravis crisis
SO SOUTHERN MEDICAL JOURNAL
VL 101
IS 1
BP 63
EP 69
PD JAN 2008
PY 2008
AB Myasthenia gravis (MG) is an autoimmune disorder resulting from the
   production of antibodies against acetylcholine receptors leading to the
   destruction of the postsynaptic membrane at the neuromuscular junction.
   In the US there are about 18,000 people with MG. Myasthenia gravis
   crisis (MGC) is defined as any MG exacerbation necessitating mechanical
   ventilation. Most patients presenting with MGC have an identifiable risk
   factor. The diagnosis of MGC should be suspected in all patients with
   respiratory failure, particularly those with unclear etiology. Acute
   management of requires supportive general and ventilatory therapy and
   institution of measures to improve the neuromuscular blockade. The
   latter includes plasma exchange or IV immunoglobulin, and removal of the
   offending trigger. The outcome of patients with MGC has improved
   significantly and the current mortality rate is about 4 to 8%.
TC 10
ZB 1
Z8 3
ZS 1
Z9 13
SN 0038-4348
UT WOS:000252264100022
PM 18176295
ER

PT J
AU Barbini, Emanuela
   Cevenini, Gabriele
   Scolletta, Sabino
   Biagioli, Bonizella
   Giomarelli, Pierpaolo
   Barbini, Paolo
TI A comparative analysis of predictive models of morbidity in intensive
   care unit after cardiac surgery - Part I: model planning
SO BMC MEDICAL INFORMATICS AND DECISION MAKING
VL 7
AR 35
DI 10.1186/1472-6947-7-35
PD NOV 22 2007
PY 2007
AB Background: Different methods have recently been proposed for predicting
   morbidity in intensive care units (ICU). The aim of the present study
   was to critically review a number of approaches for developing models
   capable of estimating the probability of morbidity in ICU after heart
   surgery. The study is divided into two parts. In this first part,
   popular models used to estimate the probability of class membership are
   grouped into distinct categories according to their underlying
   mathematical principles. Modelling techniques and intrinsic strengths
   and weaknesses of each model are analysed and discussed from a
   theoretical point of view, in consideration of clinical applications.
   Methods: Models based on Bayes rule, k-nearest neighbour algorithm,
   logistic regression, scoring systems and artificial neural networks are
   investigated. Key issues for model design are described. The
   mathematical treatment of some aspects of model structure is also
   included for readers interested in developing models, though a full
   understanding of mathematical relationships is not necessary if the
   reader is only interested in perceiving the practical meaning of model
   assumptions, weaknesses and strengths from a user point of view.
   Results: Scoring systems are very attractive due to their simplicity of
   use, although this may undermine their predictive capacity. Logistic
   regression models are trustworthy tools, although they suffer from the
   principal limitations of most regression procedures. Bayesian models
   seem to be a good compromise between complexity and predictive
   performance, but model recalibration is generally necessary. k-nearest
   neighbour may be a valid non parametric technique, though computational
   cost and the need for large data storage are major weaknesses of this
   approach. Artificial neural networks have intrinsic advantages with
   respect to common statistical models, though the training process may be
   problematical.
   Conclusion: Knowledge of model assumptions and the theoretical strengths
   and weaknesses of different approaches are fundamental for designing
   models for estimating the probability of morbidity after heart surgery.
   However, a rational choice also requires evaluation and comparison of
   actual performances of locally-developed competitive models in the
   clinical scenario to obtain satisfactory agreement between local needs
   and model response. In the second part of this study the above
   predictive models will therefore be tested on real data acquired in a
   specialized ICU.
TC 5
ZB 1
Z8 0
ZS 0
Z9 5
SN 1472-6947
UT WOS:000252736400001
PM 18034872
ER

PT J
AU Cevenini, Gabriele
   Barbini, Emanuela
   Scolletta, Sabino
   Biagioli, Bonizella
   Giomarelli, Pierpaolo
   Barbini, Paolo
TI A comparative analysis of predictive models of morbidity in intensive
   care unit after cardiac surgery - Part II: an illustrative example
SO BMC MEDICAL INFORMATICS AND DECISION MAKING
VL 7
AR 36
DI 10.1186/1472-6947-7-36
PD NOV 22 2007
PY 2007
AB Background: Popular predictive models for estimating morbidity
   probability after heart surgery are compared critically in a unitary
   framework. The study is divided into two parts. In the first part
   modelling techniques and intrinsic strengths and weaknesses of different
   approaches were discussed from a theoretical point of view. In this
   second part the performances of the same models are evaluated in an
   illustrative example.
   Methods: Eight models were developed: Bayes linear and quadratic models,
   k-nearest neighbour model, logistic regression model, Higgins and direct
   scoring systems and two feed-forward artificial neural networks with one
   and two layers. Cardiovascular, respiratory, neurological, renal,
   infectious and hemorrhagic complications were defined as morbidity.
   Training and testing sets each of 545 cases were used. The optimal set
   of predictors was chosen among a collection of 78 preoperative,
   intraoperative and postoperative variables by a stepwise procedure.
   Discrimination and calibration were evaluated by the area under the
   receiver operating characteristic curve and Hosmer-Lemeshow
   goodness-of-fit test, respectively.
   Results: Scoring systems and the logistic regression model required the
   largest set of predictors, while Bayesian and k-nearest neighbour models
   were much more parsimonious. In testing data, all models showed
   acceptable discrimination capacities, however the Bayes quadratic model,
   using only three predictors, provided the best performance. All models
   showed satisfactory generalization ability: again the Bayes quadratic
   model exhibited the best generalization, while artificial neural
   networks and scoring systems gave the worst results. Finally, poor
   calibration was obtained when using scoring systems, k-nearest neighbour
   model and artificial neural networks, while Bayes (after recalibration)
   and logistic regression models gave adequate results.
   Conclusion: Although all the predictive models showed acceptable
   discrimination performance in the example considered, the Bayes and
   logistic regression models seemed better than the others, because they
   also had good generalization and calibration. The Bayes quadratic model
   seemed to be a convincing alternative to the much more usual Bayes
   linear and logistic regression models. It showed its capacity to
   identify a minimum core of predictors generally recognized as essential
   to pragmatically evaluate the risk of developing morbidity after heart
   surgery.
TC 6
ZB 0
Z8 0
ZS 0
Z9 6
SN 1472-6947
UT WOS:000253114600001
PM 18034873
ER

PT J
AU Surridge, Julia
   Segedin, Elizabeth R.
   Grant, Cameron C.
TI Pertussis requiring intensive care
SO ARCHIVES OF DISEASE IN CHILDHOOD
VL 92
IS 11
BP 970
EP 975
DI 10.1136/adc.2006.114082
PD NOV 2007
PY 2007
AB To describe children with pertussis who require intensive care. Design,
   setting and patients: An audit in Auckland, New Zealand, of pertussis
   admissions to the national paediatric intensive care unit ( PICU) from
   1991 to 2003. Results: 72 children, 97% of whom were,12 months old. The
   annual number of cases increased with time ( p = 0.04). Forty patients (
   56%) were coughing for less than 8 days before admission. Apnoea or
   paroxysmal cough was present in 33 ( 83%) of these children. Thirty five
   ( 49%) received assisted ventilation. Four died. 19% were readmitted to
   PICU. Those readmitted presented with more atypical disease and had a
   shorter first admission but longer total PICU admission ( 9 vs 5 days, p
   = 0.009). Of the 58 children from Auckland, nine either died ( three) or
   had subsequent respiratory or neurodevelopmental problems ( six). There
   was an increased risk ( relative risk, 95% CI) of death or disability
   associated with having a co- morbidity ( RR = 5.56, 1.50 to 8.15), an
   elevated lymphocyte count ( RR = 5.75, 1.54 to 13.65), presenting with
   seizures/ encephalopathy ( 4.87, 1.18 to 8.34) or shock ( 6.50, 1.89 to
   8.94), having a PIM score of 1% or more ( RR = 6.20, 1.22 to 21.72), any
   abnormal neurological signs ( RR = 9.65, 3.32 to 15.23) or being
   readmitted to PICU ( RR = 4.63, 1.44 to 8.82). Conclusions: Apnoea and
   paroxysmal cough are key symptoms of pertussis in those with shorter
   cough duration. Death or disability are frequent. Clinical factors
   define children at increased risk of these poor outcomes. Early
   discharge from PICU is associated with an increased risk of readmission
   and poor outcome.
TC 23
ZB 7
Z8 0
ZS 1
Z9 24
SN 0003-9888
UT WOS:000250313500009
PM 17611239
ER

PT J
AU Angel, Michael J.
   Bril, Vera
   Shannon, Patrick
   Herridge, Margaret S.
TI Neuromuscular function in survivors of the acute respiratory distress
   syndrome
SO CANADIAN JOURNAL OF NEUROLOGICAL SCIENCES
VL 34
IS 4
BP 427
EP 432
PD NOV 2007
PY 2007
AB Background. Survivors of acute respiratory distress syndrome (ARDS)
   report generalized weakness and reduced exercise tolerance up to two
   years following, discharge from the intensive care unit (ICU).
   Persistent neuromuscular complications of ARDS may contribute to the
   functional disability observed in these patients. Methods: Sixteen ARDS
   survivors underwent comprehensive neurological evaluation and
   standardized electrodiagnostic testing 6 to 24 months after ICU
   discharge. Four of these patients agreed to open muscle biopsy. Results:
   Seven of sixteen patients had clinically significant focal compressive
   mononeuropathies. Electrodiagnostic testing failed to reveal any changes
   attributable to critical illness polyneuropathy or myopathy. All four
   muscle biopsies were abnormal, and although the pathological features
   were structurally non-specific, the presence of an acquired myopathy
   remains possible. Four patients had persistent mixed sensory complaints
   but had normal electrodiagnostic evaluation. Conclusions: The high
   frequency of mononeuropathies highlights the need for vigilance in daily
   ICU care. The findings also suggest that complaints of weakness and
   reduced exercise capacity in ARDS survivors may be related to combined
   effects of compressive neuropathies and generalized longstanding
   structural changes in muscle and may support an organic basis for
   longterm functional disability.
TC 16
ZB 8
Z8 0
ZS 0
Z9 16
SN 0317-1671
UT WOS:000251126400006
PM 18062450
ER

PT J
AU Stevens, Robert D.
   Dowdy, David W.
   Michaels, Robert K.
   Mendez-Tellez, Pedro A.
   Pronovost, Peter J.
   Needham, Dale M.
TI Neuromuscular dysfunction acquired in critical illness: a systematic
   review
SO INTENSIVE CARE MEDICINE
VL 33
IS 11
BP 1876
EP 1891
DI 10.1007/s00134-007-0772-2
PD NOV 2007
PY 2007
AB Objective: To determine the prevalence, risk factors, and outcomes of
   critical illness neuromuscular abnormalities (CINMA). Design: Systematic
   review. Data sources and study selection: MEDLINE, EMBASE, CINAHL, and
   the Cochrane Library were searched for reports on adult ICU patients who
   were evaluated for CINMA clinically and electrophysiologically. Studies
   were included if they contained sufficient data to quantify the
   association between CINMA and relevant exposures and/or outcome
   variables.Measurement and results: CINMA was diagnosed in 655 of 1421
   [46% (95% confidence interval 43-49%)] adult ICU patients enrolled in 24
   studies, all with inclusion criteria of sepsis, multi-organ failure, or
   prolonged mechanical ventilation. Diagnostic criteria for CINMA were not
   uniform, and few reports unequivocally differentiated between
   polyneuropathy, myopathy, and mixed types of CINMA. The risk of CINMA
   was associated with hyperglycemia (and inversely associated with tight
   glycemic control), the systemic inflammatory response syndrome, sepsis,
   multiple organ dysfunction, renal replacement therapy, and catecholamine
   administration. Across studies, there was no consistent relationship
   between CINMA and patient age, gender, severity of illness, or use of
   glucocorticoids, neuromuscular blockers, aminoglycosides, or midazolam.
   Unadjusted mortality was not increased in the majority of patients with
   CINMA, but mechanical ventilation and ICU and hospital stay were
   prolonged.
   The risk of CINMA is nearly 50% in ICU patients with sepsis, multi-organ
   failure, or protracted mechanical ventilation. The association of CINMA
   with frequently cited CINMA risk factors (glucocorticoids, neuromuscular
   blockers) and with short-term survival is uncertain. Available data
   indicate glycemic control as a potential strategy to decrease CINMA
   risk.
TC 159
ZB 43
Z8 1
ZS 0
Z9 162
SN 0342-4642
UT WOS:000250407600005
PM 17639340
ER

PT J
AU Schuetz, Philipp
   Christ-Crain, Mirjam
   Muller, Beat
TI Biomarkers to improve diagnostic and prognostic accuracy in systemic
   infections
SO CURRENT OPINION IN CRITICAL CARE
VL 13
IS 5
BP 578
EP 585
DI 10.1097/MCC.0b013e3282c9ac2a
PD OCT 2007
PY 2007
AB Purpose of review
   We review the advantages and drawbacks of biomarkers in i the diagnostic
   and prognostic assessment of systemic infections.
   Recent findings
   Since the signs and symptoms of severe infections can be ambiguous,
   biomarkers provide a more reliable tool in ascertaining the presence of
   a relevant bacterial infection, its severity and treatment response.
   Procalcitonin and, to a lesser extent, C-reactive protein and
   interleukin-8 can improve the diagnostic assessment of infections and
   guide antibiotic therapy. Promising prognostic biomarkers include
   cortisol, proadrenomedullin, copeptin and natriuretic pepticles. The
   strengths and weaknesses of biomarkers must be recognized in order to
   use them rationally and safely. Cutoff ranges of biomarkers must be
   chosen according to the specific clinical context and they should be
   used as a complementary tool, to reinforce the clinical diagnostic
   workup. Biomarkers cannot determine the causative organisms and
   associated patterns of antibiotic susceptibility.
   Summary
   If used in the proper setting, serial measurements of diagnostic
   biomarkers may allow treatments to be adjusted at an early stage in
   patients with severe infections. This may involve either intensifying
   treatment when infection levels stay high or avoiding unnecessary
   prolonged courses of antibiotics when levels rapidly decrease, thereby
   improving the allocation of healthcare resources.
TC 49
ZB 22
Z8 4
ZS 1
Z9 52
SN 1070-5295
UT WOS:000249514000019
PM 17762239
ER

PT J
AU Kingsnorth, Shauna
   Healy, Helen
   Macarthur, Colin
TI Preparing for adulthood: A systematic review of life skill programs for
   youth with physical disabilities
SO JOURNAL OF ADOLESCENT HEALTH
VL 41
IS 4
BP 323
EP 332
DI 10.1016/j.jadohealth.2007.06.007
PD OCT 2007
PY 2007
AB Purpose: With advances in health care, an increasing number of youth
   with physical disabilities are surviving into adulthood. For youth to
   reach their full potential, a number of critical life skills must be
   learned. Specific learning opportunities are important as youth with
   physical disabilities may be limited in the life experiences necessary
   to acquire these skills. The aim of this study was to determine the
   effectiveness of life skill programs emphasizing independent functioning
   in preparation for adulthood among youth with physical disabilities.
   Methods: A comprehensive search of electronic databases from 1985 to
   2006 was undertaken to identify empirical studies examining the
   effectiveness of life skill programs for youth and young adults with
   acquired and congenital physical disabilities. Eligible studies were
   those with a comparison group and that targeted life skills (as defined
   by the World Health Organization).
   Results: Six studies met the inclusion criteria. All used a
   multi-component group intervention containing a real-world or
   role-playing experiential component. Five of the six studies
   demonstrated short-term improvements in targeted life skills.
   Conclusions are limited because of heterogeneity of interventions, skill
   focus, disabilities, and outcome measures with respect to the
   effectiveness of individual components of the programs.
   Conclusion: With more youth with physical disabilities surviving into
   adulthood, there is a need to ensure that they have the skills to
   successfully manage life demands. There are relatively few rigorously
   designed, published studies that have evaluated the effectiveness of
   life skill programs. Large-sample, randomized, controlled studies are
   needed. (C) 2007 Society for Adolescent Medicine. All rights reserved.
TC 15
ZB 1
Z8 0
ZS 0
Z9 15
SN 1054-139X
UT WOS:000250028200004
PM 17875457
ER

PT J
AU Finsterer, Josef
   Stoellberger, Claudia
   Sehnal, Ernst
   Valentin, Andreas
   Huber, Johannes
   Schmiedel, Janet
TI Apical ballooning (Takotsubo syndrome) in mitochondrial disorder during
   mechanical ventilation
SO JOURNAL OF CARDIOVASCULAR MEDICINE
VL 8
IS 10
BP 859
EP 863
PD OCT 2007
PY 2007
AB A 75-year-old woman developed muscle cramps, ptosis, fasciculations and
   slowly progressive weakness and wasting of all four limbs, starting 2.5
   years earlier. After exclusion of various differential diagnoses,
   including nonspecific granulomatous myositis, inclusion body myositis,
   and motor neuron disease, mitochondrial disorder was assumed. Muscle
   weakness progressed to respiratory insufficiency, requiring mechanical
   ventilation. Five days after intubation, she developed hypotension,
   torsades de pointes, ST-segment elevation, and negative T waves.
   Echocardiography revealed apical ballooning with akinesia of the left
   ventricular anteroseptal, apical, apicolateral and inferior segments.
   Coronary angiography was normal, and ventriculography confirmed apical
   hypokinesia and ballooning. Takotsubo syndrome was diagnosed, resolving
   completely within 7 weeks under bisoprolol. This case shows that
   Takotsubo syndrome occurs also in mitochondrial disorder and under
   mechanical ventilation, and may be triggered by stress from respiratory
   insufficiency, intubation, pain from tracheostomy, stress from
   mechanical ventilation, medication, or from the uncertain prognosis.
TC 15
ZB 3
Z8 0
ZS 0
Z9 15
SN 1558-2027
UT WOS:000250150200017
PM 17885529
ER

PT J
AU Usman, Shamim
   Butt, Zahid Ahmad
   Rattani, Salma
   Somani, Nazleen
TI Application of Neurobiologic Risk Score in a tertiary care hospital in
   Pakistan.
SO Journal of pediatric nursing
VL 22
IS 5
BP 419
EP 23
DI 10.1016/j.pedn.2007.08.014
PD 2007-Oct
PY 2007
AB Many health-care institutions are equipped to provide high-quality care
   to high-risk neonates. Purpose of this study was to assess validity of a
   tool using Neurobiologic Risk Score in our setting. This tool is
   applicable in our setting, although further studies should be initiated
   to determine development delay.
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 0882-5963
UT MEDLINE:17889736
PM 17889736
ER

PT J
AU Pollard, Clair
   Kennedy, Paul
TI A longitudinal analysis of emotional impact, coping strategies and
   post-traumatic psychological growth following spinal cord injury: a
   10-year review.
SO British journal of health psychology
VL 12
IS Pt 3
BP 347
EP 62
DI 10.1348/135910707X197046
PD 2007-Sep
PY 2007
AB OBJECTIVES: To review emotional impact, psychological growth and coping
   strategies in a sample of traumatic spinal cord injured people from 12
   weeks post-injury to 10 years post-hospital discharge.
   DESIGN: Longitudinal, multiple wave panel design.
   METHODS: Eighty-seven people with traumatically acquired spinal cord
   injuries were assessed at 12 weeks post-injury and followed up 10 years
   later (43% of the original sample responded). The Beck Depression
   Inventory, the State Anxiety Inventory, the COPE Scale, the Functional
   Independence Measure and the Social Support Inventory were completed on
   both occasions.
   RESULTS: Rates of anxiety and depression had changed little over the
   10-year period. Two-thirds of the sample showed no signs or symptoms of
   depression. Coping strategies remained relatively stable over time,
   statistically significant regression models (coping strategies at week
   12 post-injury) predicted one-third of the variance in depression at
   year 10. Rates of post-traumatic psychological growth were associated
   with higher levels of psychological distress.
   CONCLUSIONS: These results suggest that many people living with spinal
   cord injury manage the consequences of their disability without
   significant levels of psychopathology. However, the coping strategies
   they employ remain critical in accounting for this adjustment. The
   relationship between post-traumatic growth and psychological well-being
   was found to be complex, raising many questions for future research.
TC 66
ZB 18
Z8 2
ZS 0
Z9 68
SN 1359-107X
UT MEDLINE:17640451
PM 17640451
ER

PT J
AU De Jonghe, Bernard
   Bastuji-Garin, Sylvie
   Durand, Marie-Christine
   Malissin, Isabelle
   Rodrigues, Pablo
   Cerf, Charles
   Outin, Herve
   Sharshar, Tarek
TI Respiratory weakness is associated with limb weakness and delayed
   weaning in critical illness
SO CRITICAL CARE MEDICINE
VL 35
IS 9
BP 2007
EP 2015
DI 10.1097/01.ccm.0000281450.01881.d8
PD SEP 2007
PY 2007
AB Objective: Although critical illness neuromyopathy might interfere with
   weaning from mechanical ventilation, its respiratory component has not
   been investigated. We designed a study to assess the level of
   respiratory muscle weakness emerging during the intensive care unit stay
   in mechanically ventilated patients and to examine the correlation
   between respiratory and limb muscle strength and the specific
   contribution of respiratory weakness to delayed weaning.
   Design: Prospective observational study.
   Setting: Two medical, one surgical, and one medicosurgical intensive
   care units in two university hospitals and one university-affiliated
   hospital.
   Patients: A total of 116 consecutive patients were enrolled after >= 7
   days of mechanical ventilation.
   Interventions: None.
   Measurements and Main Results. Maximal inspiratory and expiratory
   pressures and vital capacity were measured via the tracheal tube on the
   first day of return to normal consciousness. Muscle strength was
   measured using the Medical Research Council score. After standardized
   weaning, successful extubation was defined as the day from which
   mechanical ventilatory support was no longer required within the next 15
   days. The median value (interquartile range) of maximal inspiratory
   pressure was 30 (20-40) cm H2O, maximal expiratory pressure was 30
   (20-50) cm H2O, and vital capacity was 11.1 (6.3-19.8) mL/kg. Maximal
   inspiratory pressure, maximal expiratory pressure, and vital capacity
   were significantly correlated with the Medical Research Council score.
   The median time (interquartile range) from awakening to successful
   extubation was 6 (1-17) days. Low maximal inspiratory pressure (hazard
   ratio, 1.86; 95% confidence interval, 1.07-3.23), maximal expiratory
   pressure (hazard ratio, 2.18; 95% confidence interval, 1.44-3.84), and
   Medical Research Council score (hazard ratio, 1.96; 95% confidence
   interval, 1.27-3.02) were independent predictors of delayed extubation.
   Septic shock before awakening was significantly associated with
   respiratory weakness (odds ratio, 3.17; 95% confidence interval,
   1.17-8.58).
   Conclusions. Respiratory and limb muscle strength are both altered after
   1 wk of mechanical ventilation. Respiratory muscle weakness is
   associated with delayed extubation and prolonged ventilation. In our
   study, septic shock is a contributor to respiratory weakness.
TC 108
ZB 29
Z8 0
ZS 4
Z9 111
SN 0090-3493
UT WOS:000249038700001
PM 17855814
ER

PT J
AU Vitacca, M
   Escarrabill, J
   Galavotti, G
   Vianello, A
   Prats, E
   Scala, R
   Peratoner, A
   Guffanti, E
   Maggi, L
   Barbano, L
   Balbi, B
TI Home mechanical ventilation patients: a retrospective survey to identify
   level of burden in real life.
SO Monaldi archives for chest disease = Archivio Monaldi per le malattie
   del torace / Fondazione clinica del lavoro, IRCCS [and] Istituto di
   clinica tisiologica e malattie apparato respiratorio, Universita di
   Napoli, Secondo ateneo
VL 67
IS 3
BP 142
EP 7
PD 2007-Sep
PY 2007
AB BACKGROUND AND AIM: Home care for patients under home mechanical
   ventilation (HMV) may cause dramatic physical and economic burden in
   addition to the burden of time on family/caregivers and health care
   service (HCS) with difficult resource allocation decision-making. Our
   aims were: 1. To identify conditions causing major care burden in
   managing HMV patients according to family and payer's perspectives
   related to characteristics of the disease, dependency and accessibility;
   and 2. To find, if any, differences among diseases.
   METHODS: A questionnaire was sent to eight pulmonary centres to identify
   factors connected with the greater care burden. Retrospective data of
   792 patients still alive and in HMV was reviewed.
   RESULTS: Compared to neuromuscular disorders (NM) and chest wall
   deformities, the COPD group have presented a statistically greater
   number of hospitalisations/yr (1.37 +/- 0.77), greater length of stay
   (13 +/- 10 days), higher number of outpatient visits/yr (2.55 +/- 1.73)
   or emergency room accesses/yr (0.74 +/- 1.08). Patients with NM diseases
   need more home care. The prevalence of one, two and three among five
   selected burden criteria (needs of MV > 12 hrs/day, tracheotomy, high
   dependency, distance from hospital, frequent hospitalisations) was
   respectively 19%, 30% and 33% of the cases; the NM was the group most
   represented.
   CONCLUSIONS: In HMV patients: 1. underlying disease, level of their
   dependency, hours spent under MV, presence of tracheotomy, home distance
   from hospital, hospital accesses are the causes of major care burden;
   and 2. as a novelty we have demonstrated that more than fifty percent of
   them present two or three contemporaneous criteria selected as care
   burden, being NM and COPD patients the most representative group
   necessitating of family's and HCS's care respectively.
TC 15
ZB 2
Z8 0
ZS 0
Z9 15
SN 1122-0643
UT MEDLINE:18018753
PM 18018753
ER

PT J
AU Dreher, Michael
   Rauter, Isabelle
   Storre, Jan H.
   Geiseler, Jens
   Windisch, Wolfram
TI When should home mechanical ventilation be started in patients with
   different neuromuscular disorders?
SO RESPIROLOGY
VL 12
IS 5
BP 749
EP 753
DI 10.1111/j.1440-1843.2007.01116.x
PD SEP 2007
PY 2007
AB Background and Objectives: Current international consensus guidelines
   identify a number of indicators for the establishment of home mechanical
   ventilation (HMV) for patients with neuromuscular diseases but do not
   address the possible clinical differences between each of the underlying
   disorders. This study assessed the differences in the physiological
   parameters of patients with neuromuscular disease commenced on HMV for
   the treatment of symptomatic chronic hypercapnic respiratory failure.
   Methods: Patients commenced on HMV for the treatment of symptomatic
   chronic hypercapnic respiratory failure over a 9-year period were
   studied. Physiological parameters at the time of referral for HMV,
   impact of HMV and survival were analysed.
   Results: The study recruited 66 patients with neuromuscular disease.
   Thirty-one patients had rapidly progressive disease: amyotrophic lateral
   sclerosis (ALS, n = 19), Duchenne muscular dystrophy (DMD, n = 12) and
   35 patients had slowly progressive disease. Mean FVC at HMV onset was
   40.3 +/- 17.5% predicted in all patients, but was > 50% predicted in
   eight patients (12%). ALS patients were more hypercapnic (P = 0.03) and
   more hypoxaemic (P < 0.001), but had better FEV1 at HMV onset, compared
   with DMD patients (P = 0.005). Maximal inspiratory mouth occlusion
   pressure (PImax) was 3.0 +/- 1.6 kPa in all patients, but values were
   lower compared with international consensus guidelines (5.88 kPa).
   Median survival in DMD, slowly progressive diseases and ALS was 132, 82
   and 16 months, respectively (P < 0.001).
   Conclusions: Blood gases and lung function parameters vary substantially
   between patients with differing underlying neuromuscular disorders when
   commenced on HMV for the treatment of symptomatic chronic hypercapnic
   respiratory failure. In contrast, PImax is equally reduced in all
   patients and more severely reduced compared with consensus guidelines.
   The specific underlying neuromuscular disease has a major impact on
   outcome. Specific selection criteria are needed for the use of HMV in
   the different diseases that comprise neuromuscular disorders.
TC 18
ZB 5
Z8 0
ZS 0
Z9 18
SN 1323-7799
UT WOS:000249493600020
PM 17875066
ER

PT J
AU Gottlieb, Sami L.
   Kretsinger, Katrina
   Tarkhashvili, Nato
   Chakvetadze, Neli
   Chokheli, Maia
   Chubinidze, Marina
   Hoekstra, R. Michael
   Jhorjholiani, Ekaterina
   Mirtskhulava, Merab
   Moistsrapishvili, Maia
   Sikharulidze, Merab
   Zardiashvili, Tamar
   Imnadze, Paata
   Sobel, Jeremy
TI Long-term outcomes of 217 botulism cases in the Republic of Georgia
SO CLINICAL INFECTIOUS DISEASES
VL 45
IS 2
BP 174
EP 180
DI 10.1086/518890
PD JUL 15 2007
PY 2007
AB Background. The acute paralytic syndrome of botulism has been
   well-described; however, little is known about its long-term
   consequences.
   Methods. We conducted a case-control study in the Republic of Georgia to
   evaluate the health of patients >= 6 months after they had experienced
   an episode of botulism. Case patients were selected on the basis of who
   had had a clinical diagnosis of foodborne botulism reported to the
   national surveillance system from 1998 through 2003. Three control
   subjects were randomly selected from each patient's community.
   Results. We located 217 patients who had had botulism from surveillance
   records, with a median time since onset of illness of 4.3 years. The
   median age was 37 years, and 49% of the patients were female, similar to
   the control subjects. Most of the patients ( 68%) had acquired botulism
   from home-conserved vegetables ( probably containing toxin type B), 15%
   had been hospitalized for 11 month, and 25% had required mechanical
   ventilation. Six patients died. Of the remaining 211 patients, 68%
   reported having worse health at the time of the interview than 6 years
   before the interview, compared with 17% of 656 control subjects (
   matched odds ratio, 17.6; 95% confidence interval, 10.9-28.4). Overall,
   49% of the patients reported their current health as "fair" or "poor,"
   versus 25% of the control subjects ( odds ratio, 5.0; 95% confidence
   interval, 3.2-7.6). Patients were more likely than control subjects to
   report fatigue, weakness, dizziness, dry mouth, and difficulty lifting
   objects (P < .05, for each). Patients were more likely than control
   subjects to report difficulty breathing caused by moderate exertion (P <
   .001) but not by minimal exertion or at rest. Patients were also more
   likely to report being limited in vigorous activities, walking 3 blocks,
   and climbing 3 flights of stairs (P < .05, for each). Finally, patients
   reported feeling significantly worse than control subjects for 6 of 11
   questions regarding psychosocial well-being (P < .05, for each). In a
   multivariable model involving patients who had had botulism, mechanical
   ventilation during acute illness, older age, and region of residence
   independently predicted worse health.
   Conclusions. Several years after acute botulism, patients reported
   significant health, functional, and psychosocial limitations that are
   likely to be consequences of the illness.
TC 10
ZB 6
Z8 0
ZS 0
Z9 10
SN 1058-4838
UT WOS:000247343900005
PM 17578775
ER

PT J
AU Almeida-Junior, Armando A.
   Nolasco da Silva, Marcos T.
   Almeida, Celize C. B.
   Ribeiro, Jose D.
TI Relationship between physiologic deadspace/tidal volume ratio and gas
   exchange in infants with acute bronchiolitis on invasive mechanical
   ventilation
SO PEDIATRIC CRITICAL CARE MEDICINE
VL 8
IS 4
BP 372
EP 377
DI 10.1097/01.PCC.0000269389.51189.A8
PD JUL 2007
PY 2007
AB Objectives. To evaluate the association between deadspace/ tidal volume
   ratio (V-D/V-T) and gas exchange variables: PaO2, PacO(2), PaO2/FIO2,
   arterial/alveolar oxygen tension ratio (PaO2/PAO(2)), alveolar-arterial
   oxygen tension difference/arterial oxygen tension ratio
   (P(A-a)O-2/PaO2), carbon dioxide production (VCO2), ventilation index
   ([PaCO2 x peak inspiratory pressure x mechanical respiratory
   rate]/1000), and oxygenation index ([mean airway pressure x FIO2 x
   100]/PaO2), all measured at an early stage in children with obstructive
   acute respiratory failure.
   Design: Prospective, cross-sectional, observational study.
   Setting: Pediatric intensive care unit, university hospital.
   Patients: Twenty-nine infants with acute bronchiolitis, defined
   according to clinical and radiologic criteria, Children with chronic
   pulmonary disease, neuromuscular disease, congenital cardiopathies, or
   hemodynamic instability were excluded.
   Interventions: Measurements were made between 24 and 72 hrs of
   mechanical ventilation using volumetric capnography and arterial blood
   gas analysis.
   Measurements and Main Results: The following variables significantly
   correlated with V-D/V-T, calculated using Spearman's correlation
   coefficient (r(s)): PaO2 (r(s) = -0.63, p < .001), PaO2/FIO2 (r(s) =
   -0.56, p = .002), PaO2/PAO(2) (r(s) = -0.46, p = .012), P(A-a)O-2/PaO2
   (r(s) = 0.46, p =.012), PaCO2 (r(s) = 0.51, p = .005), VCO2 (r(s) =
   -0,62, p < .01), oxygenation index (r(s) = 0.48, p = .009), and
   ventilation index (r(s) = -0.53, p =.003). A statistically significant
   association was found between an increase in V-D/V-T and severity of
   lung injury, defined as PaO2/FIO2 < 200 (p =.03, Mann-Whitney).
   Conclusions: In the study population, V-D/V-T not only reflected
   ventilatory disorders, as is well recognized, but also was associated
   with disturbances of oxygenation. These results warrant further
   evaluation of the usefulness of serial measurement of V-D/V-T as a
   marker of disease severity in severe acute bronchiolitis and other
   causes of respiratory failure.
TC 7
ZB 0
Z8 0
ZS 1
Z9 7
SN 1529-7535
UT WOS:000248062800010
PM 17545938
ER

PT J
AU Wilkesmann, Anja
   Ammann, Roland A.
   Schildgen, Oliver
   Eis-Huebinger, Anna M.
   Mueller, Andreas
   Seidenberg, Juergen
   Stephan, Volker
   Rieger, Christian
   Herting, Egbert
   Wygold, Thorsten
   Hornschuh, Friedeman
   Groothuis, Jessie R.
   Simon, Arne
CA DSM RSV Ped Study Grp
TI Hospitalized children with respiratory syncytial virus infection and
   neuromuscular impairment face an increased risk of a complicated course
SO PEDIATRIC INFECTIOUS DISEASE JOURNAL
VL 26
IS 6
BP 485
EP 491
DI 10.1097/INF.0b013e31805d01e3
PD JUN 2007
PY 2007
AB Background: Respiratory syncytial virus (RSV) infection is an important
   cause of viral respiratory tract infection in children. In contrast to
   other confirmed risk factors that predispose to a higher morbidity and
   mortality, the particular risk of a preexisting neuromuscular impairment
   (NMI) in hospitalized children with RSV infection has not been
   prospectively studied in a multicenter trial.
   Methods: The DMS RSV Paed database was designed for the prospective
   multicenter documentation and analysis of all clinically relevant
   aspects of the management of inpatients with RSV infection. Patients
   with clinically relevant NMI were identified according to the specific
   comments of the attending physicians and compared with those without
   NMI.
   Results: This study covers 6 consecutive seasons; the surveillance took
   place in 14 pediatric hospitals in Germany from 1999 to 2005. In total,
   1568 RSV infections were prospectively documented in 1541 pediatric
   patients. Of these, 73 (4.7%) patients displayed a clinically relevant
   NMI; 41 (56%) NMI patients had at least I additional risk factor for a
   severe course of the infection (multiple risk factors in some patients;
   prematurity in 30, congenital heart disease in 19, chronic lung disease
   6 and immunodeficiency in 8). Median age at diagnosis was higher in NMI
   patients (14 vs. 5 months); NMI patients had a greater risk of seizures
   (15.1% vs. 1.6%), and a higher proportion in the NMI group had to be
   mechanically ventilated (9.6% vs. 1.9%). Eventually, the attributable
   mortality was significantly higher in the NMI group (5.5% vs. 0.2%; P <
   0.001 for all). Multivariate logistic regression confirmed that NMI was
   independently associated with pediatric intensive care unit (PICU)
   admission (OR, 4.94; 95% Cl, 2.69-8.94; P < 0.001] and mechanical
   ventilation (OR, 3.85; 95% CI, 1.28-10.22; P 0.017).
   Conclusion: This is the first prospective multicenter study confirming
   the hypothesis that children with clinically relevant NMI face an
   increased risk for severe RSV-disease. It seems reasonable to include
   NMI as a cofactor into the decision algorithm of passive immunization.
RI Schildgen, Oliver/D-5327-2014
OI Schildgen, Oliver/0000-0003-4297-9627
TC 56
ZB 31
Z8 0
ZS 0
Z9 58
SN 0891-3668
UT WOS:000246931600006
PM 17529864
ER

PT J
AU Graham, Robert J.
   Fleegler, Eric W.
   Robinson, Walter M.
TI Chronic ventilator need in the community: A 2005 pediatric census of
   Massachusetts
SO PEDIATRICS
VL 119
IS 6
BP E1280
EP E1287
DI 10.1542/peds.2006-2471
PD JUN 2007
PY 2007
AB Objectives. The purpose of this study was to describe the population of
   children with chronic mechanical ventilation in Massachusetts and their
   patterns of medical care.
   Patients and Methods. Investigators surveyed all of the Massachusetts
   home ventilator clinics, pediatric pulmonary services, hospital-based
   pediatric services for special health care needs, insurers, home care
   vendors, nursing agencies, the Massachusetts Department of Public
   Health, selected individual providers, and rehabilitation and long-term
   care facilities providing services to children with chronic respiratory
   support needs. Support was defined as daily use of noninvasive,
   negative-pressure, or invasive/transtracheal ventilators. Subsequent
   matching of demographic data, including date of birth, zip code, and
   gender supported maximal census yield without duplications. Geographic
   information systems were used to create distribution maps and estimate
   distances between children with chronic mechanical ventilator needs and
   key resources.
   Results. A total of 197 children were identified as requiring chronic
   mechanical respiratory support in Massachusetts in 2005, which was a
   nearly threefold increase in this population in the 15-year interval
   since the last census. Congenital or perinatal-acquired neurologic or
   neuromuscular disorders constituted the majority of primary diagnoses (n
   = 107 [54%]). Chronic lung disease attributed to prematurity represented
   only 7% of the sample.
   Conclusions. Children receiving chronic mechanical respiratory support
   are a growing population. The shift in underlying diagnoses from
   pulmonary disease to neurogenic respiratory insufficiency has
   implications for hospital and community-based providers from all
   disciplines in extending services to the home setting. Barriers
   encountered when performing this study, however, reflect an overall lack
   of coordination among the many individuals and agencies involved in
   their care. Coordinated and centralized care efforts require a clear and
   managed flow of information; census reports such as this one are only
   the beginning. Direct needs
TC 33
ZB 11
Z8 0
ZS 2
Z9 35
SN 0031-4005
UT WOS:000246948900070
PM 17485451
ER

PT J
AU Bolton, Charles F.
   Young, G. Bryan
TI Managing the nervous system effects of sepsis
SO CHEST
VL 131
IS 5
BP 1273
EP 1274
DI 10.1378/chest.07-0367
PD MAY 2007
PY 2007
TC 3
ZB 1
Z8 0
ZS 0
Z9 3
SN 0012-3692
UT WOS:000246544700001
PM 17494774
ER

PT J
AU Schweickert, William D.
   Hall, Jesse
TI ICU-acquired weakness
SO CHEST
VL 131
IS 5
BP 1541
EP 1549
DI 10.1378/chest.06-2065
PD MAY 2007
PY 2007
AB Observational studies of patients receiving prolonged mechanical
   ventilation and other forms of critical care support have determined
   acquired neuromuscular disorders to be extremely common. Early studies
   used electrophysiologic investigations to diagnose critical illness
   polyneuropathy (CIP) and muscle biopsy to confirm critical illness
   myopathy (CIM). More recent approaches seek to obviate these invasive
   techniques and build on a standardized bedside neuromuscular examination
   to identify patients with acquired weakness syndromes. Serial
   examination in the alert patient may serve as a reasonable
   prognosticator for most patients. The importance of ICU-acquired
   weakness syndromes is supported by the observation that muscle wasting
   and weakness are among the most prominent long-term complications of
   survivors of ARDS. In addition, a strong association appears to exist
   between acquired weakness and protracted ventilator dependence, an
   important determinant of ICU length of stay. Multivariate analysis has
   identified several risk factors associated with increased incidence for
   ICU-acquired weakness, including severe systemic inflammation,
   medications (specifically, corticosteroids and neuromuscular blocking
   agents), glycemic control, and immobility. We advocate an approach to
   this common syndrome that identifies risk factors early in the hope of
   minimizing their impact.
TC 112
ZB 26
Z8 3
ZS 5
Z9 122
SN 0012-3692
UT WOS:000246544700041
PM 17494803
ER

PT J
AU Deep, Akash
   De Munter, Claudine
   Desai, Ajay
TI Negative pressure ventilation in pediatric critical care setting
SO INDIAN JOURNAL OF PEDIATRICS
VL 74
IS 5
BP 483
EP 488
DI 10.1007/s12098-007-0082-2
PD MAY 2007
PY 2007
AB Invasive ventilation is associated with both pulmonary and non-pulmonary
   complications. There has been a renewed interest in the use of negative
   pressure ventilation (NPV) for various medical conditions to minimise
   the complications associated with positive pressure ventilation. The
   routine use of NPV in an ICU setting still requires further studies and
   research. In this article, the authors review the clinical applications
   of NPV together with associated risks and limitations. Case reports of
   patients with cardiac, neuromuscular, and respiratory diseases managed
   with NPV on our unit are described. NPV improved the clinical condition
   in each of these patients and decreased the requirement for invasive
   therapy.
TC 1
ZB 0
Z8 0
ZS 0
Z9 1
SN 0019-5456
UT WOS:000249505100009
PM 17526961
ER

PT J
AU Gaspari, Romolo J.
   Paydarfar, David
TI Pathophysiology of respiratory failure following acute dichlorvos
   poisoning in a rodent model
SO NEUROTOXICOLOGY
VL 28
IS 3
BP 664
EP 671
DI 10.1016/j.neuro.2007.02.002
PD MAY 2007
PY 2007
AB Organophosphate (OP) poisoning causes a cholinergic crisis with a wide
   range of clinical effects including central apnea, pulmonary
   bronchoconstriction and secretions, seizures, and muscle weakness. The
   morbidity and mortality from acute OP poisoning is attributed to 14
   respiratory failure but the relative contributions of the central and
   peripheral effects in producing collapse of the respiratory system are
   unclear. In this study we used a novel adult rat model of acute OP
   poisoning to analyze the pathophysiology of acute OP poisoning. We found
   that poisoning caused rapidly lethal central apnea. In animals sustained
   with mechanical ventilation, we found that following central apnea there
   ensued progressive pulmonary insufficiency that was variable in timing
   and severity. Our findings support the hypothesis that OP poisoning in
   this animal model causes a sequential "two hit" insult, with rapid
   central apnea followed by delayed impairment of pulmonary gas exchange
   with prominent airway secretions. (C) 2007 Elsevier Inc. All rights
   reserved.
RI Gaspari, Romolo/I-4649-2014
OI Gaspari, Romolo/0000-0002-8411-0308
TC 16
ZB 14
Z8 3
ZS 0
Z9 20
SN 0161-813X
UT WOS:000247808700026
PM 17350689
ER

PT J
AU Ortiz-Corredor, F.
   Pena-Preciado, M.
TI Use of immunoglobulin in severe childhood Guillain-Barre syndrome
SO ACTA NEUROLOGICA SCANDINAVICA
VL 115
IS 4
BP 289
EP 293
DI 10.1111/j.1600-0404.2006.00766.x
PD APR 2007
PY 2007
AB Objectives- To compare the clinical results in children with
   Guillain-Barre syndrome (GBS) admitted to the intensive care unit.
   Patients treated with intravenous immunoglobulin (IVIg) were compared
   with patients admitted before the immunoglobulin treatment was
   introduced. Design- Study of historical cohorts. Methods- The outcome of
   the children who did not receive IVIg before 1993 was compared with
   those children who received immunoglobulin treatment from this year
   until 2002. The days of ventilatory support and the time it took to
   reach state III on the GBS disability scale were used as measures of
   outcome. Age, muscular strength, cranial nerve palsy and the
   electrophysiological classification were the independent variables.
   Results- In all, 48 of 96 children were classified - 18 patients as
   axonal motor acute neuropathy (AMAN) and 30 patients as axonal
   inflammatory demyelinating polyneuropathy (AIDP). For both groups the
   analysis showed similar results behavior when comparing the outcome of
   patients with or without immunoglobulin treatment. A high proportion of
   patients with unexcitable nerves was found in the group with
   immunoglobulin treatment. Quadriplegia and the presence of unexcitable
   motor nerves were associated with a longer period of recovery.
   Conclusions- Immunoglobulin did not change the history of the illness as
   far as the time of ventilatory support in AMAN and AIDP groups is
   concerned and the time to reach state III on the GBS disability scale.
TC 2
ZB 1
Z8 0
ZS 0
Z9 2
SN 0001-6314
UT WOS:000245054800013
PM 17376129
ER

PT J
AU Koh, Younsuck
TI Ventilatory management in patients with chronic airflow obstruction
SO CRITICAL CARE CLINICS
VL 23
IS 2
BP 169
EP +
DI 10.1016/j.ccc.2006.12.008
PD APR 2007
PY 2007
AB Mechanical ventilatory support allows patients who have CAO to gain time
   for pharmacologic treatment to work and to avoid and/or recover from
   respiratory muscle fatigue. The cornerstone to avoiding associated
   morbidity with mechanical ventilation in these patients is to prevent
   dynamic hyperinflation of the lung by limiting minute ventilation and
   maximizing time for expiration and by inducing synchronization between
   the patient and mechanical ventilator. When mechanical ventilation is
   necessary NPPV should be considered first, whenever possible, in these
   patients. Patients who have CAO requiring mechanical ventilatory support
   have an increased risk of death following such an event. Therefore,
   careful followup is needed after hospital discharge.
TC 3
ZB 0
Z8 0
ZS 0
Z9 3
SN 0749-0704
UT WOS:000245570300006
PM 17368164
ER

PT J
AU Barreiro, Timothy J.
   Gemmel, David J.
TI Noninvasive ventilation
SO CRITICAL CARE CLINICS
VL 23
IS 2
BP 201
EP +
DI 10.1016/j.ccc.2006.11.015
PD APR 2007
PY 2007
AB Noninvasive positive-pressure ventilation (NPPV) is the delivery of
   mechanical-assisted breathing without placement of an artificial airway
   such as an endotracheal tube or tracheostomy. During the first half of
   20th century, negative-pressure ventilation (iron lung) provided
   mechanical ventilatory assistance. By the 1960s, however, invasive (ie,
   by means of an endotracheal tube) positive-pressure ventilation
   superseded negative-pressure ventilation as the primarily mode of
   support for ICU patients because of its superior delivery of support and
   better airway protection. Over the past decade, the use of NPPV has been
   integrated into the treatment of many medical diseases, largely because
   the development of nasal ventilation. Nasal ventilation has the
   potential benefit of providing ventilatory assistance with greater
   convenience, comfort, safety, and less cost than invasive ventilation.
   NPPV is delivered by a tightly fitted mask or helmet that covers the
   nares, face, or head. NPPV is used in various clinical settings and is
   beneficial in many acute medical situations. This article explores the
   trends regarding the use of non-invasive ventilation. It also provides a
   current perspective on applications in patients with acute and chronic
   respiratory failure, neuromuscular disease, congestive heart failure,
   and sleep apnea. Additionally, it discusses the general guidelines for
   application, monitoring, and avoidance of complications for NPPV.
TC 11
ZB 4
Z8 1
ZS 0
Z9 12
SN 0749-0704
UT WOS:000245570300008
PM 17368166
ER

PT J
AU Markusohn, Erez
   Roguin, Ariel
   Sebbag, Anat
   Aronson, Doren
   Dragu, Robert
   Amikam, Shlomo
   Boulus, Monter
   Grenadier, Ehud
   Kerner, Arthur
   Nikolsky, Eugenia
   Markiewicz, Walter
   Hammerman, Haim
   Kapeliovich, Michael
TI Primary percutaneous coronary intervention after out-of-hospital cardiac
   arrest: Patients and outcomes
SO ISRAEL MEDICAL ASSOCIATION JOURNAL
VL 9
IS 4
BP 257
EP 259
PD APR 2007
PY 2007
AB Background: The decision to perform primary percutaneous coronary
   intervention in unconscious patients resuscitated after out-of-hospital
   cardiac arrest is challenging because of uncertainty regarding the
   prognosis of recovery of anoxic brain damage and difficulties in
   interpreting ST segment deviations. In ST elevation myocardial
   infarction patients after OHCA, primary PCI is generally considered the
   only option for reperfusion. There are few published studies and no
   randomized trial has yet been performed in this specific group of
   patients.
   Objectives: To define the demographic, clinical and angiographic
   characteristics, and the prognosis of STEMI patients undergoing primary
   PCI after out-of-hospital cardiac arrest.
   Methods: We performed a retrospective analysis of medical records and
   used the prospectively acquired information from the Rambam Primary
   Angioplasty Registry (PARR) and the Rambam Intensive Cardiac Care
   (RICCa) databases.
   Results: During the period March 1998 to June 2006, 25 STEMI patients
   (21 men and 4 women, mean age 56 11 years) after OHCA were treated with
   primary PCI. The location of myocardial infarction was anterior in 13
   patients (52%) and non-anterior in 12 (48%). Cardiac arrest was
   witnessed in 23 patients (92%), but bystander resuscitation was
   performed in only 2 patients (8%). Eighteen patients (72%) were
   unconscious on admission, and Glasgow Coma Scale > 5 was noted in 2
   patients (8%). Candiogenic shock on admission was diagnosed in 4
   patients (16%). PCI procedure was successful in 22 patients (88%).
   In-hospital, 30 day, 6 month and I year survival was 76%, 76%, 76% and
   72%, respectively. In-hospital, 30 day, 6 month and 1 year survival
   without severe neurological disability was 68%, 68%, 68% and 64%,
   respectively.
   Conclusions: In a selected group of STEM patients after out-of-hospital
   cardiac arrest, primary PCI can be performed with a high success rate
   and provides reasonably good results in terms of short and longer term
   survival.
RI Aronson, Doron/F-3390-2010
TC 16
ZB 3
Z8 0
ZS 0
Z9 17
SN 1565-1088
UT WOS:000246124900009
ER

PT J
AU Ryan, Monique M.
   Kilham, Henry
   Jacobe, Stephen
   Tobin, Bernadette
   Isaacs, David
TI Spinal muscular atrophy type 1: Is long-term mechanical ventilation
   ethical?
SO JOURNAL OF PAEDIATRICS AND CHILD HEALTH
VL 43
IS 4
BP 237
EP 242
DI 10.1111/j.1440-1754.2007.01052.x
PD APR 2007
PY 2007
AB We present a baby with spinal muscular atrophy type 1, an inherited
   disorder causing progressive weakness, leading to complete paralysis of
   respiratory, facial and limb muscles. Without intervention, death occurs
   in infancy due to respiratory failure. Mechanical ventilatory support
   can prolong life, but the child's quality of life is highly debatable.
   We discuss the appropriateness of initiating and continuing intensive
   care for this child and others in a similar position.
TC 18
ZB 3
Z8 0
ZS 0
Z9 18
SN 1034-4810
UT WOS:000245411800006
PM 17444824
ER

PT J
AU Doyle, Lex W.
   Davis, Peter G.
   Morley, Colin J.
   McPhee, Andy
   Carlin, John B.
CA DART Study Investigators
TI Outcome at 2 years of age of infants from the DART study: a multicenter,
   international, randomized, controlled trial of low-dose dexamethasone
SO PEDIATRICS
VL 119
IS 4
BP 716
EP 721
DI 10.1542/peds.2006-2806
PD APR 2007
PY 2007
AB OBJECTIVE. Low-dose dexamethasone facilitates extubation in chronically
   ventilator-dependent infants with no obvious short-term complications.
   The objective of this study was to determine the long-term effects of
   low-dose dexamethasone.
   METHODS. Very preterm (< 28 weeks' gestation) or extremely low birth
   weight (birth weight < 1000 g) infants who were ventilator dependent
   after the first week of life for whom clinicians considered
   corticosteroids were indicated were eligible. After informed consent,
   infants were randomly assigned to masked dexamethasone (0.89 mg/kg over
   10 days) or saline placebo. Survivors were assessed at 2 years'
   corrected age by staff blinded to treatment group allocation to
   determine neurosensory outcome, growth, and health.
   RESULTS. The trial was abandoned well short of its target sample size
   because of recruitment difficulties. Seventy infants were recruited from
   11 centers, 35 in each group: 59 survived to 2 years of age, and 58
   (98%) were assessed at follow-up, but data for cerebral palsy were
   available for only 56 survivors. There was little evidence for a
   difference in the major end point, the rate of the combined outcome of
   death, or major disability at 2 years of age ( dexamethasone group: 46%;
   controls: 43%). Rates of mortality before follow-up (11% vs 20%), major
   disability (41% vs 31%), cerebral palsy (14% vs 22%), or of the combined
   outcomes of death or cerebral palsy (23% vs 37%) were not substantially
   different between the groups. There were no obvious effects of low-dose
   dexamethasone on growth or readmissions to hospital after discharge.
   CONCLUSIONS. Although this trial was not able to provide definitive
   evidence on the long-term effects of low-dose dexamethasone after the
   first week of life in chronically ventilator-dependent infants, our data
   indicate no strong association with long-term morbidity.
RI Carlin, John/B-3492-2012
OI Carlin, John/0000-0002-2694-9463
TC 44
ZB 23
Z8 1
ZS 0
Z9 44
SN 0031-4005
UT WOS:000245406200033
PM 17403842
ER

PT J
AU Marcusohn, Erez
   Roguin, Ariel
   Sebbag, Anat
   Aronson, Doron
   Dragu, Robert
   Amikam, Shlomo
   Boulus, Monter
   Grenadier, Ehud
   Kerner, Arthur
   Nikolsky, Eugenia
   Markiewicz, Walter
   Hammerman, Haim
   Kapeliovich, Michael
TI Primary percutaneous coronary intervention after out-of-hospital cardiac
   arrest: patients and outcomes.
SO The Israel Medical Association journal : IMAJ
VL 9
IS 4
BP 257
EP 9
PD 2007-Apr
PY 2007
AB BACKGROUND: The decision to perform primary percutaneous coronary
   intervention in unconscious patients resuscitated after out-of-hospital
   cardiac arrest is challenging because of uncertainty regarding the
   prognosis of recovery of anoxic brain damage and difficulties in
   interpreting ST segment deviations. In ST elevation myocardial
   infarction patients after OHCA, primary PCI is generally considered the
   only option for reperfusion. There are few published studies and no
   randomized trial has yet been performed in this specific group of
   patients.
   OBJECTIVES: To define the demographic, clinical and angiographic
   characteristics, and the prognosis of STEMI patients undergoing primary
   PCI after out-of-hospital cardiac arrest.
   METHODS: We performed a retrospective analysis of medical records and
   used the prospectively acquired information from the Rambam Primary
   Angioplasty Registry (PARR) and the Rambam Intensive Cardiac Care
   (RICCa) databases.
   RESULTS: During the period March 1998 to June 2006, 25 STEMI patients
   (21 men and 4 women, mean age 56 +/- 11years) after OHCA were treated
   with primary PCI. The location of myocardial infarction was anterior in
   13 patients (52%) and non-anterior in 12 (48%). Cardiac arrest was
   witnessed in 23 patients (92%), but bystander resuscitation was
   performed in only 2 patients (8%). Eighteen patients (72%) were
   unconscious on admission, and Glasgow Coma Scale > 5 was noted in 2
   patients (8%). Cardiogenic shock on admission was diagnosed in 4
   patients (16%). PCI procedure was successful in 22 patients (88%).
   In-hospital, 30 day, 6 month and 1 year survival was 76%, 76%, 76% and
   72%, respectively. In-hospital, 30 day, 6 month and 1 year survival
   without severe neurological disability was 68%, 68%, 68% and 64%,
   respectively.
   CONCLUSIONS: In a selected group of STEMI patients after out-of-hospital
   cardiac arrest, primary PCI can be performed with a high success rate
   and provides reasonably good results in terms of short and longer term
   survival.
TC 17
ZB 6
Z8 2
ZS 1
Z9 19
SN 1565-1088
UT MEDLINE:17491217
PM 17491217
ER

PT J
AU De Jonghe, Bernard
   Finfer, Simon
TI Critical illness neuromyopathy - From risk factors to prevention
SO AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE
VL 175
IS 5
BP 424
EP 425
DI 10.1164/rccm.200612-1762ED
PD MAR 1 2007
PY 2007
TC 6
ZB 0
Z8 0
ZS 0
Z9 6
SN 1073-449X
UT WOS:000244499800002
PM 17303895
ER

PT J
AU Hermans, Greet
   Wilmer, Alexander
   Meersseman, Wouter
   Milants, Ilse
   Wouters, Pieter J.
   Bobbaers, Herman
   Bruyninckx, Frans
   Van den Berghe, Greet
TI Impact of intensive insulin therapy on neuromuscular complications and
   ventilator dependency in the medical intensive care unit
SO AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE
VL 175
IS 5
BP 480
EP 489
DI 10.1164/rccm.200605-665OC
PD MAR 1 2007
PY 2007
AB Rationale: Critical illness polyneuropathy/myopathy causes limb and
   respiratory muscle weakness, prolongs mechanical ventilation, and
   extends hospitalization of intensive care patients. Besides controlling
   risk factors, no specific prevention or treatment exists. Recently,
   intensive insulin therapy prevented critical illness polyneuropathy in a
   surgical intensive care unit.
   Objectives: To investigate the impact of intensive insulin therapy on
   polyneuropathy/myopathy and treatment with prolonged mechanical
   ventilation in medical patients in the intensive care unit for at least
   7 days.
   Methods: This was a prospectively planned subanalysis of a randomized
   controlled trial evaluating the effect of intensive insulin versus
   conventional therapy on morbidity and mortality in critically ill
   medical patients. All patients who were still in intensive care on Day 7
   were screened weekly by electroneuromyography. The effect of intensive
   insulin therapy on critical illness polyneuropathy/myopathy and the
   relationship with duration of mechanical ventilation were assessed.
   Measurements and Main Results: Independent of risk factors, intensive
   insulin therapy reduced incidence of critical illness
   polyneuropathy/myopathy (107/212 [50.5%] to 81/208 [38.9%], p = 0.02).
   Treatment with prolonged (>= 14 d) mechanical ventilation was reduced
   from 99 of 212 (46.7%) to 72 of 208 (34.6%) (p = 0.01). This was
   statistically only partially explained by prevention of critical illness
   polyneuropathy/myopathy.
   Conclusion: In a subset of medical patients in the intensive care unit
   for at least 7 days, enrolled in a randomized controlled trial of
   intensive insulin therapy, those assigned to intensive insulin therapy
   had a reduced incidence of critical illness polyneuropathy/myopathy and
   were treated with prolonged mechanical ventilation less frequently.
TC 128
ZB 39
Z8 3
ZS 0
Z9 131
SN 1073-449X
UT WOS:000244499800011
PM 17138955
ER

PT J
AU van Kaam, Anton H.
   Rimensberger, Peter C.
TI Lung-protective ventilation strategies in neonatology: What do we know -
   What do we need to know?
SO CRITICAL CARE MEDICINE
VL 35
IS 3
BP 925
EP 931
DI 10.1097/01.CCM.0000256724.70601.3A
PD MAR 2007
PY 2007
AB Objective: Randomized controlled trials (RCTs) investigating various
   lung-protective ventilation modes or strategies in newborn infants have
   failed to show clear differences in mortality or bronchopulmonary
   dysplasia. This review tries to identify possible reasons for this
   observation, applying modern concepts on ventilator-induced lung injury
   and lung-protective ventilation.
   Data Source: Published RCTs and systematic reviews on mechanical
   ventilation in newborn infants were identified by searching PubMed and
   the Cochrane Library.
   Data Synthesis: A total of 16 RCTs and four systematic reviews comparing
   high-frequency ventilation with conventional mechanical ventilation
   (CMV) failed to show consistent differences in mortality and
   bronchopulmonary dysplasia. Unfortunately, clear information or data on
   ventilation and oxygenation targets in the search for optimal lung
   volumes during high-frequency ventilation or CMV is lacking in many
   RCTs, questioning the validity of the results and the meta-analytic
   subgroup analysis. Based on improvement in oxygenation, only three RCTs
   successfully applied the optimal lung volume strategy during
   high-frequency ventilation. A total of 24 RCTs and three systematic
   reviews comparing various CMV modes and settings and two RCTs
   investigating permissive hypercapnia reported no differences in
   mortality or bronchopulmonary dysplasia. However, the intervention arms
   in these RCTs did not differ in tidal volume or positive end-expiratory
   pressures, variables that are considered important determinants in
   ventilator-induced lung injury. In fact, no RCT in newborn infants has
   substantiated so far the experimental finding that avoiding large tidal
   volumes and low positive end-expiratory pressure during CMV is lung
   protective in newborn infants.
   Conclusion: RCTs investigating lung-protective ventilation in neonates
   have mainly focused on comparing high-frequency ventilation with CMV.
   Most of these RCTs show weaknesses in the design, which may explain the
   inconsistent effect of high-frequency ventilation on bronchopulmonary
   dysplasia. RCTs on CMV only focused on comparing various modes and
   settings, leaving the important question whether reducing tidal volume
   or increasing positive end-expiratory pressure is also lung protective
   in newborn infants unanswered.
TC 30
ZB 11
Z8 0
ZS 1
Z9 31
SN 0090-3493
UT WOS:000244470800034
PM 17255875
ER

PT J
AU Bird, Shawn J
TI Diagnosis and management of critical illness polyneuropathy and critical
   illness myopathy.
SO Current treatment options in neurology
VL 9
IS 2
BP 85
EP 92
DI 10.1007/s11940-007-0034-1
PD 2007-Mar
PY 2007
AB Newly acquired neuromuscular weakness commonly develops in the setting
   of critical illness. This weakness delays recovery and often causes
   prolonged ventilator dependence. An axonal sensory-motor polyneuropathy,
   critical illness polyneuropathy (CIP), is seen in up to a third of
   critically ill patients with the systemic inflammatory response syndrome
   (usually due to sepsis). As frequently, or more so, an acute myopathy,
   critical illness myopathy (CIM), develops in a similar setting, often in
   association with the use of corticosteroids and/or nondepolarizing
   neuromuscular-blocking agents. This paper reviews the clinical features,
   diagnostic approach, and treatment of CIP and CIM. There are no specific
   pharmacologic treatments for CIP or CIM, but recognizing the presence of
   one of these disorders often improves management. Prevention of CIP and
   CIM is feasible in part by avoiding risk factors and by aggressive
   medical management of critically ill patients. Intensive insulin therapy
   in intensive care unit patients appears to reduce the likelihood of
   developing CIP and/or CIM. Future treatments of sepsis may further
   reduce the incidence of these neuromuscular consequences of critical
   illness.
TC 7
ZB 3
Z8 0
ZS 0
Z9 8
SN 1092-8480
UT MEDLINE:17298769
PM 17298769
ER

PT J
AU Gowans, Melissa
   Keenan, Heather T.
   Bratton, Susan L.
TI The population prevalence of children receiving invasive home
   ventilation in Utah
SO PEDIATRIC PULMONOLOGY
VL 42
IS 3
BP 231
EP 236
DI 10.1002/ppul.20558
PD MAR 2007
PY 2007
AB Children requiring home mechanical ventilation (HMV) represent a select
   group of technology-dependent patients. We evaluated the prevalence of
   children using invasive HMV in Utah from 1996 to 2004. Residents of
   Utah, 16 years old and less ventilated via a tracheostomy between 1996
   and 2004 were identified. Children ventilated in 1996 and 2004 were
   compared. Data including demographic information, diagnosis leading to
   HMV, and age at initiation were compared between the two groups. The
   prevalence of HMV in 1996 was 5.0/100,000 (95% CI: 4.4-8.1) and
   6.3/100,000 (95%CI: 4.7-8.4) in 2004. Median age at initiation was 6.5
   months (IQR: 1.3, 24.0). Sixty-one percent (n = 47) were male, 84% (n =
   65) lived in an urban county, and 86% (n 66) had public insurance. The
   most frequent diagnostic category was abnormal ventilatory control (n =
   36, 47%), followed by chronic lung disease (n = 19, 25%), airway
   abnormalities (n = 12, 16%), and neuromuscular weakness (n = 10, 13%).
   Thirteen patients died (17%). The median length of HMV was 39 months
   (IOR: 15, 102). Diagnostic categories, age at initiation of HMV, and sex
   did not differ significantly over the 8 years. The prevalence of
   children requiring HMV differed very little between 1996 and 2004.
   Moreover, the diagnoses for which children received this therapy
   remained constant.
TC 19
ZB 5
Z8 0
ZS 0
Z9 19
SN 8755-6863
UT WOS:000244773100008
PM 17262859
ER

PT J
AU Terzi, Nicolas
   Orlikowski, David
   Aegerter, Philippe
   Lejaille, Michele
   Ruquet, Maria
   Zalcman, Gerard
   Fermanian, Christophe
   Raphael, Jean-Claude
   Lofaso, Frederic
TI Breathing-swallowing interaction in neuromuscular patients - A
   physiological evaluation
SO AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE
VL 175
IS 3
BP 269
EP 276
DI 10.1164/rccm.200608-1067OC
PD FEB 1 2007
PY 2007
AB Rationale: Malnutrition and aspiration are major problems in patients
   with neuromuscular disease. Because impaired swallowing contributes to
   malnutrition, means of improving swallowing are needed.
   Objectives: To investigate interactions between breathing and swallowing
   in neuromuscular disorders and to evaluate the impact of mechanical
   ventilation (MV) on swallowing in tracheostomized patients.
   Methods: We studied 10 healthy individuals and 29 patients with
   neuromuscular disease and chronic respiratory failure (including 19 with
   tracheostomy). The tracheostomized patients who could breathe
   spontaneously were recorded during spontaneous breathing (SB) and with
   MV, in random order.
   Measurements and Main Results: Breathing-swallowing interactions were
   investigated by chin electromyography and inductive respiratory
   plethysmography, using three water-bolus sizes (5, 10, and 15 ml) in
   random order. In contrast to healthy individuals, neuromuscular patients
   showed piecemeal deglutition with several swallows over several
   breathing cycles for each bolus. The percentage of swallows followed by
   expiration was about 50% in the patients compared with nearly 100% in
   the control subjects. The number of swallows and total swallowing time
   per bolus correlated significantly to maximal inspiratory pressure. In
   the 10 tracheostomized patients who were recorded both in SB and MV, the
   number of swallows and total swallowing time per bolus were
   significantly reduced during MV compared with 5B.
   Conclusion: Neuromuscular patients showed abnormal breathing-swallowing
   interactions, which correlated to maximal inspiratory pressure.
   Moreover, MV improved the swallowing parameters in tracheostomized
   patients who were able to breathe spontaneously.
TC 22
ZB 8
Z8 0
ZS 3
Z9 24
SN 1073-449X
UT WOS:000243949300012
PM 17110642
ER

PT J
AU Moore, Wayne A.
   Goldberg, Stephen J.
   Shall, Mary S.
TI Effects of artificial rearing on contractile properties of genioglossus
   muscle in Sprague-Dawley rat
SO ARCHIVES OF ORAL BIOLOGY
VL 52
IS 2
BP 133
EP 141
DI 10.1016/j.archoralbio.2006.09.004
PD FEB 2007
PY 2007
AB Mammals suckle from a nipple during the early neonatal period to obtain
   nourishment. The genioglossus muscle helps position and move the tongue
   for efficient suckling. The purpose of this study was to examine the
   contractile properties and myosin heavy chain (MHC) phenotype of the
   genioglossus following an early period of artificial rearing, which
   reduced nutritive suckling. Beginning at 3 days of age, rats were fed
   via gastric cannula until postnatal day 14 (P14). At P14, artificially
   reared rat pups were either allowed to grow to postnatal day 42 (P42) or
   anaesthetised and prepared for experimentation. Comparisons were made
   between artificially reared and dam reared groups at P14 and P42. At P14
   maximum tetanic tension and fatigue index were lower in the artificially
   reared group than the dam reared group. By P42, artificially reared rats
   had a higher fatigue index and lower percentage of MHCIIa than dam
   reared rats. The artificial rearing technique employed in this study was
   adequate to produce chronic changes in fatigue resistance and MHC
   distribution in genioglossus muscle of rat; the changes observed here
   may be similar to changes that occur in premature human infants
   requiring early artificial feedings. (c) 2006 Elsevier Ltd. All rights
   reserved.
TC 3
ZB 4
Z8 0
ZS 0
Z9 4
SN 0003-9969
UT WOS:000244145500005
PM 17045955
ER

PT J
AU Telford, K.
   Waters, L.
   Vyas, H.
   Manktelow, B. N.
   Draper, E. S.
   Marlow, N.
TI Respiratory outcome in late childhood after neonatal continuous negative
   pressure ventilation
SO ARCHIVES OF DISEASE IN CHILDHOOD-FETAL AND NEONATAL EDITION
VL 92
IS 1
BP F19
EP F24
DI 10.1136/adc.2006.096420
PD JAN 2007
PY 2007
AB Background: The outcome in late childhood for children entered into a
   randomised trial of continuous negative extrathoracic pressure (CNEP)
   versus standard respiratory management for the treatment of neonatal
   respiratory distress was studied. In the original trial, there were
   advantages in the duration of oxygen and the prevalence of chronic lung
   disease for those assigned to receive CNEP.
   Aim: To determine whether the above differences had persisted into
   childhood.
   Methods: Outpatient evaluation of children by a paediatrician using
   Spirometry (Vitalograph Spirometer 2120, Ennis, Ireland) and MicroRint
   (Micro Medical, Rochester, Kent, UK) techniques independently of the
   original trial. Parents completed questionnaires about their child's
   respiratory history and social-demographic information.
   Results: 133 (65%) survivors were evaluated at 9.6-14.9 years of age.
   The group examined were representative of the original cohort and no
   significant baseline differences were observed between children
   evaluated who had been allocated to CNEP or standard treatments. We
   compared Rint (before and after bronchodilator) and forced expiratory
   flow, volume and vital capacity between the two study groups; none were
   significant. Children in the standard group had received paediatric
   intensive care more often (p = 0.19) and were more likely to be
   receiving inhaled drugs for asthma (p = 0.19; all not significant).
   Conclusions: No important differences were found at follow-up in late
   childhood in respiratory outcomes for children treated with neonatal
   CNEP or standard treatment. Caution should be exercised, as the original
   trial was not powered to show these differences, but there seems to be
   no long-term detriment in respiratory outcomes for children treated with
   CNEP in the neonatal period.
RI Marlow, Neil/D-2918-2009; Manktelow, Bradley/G-2794-2011
OI Marlow, Neil/0000-0001-5890-2953; Manktelow, Bradley/0000-0002-3264-0323
TC 2
ZB 1
Z8 0
ZS 0
Z9 2
SN 1359-2998
UT WOS:000243394000008
PM 16905573
ER

PT J
AU Toussaint, M
   Chatwin, M
   Soudon, P
TI Mechanical ventilation in Duchenne patients with chronic respiratory
   insufficiency: clinical implications of 20 years published experience.
SO Chronic respiratory disease
VL 4
IS 3
BP 167
EP 77
DI 10.1177/1479972307080697
PD 2007
PY 2007
AB Chronic respiratory insufficiency is inevitable in the course of disease
   progression in patients with Duchenne muscular dystrophy (DMD). Without
   mechanical ventilation (MV), morbidity and mortality are highly likely
   towards the end of the second decade of life. The present review reports
   evidence and clinical implications regarding DMD patients treated with
   MV. There is no doubt that nocturnal hypercapnia precedes daytime
   hypercapnia. Historical comparisons have provided evidence that
   non-invasive intermittent positive pressure ventilation (NIPPV) at night
   is effective and improves quality of life and survival by 5-10 years. By
   contrast, the optimal criteria and timing for initiation of NIPPV are
   inconsistent. A recent randomized study however demonstrated the
   benefits of commencing NIPPV as soon as nocturnal hypoventilation is
   detected (Ward S, et al., Randomised controlled trial of non-invasive
   ventilation (NIV) for nocturnal hypoventilation in neuromuscular and
   chest wall disease patients with daytime normocapnia. Thorax 2005; 60:
   1019-24). The respective role of the three hypotheses of the indirect
   action of nocturnal NIPPV on daytime blood gases may be complimentary;
   the main improvement may be due to improved ventilatory response to CO2.
   The ultimate time to offer full time ventilation with the most
   advantageous interface is lacking in evidence. Full time NIV is possible
   with a combination of a nasal mask during the night and a mouthpiece
   during the day, however tracheostomy may be provided when mechanical
   techniques of cough-assistance are useless to treat chronic cough
   insufficiency.
TC 27
ZB 8
Z8 0
ZS 4
Z9 30
SN 1479-9723
UT MEDLINE:17711917
PM 17711917
ER

PT J
AU Annane, D.
   Orlikowski, D.
   Chevret, S.
   Chevrolet, J. C.
   Raphael, J. C.
TI Nocturnal mechanical ventilation for chronic hypoventilation in patients
   with neuromuscular and chest wall disorders
SO COCHRANE DATABASE OF SYSTEMATIC REVIEWS
IS 4
AR CD001941
DI 10.1002/14651858.CD001941.pub2
PD 2007
PY 2007
AB Background Chronic alveolar hypoventilation is a common complication of
   many neuromuscular and chest wall disorders. Long-term nocturnal
   mechanical ventilation is increasingly used to treat it.
   Objectives To examine the efficacy of nocturnal mechanical ventilation
   in relieving hypoventilation related symptoms and in prolonging survival
   in people with neuromuscular or chest wall disorders.
   Search strategy We searched the CochraneNeuromuscularDisease Group
   Trials Register, MEDLINE ( from January 1966 to June 2006), and EMBASE (
   from January 1980 to June 2006) for randomised trials and contacted
   authors of trials and other experts in the field.
   Selection criteria We searched for quasi-randomised or randomised
   controlled trials of participants with neuromuscular or chest wall
   disorder-related stable chronic hypoventilation of all ages and all
   degrees of severity, receiving any type and any mode of nocturnal
   mechanical ventilation. The primary outcome measure was short-termand
   long-term reversal of hypoventilation related clinical symptoms and
   secondary outcomes were unplanned hospital admission, one year
   mortality, short-term and long-term reversal of daytime hypercapnia,
   improvement of lung function and sleep breathing disorders.
   Data collection and analysis We identified eight randomised trials.
   Main results The eight eligible trials included a total of 144
   participants. The relative risk of 'no improvement of hypoventilation
   related clinical symptoms' in the short-term following nocturnal
   mechanical ventilation was available in only one trial with 10
   participants and was not significant, 0.09 ( 95% confidence interval
   (CI) 0.01 to 1.31). The relative risk of' no reversal of daytime
   hypercapnia' in the short-term following nocturnal ventilation was
   significant and favoured treatment, 0.37 ( 95% CI 0.20 to 0.65). The
   weighted mean difference of nocturnal mean oxygen saturation was 5.45% (
   95% CI 1.47 to 9.44) more improvement in participants treated with
   nocturnal mechanical ventilation. For most of the outcome measures there
   was no significant long-term difference between nocturnal mechanical
   ventilation and no ventilation. However, the estimated risk of death
   based on three studies was reduced following nocturnal ventilation, 0.62
   ( 95% CI 0.42 to 0.91). There was considerable and significant
   heterogeneity between the trials possibly related to differences between
   the study populations. Most of the secondary outcomes were not assessed
   in the eligible trials. Data from two crossover trials suggested no
   evidence for a difference in reversal of daytime hypercapnia and sleep
   study parameters between volume-cycled and pressure-cycled ventilation.
   No data could be summarised for the comparisons between invasive and
   non-invasive mechanical ventilation or between intermittent positive
   pressure and negative pressure ventilation.
   Authors' conclusions Current evidence about the therapeutic benefit of
   mechanical ventilation is weak, but consistent, suggesting alleviation
   of the symptoms of chronic hypoventilation in the short-term. In three
   small studies survival was prolonged mainly in participants with motor
   neuron diseases. With the exception of motor neuron disease, further
   larger randomised trials are needed to confirm long-term beneficial
   effects of nocturnal mechanical ventilation on quality of life,
   morbidity and mortality, to assess its cost-benefit ratio in
   neuromuscular and chest wall diseases and to compare the different types
   and modes of ventilation.
TC 20
ZB 5
Z8 1
ZS 0
Z9 21
SN 1469-493X
UT WOS:000250188700129
PM 17943762
ER

PT J
AU Subirana, M.
   Sola, I
   Benito, S.
TI Closed tracheal suction systems versus open tracheal suction systems for
   mechanically ventilated adult patients
SO COCHRANE DATABASE OF SYSTEMATIC REVIEWS
IS 4
AR CD004581
DI 10.1002/14651858.CD004581.pub2
PD 2007
PY 2007
AB Background Ventilator-associated pneumonia is a common complication in
   ventilated patients. Endotracheal suctioning is a procedure that may
   constitute a risk factor for ventilator-associated pneumonia. It can be
   performed with an open system or with a closed system. In view of
   suggested advantages being reported for the closed system, a systematic
   review comparing both techniques was warranted.
   Objectives To compare the closed tracheal suction system and the open
   tracheal suction system in adults receiving mechanical ventilation for
   more than 24 hours.
   Search strategy
   We searched CENTRAL (The Cochrane Library 2006, Issue 1) MEDLINE,
   CINAHL, EMBASE and LILACS from their inception to July 2006. We
   handsearched the bibliographies of relevant identified studies, and
   contacted authors and manufacturers.
   Selection criteria
   The review included randomized controlled trials comparing closed and
   open tracheal suction systems in adult patients who were ventilated for
   more than 24 hours.
   Data collection and analysis
   We included the relevant trials fitting the selection criteria. We
   assessed methodological quality using method of randomization,
   concealment of allocation, blinding of outcome assessment and
   completeness of follow up. Effect measures used for pooled analyses were
   relative risk (RR) for dichotomous data and weighted mean differences
   (WMD) for continuous data. We assessed heterogeneity prior to
   meta-analysis.
   Main results
   Of the 51 potentially eligible references, the review included 16 trials
   (1684 patients), many with methodological weaknesses. The two tracheal
   suction systems showed no differences in risk of ventilator-associated
   pneumonia (11 trials; RR 0.88; 95% CI 0.70 to 1.12), mortality (five
   trials; RR 1.02; 95% CI 0.84 to 1.23) or length of stay in intensive
   care units ( two trials; WMD 0.44; 95% CI -0.92 to 1.80). The closed
   tracheal suction system produced higher bacterial colonization rates
   (five trials; RR 1.49; 95% CI 1.09 to 2.03).
   Authors' conclusions
   Results from 16 trials showed that suctioning with either closed or open
   tracheal suction systems did not have an effect on the risk of
   ventilator-associated pneumonia or mortality. More studies of high
   methodological quality are required, particularly to clarify the
   benefits and hazards of the closed tracheal suction system for different
   modes of ventilation and in different types of patients.
TC 18
ZB 5
Z8 2
ZS 1
Z9 21
SN 1469-493X
UT WOS:000250188700019
PM 17943823
ER

PT J
AU Cox, Christopher E.
   Carson, Shannon S.
   Lindquist, Jennifer H.
   Olsen, Maren K.
   Govert, Joseph A.
   Chelluri, Lakshmipathi
CA QOL-MV Investigators
TI Differences in one-year health outcomes and resource utilization by
   definition of prolonged mechanical ventilation: a prospective cohort
   study
SO CRITICAL CARE
VL 11
IS 1
AR R9
DI 10.1186/cc5667
PD 2007
PY 2007
AB Introduction The outcomes of patients ventilated for longer than average
   are unclear, in part because of the lack of an accepted definition of
   prolonged mechanical ventilation ( PMV). To better understand the
   implications of PMV provision, we compared one-year health outcomes
   between two common definitions of PMV as well as between PMV patients
   and those ventilated for shorter periods of time.
   Methods We conducted a secondary analysis of prospectively collected
   data from medical and surgical intensive care units at an academic
   tertiary care medical center. The study included 817 critically ill
   patients ventilated for >= 48 hours, 267 ( 33%) of whom received PMV
   based on receipt of a tracheostomy and ventilation for >= 96 hours. A
   total of 114 ( 14%) patients met the alternate definition of PMV by
   being ventilated for >= 21 days. Survival, functional status, and costs
   were measured at baseline and at 2, 6, and 12 months after discharge. Of
   one-year survivors, 71 ( 17%) were lost to follow up.
   Results PMV patients ventilated for >= 21 days had greater costs ($
   140,409 versus $ 143,389) and higher one-year mortality ( 58% versus
   48%) than did PMV patients with tracheostomies who were ventilated for
   >= 96 hours. The majority of PMV deaths ( 58%) occurred after hospital
   discharge whereas 67% of PMV patients aged 65 years or older had died by
   one year. At one year PMV patients on average had limitations in two
   basic and five instrumental elements of functional status that exceeded
   both their pre-admission status and the one-year disability of those
   ventilated for < 96 hours. Costs per one-year survivor were $ 423,596, $
   266,105, and $ 165,075 for patients ventilated >= 21 days, >= 96 hours
   with a tracheostomy, and < 96 hours, respectively.
   Conclusion Contrasting definitions of PMV capture significantly
   different patient populations, with >= 21 days of ventilation specifying
   the most resource-intensive recipients of critical care. PMV patients,
   particularly the elderly, suffer from a significant burden of costly,
   chronic critical illness and are at high risk for death throughout the
   first year after intensive care.
RI Benneyworth, Brian/A-4667-2009
OI Benneyworth, Brian/0000-0002-4692-5303
TC 53
ZB 8
Z8 1
ZS 4
Z9 56
SN 1466-609X
UT WOS:000247721000009
PM 17244364
ER

PT J
AU Siempos, Ilias I.
   Fragoulis, Konstantinos N.
   Falagas, Matthew E.
TI World wide web resources on control of nosocomial infections
SO CRITICAL CARE
VL 11
IS 1
AR 101
DI 10.1186/cc5116
PD 2007
PY 2007
AB Nosocomial infections are a major worldwide cause of death and
   disability, infection control programs are effective in limiting these
   infections, especially those acquired in the intensive care unit. The
   development of the world wide web has provided health care professionals
   with immediate access to continuously updated information in the field
   of infection control. We sought to identify websites that contain
   information on nosocomial infection control by using popular internet
   search engines, such as Google, Yahoo and AltaVista, and by reviewing
   relevant publications identified in the PubMed and Current Contents
   databases. Only those sites that were English language, open access, and
   developed by a government, academic institution, or national or
   international scientific association were eligible for inclusion. From a
   vast number of internet sites initially identified, we selected 49 that
   provide information on infection control for inclusion in our list of
   practical and relevant internet resources. Several sites provide general
   information on infection control practices, whereas others focus on one
   or a few specific infection(s). We provide health care professionals
   with a timely and succinct list of open access internet resources that
   contain information regarding the prevention and control of nosocomial
   infections in order to help in the dissemination of relevant information
   and so contribute to the limitation of such hazards.
TC 11
ZB 4
Z8 0
ZS 0
Z9 11
SN 1466-609X
UT WOS:000247721000031
PM 17254319
ER

PT J
AU De Jonghe, Bernard
   lacherade, Jean-Claude
   Durand, Marie-Christine
   Sharshar, Tarek
TI Critical illness neuromuscular syndromes
SO CRITICAL CARE CLINICS
VL 23
IS 1
BP 55
EP +
DI 10.1016/j.ccc.2006.11.001
PD JAN 2007
PY 2007
AB Critical illness neuromyopathy (CINM) is the most common peripheral
   neuromuscular disorder encountered in the ICU. Bilateral diffuse
   weakness predominant in the proximal part of the limbs after improvement
   of the acute phase of the critical illness is highly suggestive of CINM.
   Although muscle and peripheral nerve often are involved in combination,
   muscle involvement alone increasingly is identified on
   electrophysiological investigation, including direct muscle stimulation.
   Respiratory muscles also are involved, and CINM may cause delayed
   weaning and prolonged MV. Besides muscle immobilization and prolonged
   sepsis-induced multiple organ failure, which are both strong
   contributors to CINM, hyperglycemia and use of corticosteroids also
   might have a deleterious effect on the neuromuscular system in
   critically ill patients.
TC 12
ZB 2
Z8 0
ZS 0
Z9 12
SN 0749-0704
UT WOS:000244939900005
PM 17307116
ER

PT J
AU Bailey, Polly
   Thomsen, George E.
   Spuhler, Vicki J.
   Blair, Robert
   Jewkes, James
   Bezdjian, Louise
   Veale, Kristy
   Rodriquez, Larissa
   Hopkins, Ramona O.
TI Early activity is feasible and safe in respiratory failure patients
SO CRITICAL CARE MEDICINE
VL 35
IS 1
BP 139
EP 145
DI 10.1097/01.CCM.0000251130.69568.87
PD JAN 2007
PY 2007
AB Objective., To determine whether early activity is feasible and safe in
   respiratory failure patients.
   Design. Prospective cohort study.
   Setting. From June 1, 2003, through December 31, 2003, we assessed
   safety and feasibility of early activity in all consecutive respiratory
   failure patients who required mechanical ventilation for > 4 days
   admitted to our respiratory intensive care unit (RICU). A majority of
   patients were treated in another intensive care unit (ICU) before RICU
   admission. We excluded patients who required mechanical ventilation for
   :<= 4 days.
   Patients: Eight-bed RICU at LDS Hospital.
   Interventions., We assessed patients for early activity as part of
   routine respiratory ICU care. We prospectively recorded activity events
   and adverse events. We defined three activity events as sit on bed, sit
   in chair, and ambulate. We defined six activity-related adverse events
   as fall to knees, tube removal, systolic blood pressure > 200 mm Hg,
   systolic blood pressure < 90 mm Hg, oxygen desaturation < 80%, and
   extubation.
   Measurements and Main Results., During the study period, we conducted a
   total of 1,449 activity events in 103 patients. The activity events
   included 233 (16%) sit on bed, 454 (31%) sit in chair, and 762 (53%)
   ambulate. In patients with an endotracheal tube in place, there were a
   total of 593 activity events, of which 249 (42%) were ambulation. There
   were < 1% activity-related adverse events, including fall to the knees
   without injury, feeding tube removal, systolic blood pressure > 200 mm
   Hg, systolic blood pressure < 90 mm Hg, and desaturation < 80%. No
   patient was extubated during activity.
   Conclusions., We conclude that early activity is feasible and safe in
   respiratory failure patients. A majority of survivors (69%) were able to
   ambulate >100 feet at RICU discharge. Early activity is a candidate
   therapy to prevent or treat the neuromuscular complications of critical
   illness.
TC 212
ZB 24
Z8 4
ZS 8
Z9 223
SN 0090-3493
UT WOS:000243046700021
PM 17133183
ER

PT J
AU Kaida, K.
   Morita, D.
   Kanzaki, M.
   Kamakura, K.
   Motoyoshi, K.
   Hirakawa, M.
   Kusunoki, S.
TI Anti-ganglioside complex antibodies associated with severe disability in
   GBS
SO JOURNAL OF NEUROIMMUNOLOGY
VL 182
IS 1-2
BP 212
EP 218
DI 10.1016/j.jneuroim.2006.09.013
PD JAN 2007
PY 2007
AB Ganglioside complexes (GSCs) are known as target antigens in
   Guillain-Barre syndrome (GBS). To elucidate the clinical importance of
   the anti-GSC antibodies in GBS, We investigated serum antibodies to GSCs
   containing two of the gangliosides, GM1, GD1a, GD1b and GT1b, and
   analyzed clinical features of anti-GSC-positive GBS patients.
   Thirty-nine (17%) of 234 GBS patients had IgG anti-GSC antibodies.
   Anti-GSC-positive GBS had antecedent gastrointestinal infection and
   lower cranial nerve deficits more frequently than control GBS. The
   presence of antibody specificity to GD1a/GD1b and/or GD1b/GT1b was
   significantly associated with severe disability and a requirement for
   mechanical ventilation. (c) 2006 Elsevier B.V. All rights reserved.
TC 51
ZB 41
Z8 1
ZS 0
Z9 53
SN 0165-5728
UT WOS:000243962200023
PM 17113161
ER

PT J
AU Sopena, Nieves
   Pedro-Botet, Luisa
   Mateu, Lourdes
   Tolschinsky, Gustavo
   Rey-Joly, Celestino
   Sabria, Miquel
TI Community-acquired Legionella pneumonia in elderly patients:
   Characteristics and outcome
SO JOURNAL OF THE AMERICAN GERIATRICS SOCIETY
VL 55
IS 1
BP 114
EP 119
DI 10.1111/j.1532-5415.2006.01021.x
PD JAN 2007
PY 2007
AB OBJECTIVES: To compare the risk factors, clinical and laboratory
   features, and outcome of community-acquired pneumonia (CAP) caused by
   Legionella pneumophila in elderly (aged >= 65) and younger patients.
   DESIGN: Prospective enrollment of subjects with retrospective data
   analysis.
   SETTING: A 630-bed tertiary center in Badalona (Barcelona), Spain.
   PARTICIPANTS: A total of 158 patients diagnosed with CAP caused by L.
   pneumophila from 1994 to 2004: 104 younger than 65 and 54 aged 65 and
   older.
   MEASUREMENTS: Epidemiological, clinical, laboratory, and radiological
   data and the outcome of the two groups were compared using univariate
   and multivariate analysis.
   RESULTS: Underlying diseases, such as chronic pulmonary diseases,
   diabetes mellitus, neuromuscular diseases, and heart failure; risk of
   aspiration; and therapy with corticosteroids were significantly more
   frequent in patients aged 65 and older. Patients younger than 65 were
   more likely to be male and have toxic habits (cigarette smoking,
   alcoholism) and human immunodeficiency virus infection than older
   patients. Fever, nonrespiratory symptoms (diarrhea and headache), and
   some laboratory abnormalities (hyponatremia (serum sodium concentration
   < 130 mmol/L) and high aspartate aminotransferase and creatinine kinase
   levels) were significantly less frequent in patients aged 65 and older
   than in younger patients. No significant differences were observed
   between the two groups in the frequency of higher-severity risk classes
   and intensive care unit admission or in outcome (complications and
   mortality).
   CONCLUSION: Elderly patients with CAP caused by L. pneumophila had a
   higher frequency of underlying comorbidities and presented less
   frequently with fever and classical nonrespiratory symptoms and
   laboratory abnormalities of Legionnaires' disease than younger patients,
   although greater severity of illness at onset and higher mortality were
   not significantly different between the two age groups.
CT 45th Interscience Conference on Antimicrobial Agents and Chemotherapy
CY DEC 16-19, 2005
CL Washington, DC
TC 13
ZB 5
Z8 1
ZS 0
Z9 14
SN 0002-8614
UT WOS:000243507500016
PM 17233694
ER

PT J
AU Field, D.
   Elbourne, D.
   Hardy, P.
   Fenton, A. C.
   Ahluwalia, J.
   Halliday, H. L.
   Subhedar, N.
   Heinonen, K.
   Aikio, O.
   Grieve, R.
   Truesdale, A.
   Tomlin, K.
   Normand, C.
   Stocks, J.
CA INNOVO Trial Collaborating Grp
TI Neonatal ventilation with inhaled nitric oxide vs. ventilatory support
   without inhaled nitric oxide for infants with severe respiratory failure
   born at or near term: The INNOVO multicentre randomised controlled trial
SO NEONATOLOGY
VL 91
IS 2
BP 73
EP 82
DI 10.1159/000097123
PD 2007
PY 2007
AB Background: Evidence from European centres to support the use of nitric
   oxide (NO) in mature newborns with evidence of severe respiratory
   failure is sparse. Methods: Infants of > 33 weeks' gestation, < 28 days
   old, and with severe respiratory failure requiring ventilatory support
   were randomised to receive or not to receive inhaled NO (iNO). The study
   was not blinded. Results: Sixty infants were recruited (29 allocated
   iNO, 31 no iNO) from 15 neonatal units in the UK, Finland, Belgium and
   the Republic of Ireland. 15/60 recruited babies died, and 8.1% of the
   survivors (4/45) were classified as severely disabled at 1 year. There
   was no statistically significant difference between the randomised
   groups in terms of the primary outcome of death or severe disability by
   the corrected age of 1 year (relative risk = 0.96 (95% confidence
   interval = 0.46 -2.03); p = 0.86) (Fisher's exact p = 1.00). The costs
   of NO were outweighed by reduced extra corporeal membrane oxygenation
   costs in the iNO group. The mean total hospitalisation costs were lower
   in the iNO group, although the mean difference ( pound 1,697) was not
   statistically significant (95% confidence interval = -14,472 to 11,478).
   Conclusions: The results complement those of previous studies that
   suggest NO is cost-effective and reduces the need for extra corporeal
   membrane oxygenation in this group of babies. Overall survival rates
   compare unfavourably with results of US trials. Copyright (c) 2007 S.
   Karger AG, Basel.
RI Stocks, Janet/C-1892-2008
TC 10
ZB 5
Z8 5
ZS 0
Z9 14
SN 1661-7800
UT WOS:000244967400001
PM 17344656
ER

PT J
AU Kaur, Paramjit
   Bennett, Jeffrey L.
TI Optic neuritis and the neuro-ophthalmology of multiple sclerosis
SO NEUROBIOLOGY OF MULTIPLE SCLEROSIS
SE INTERNATIONAL REVIEW OF NEUROBIOLOGY
VL 79
BP 633
EP +
DI 10.1016/S0074-7742(07)79028-1
PD 2007
PY 2007
AB Multiple sclerosis (MS) is the most common cause of neurological
   disability in young adults. Since approximately 40% of the brain is
   devoted to vision, demyelination commonly affects visual function,
   resulting in a myriad of neuro-ophthalmic symptoms. In this chapter, we
   examine the seminal afferent and efferent neuro-ophthalmological
   manifestations of MS, highlighting those history and examination
   findings critical for the diagnosis and treatment of various visual and
   ocular motor disorders. Among the topics, a special emphasis will be
   placed on optic neuritis, the most common clinically isolated
   demyelinating syndrome. This chapter focuses on the evaluation and
   treatment of visual sensory and oculomotor disorders in MS. The
   objective is to provide the reader with a working model for enhancing
   their care of patients with demyelinating disease.
TC 11
ZB 7
Z8 1
ZS 0
Z9 12
SN 0074-7742
UT WOS:000247375800029
PM 17531862
ER

PT J
AU Boschen, Kathryn
   Gargaro, Judith
   Gan, Caron
   Gerber, Gary
   Brandys, Clare
TI Family interventions after acquired brain injury and other chronic
   conditions: a critical appraisal of the quality of the evidence.
SO NeuroRehabilitation
VL 22
IS 1
BP 19
EP 41
PD 2007
PY 2007
AB Family caregivers of individuals with acquired brain injury (ABI) and
   other chronic disabilities typically experience long-term adjustment
   difficulties within the entire family system. Interventions to assist
   parents and spouses are rare, and for siblings and offspring even more
   so. Among the few existing interventions, only a very small number have
   been evaluated in any scientifically sound manner for effectiveness in
   alleviating stress and burden. A highly targeted literature search of
   family caregiver intervention studies identified 31 articles, only four
   of which were in brain injury, which met specific inclusion criteria.
   Randomized controlled trial studies of six types of family caregiver
   interventions were systematically assessed for their quality of design
   and evidence of effectiveness. The results revealed a body of literature
   lacking in methodological rigor. At present there is no strong research
   evidence supporting any specific intervention method for family
   caregivers of individuals with ABI or any of the other chronic condition
   groups surveyed, although an abundance of anecdotal, descriptive, and
   quasi-experimental support exists in the rehabilitation literature. This
   conclusion points to the need for launching new pilot studies and
   rigorous evaluations of caregiver intervention effectiveness, some of
   which are now emerging or in process in several locations across the
   United States.
TC 31
ZB 7
Z8 2
ZS 0
Z9 33
SN 1053-8135
UT MEDLINE:17379946
PM 17379946
ER

PT J
AU Lumbierres, M.
   Prats, E.
   Farrero, E.
   Monasterio, C.
   Gracia, T.
   Manresa, F.
   Escarrabill, J.
TI Noninvasive positive pressure ventilation prevents postoperative
   pulmonary complications in chronic ventilators users
SO RESPIRATORY MEDICINE
VL 101
IS 1
BP 62
EP 68
DI 10.1016/j.rmed.2006.04.012
PD JAN 2007
PY 2007
AB Objective: To evaluate the postoperative pulmonary complications and the
   long-term impact on pulmonary function of different surgical procedures
   with general anaesthesia in chronic respiratory failure (CRF) patients
   who were using noninvasive positive pressure ventilation (NPPV).
   Design: We retrospectively studied 20 stable patients on NPPV for CRF
   secondary to: kyphoscoliosis (eight), morbid obesity (six),
   thoracoplasty (four), neuromuscutar diseases (two), who underwent
   surgical procedures with general anaesthesia, between January 1998 and
   December 2003.
   Material and methods: The variables studied were: type of surgery, hours
   of orotracheal intubation, hours of stay in the postsurgical reanimation
   unit (PRU), postoperative pulmonary complications and days of hospital
   stay. These results were compared with those obtained in patients
   without respiratory pathology and who were submitted to the same type of
   surgical interventions during the study period. All patients were tested
   for: arterial blood gases, forced vital capacity (FVC) and forced
   expiratory volume in 1 s (FVE1). These tests were carried out both prior
   to surgical intervention and 12 months after this intervention, and the
   use of medical assistance resources the year prior to and the year after
   the surgical intervention were also analysed.
TC 11
ZB 3
Z8 0
ZS 3
Z9 13
SN 0954-6111
UT WOS:000243772900008
PM 16774819
ER

PT J
AU Almenrader, N.
   Patel, D.
TI Spinal fusion surgery in children with non-idiopathic scoliosis: is
   there a need for routine postoperative ventilation?
SO BRITISH JOURNAL OF ANAESTHESIA
VL 97
IS 6
BP 851
EP 857
DI 10.1093/bja/ael273
PD DEC 2006
PY 2006
AB Background. The perioperative management of children with non-idiopathic
   scoliosis undergoing spinal deformity surgery has not been standardized
   and the current practice is to routinely ventilate these patients in the
   postoperative period. This study reports the experience from a single
   institution and evaluates the need and reasons for postoperative
   ventilation. Details of ventilated patients are presented.
   Methods. All patients undergoing spinal fusion surgery for
   non-idiopathic scoliosis were recorded prospectively (2003-4). Patients
   were anaesthetized according to a standardized technique. Physical
   characteristics, cardiopulmonary function, intraoperative blood loss and
   fluid requirement, postoperative need for ventilation and all
   perioperative adverse events were recorded on a computer database.
   Results. A total of 76.2% of patients were safely extubated at the end
   of surgery without any further complications or need for re-ventilation;
   23.8% of patients required postoperative ventilation with half of the
   cases being planned before operation and 40% of all patients with
   Duchenne muscular dystrophy (DMD) required postoperative ventilation.
   There were no specific factors that could predict the need for
   postoperative ventilation, although an increased tendency for children
   with DMD and those with a preoperative forced vital capacity < 30%
   towards requiring postoperative ventilation was observed.
   Conclusions. Early extubation can be safely performed after spinal
   deformity surgery for non-idiopathic scoliosis. The use of short-acting
   anaesthetics, drugs to reduce blood loss, experienced spinal
   anaesthetists and the availability of intensive care support are all
   essential for a good outcome in patients with neuromuscular disease and
   cardiopulmonary co-morbidity.
TC 20
ZB 4
Z8 0
ZS 0
Z9 20
SN 0007-0912
UT WOS:000242246800016
PM 17035337
ER

PT J
AU Gustafson, Torbjoern
   Franklin, Karl A.
   Midgren, Bengt
   Pehrsson, Kertin
   Ranstam, Jonas
   Strom, Kertin
TI Survival of patients with kyphoscoliosis receiving mechanical
   ventilation or oxygen at home
SO CHEST
VL 130
IS 6
BP 1828
EP 1833
DI 10.1378/chest.130.6.1828
PD DEC 2006
PY 2006
AB Background: Home mechanical ventilation (HMV) and long-term oxygen
   therapy (LTOT) are the two treatment alternatives when treating
   respiratory insufficiency in patients with kyphoscoliosis. We aimed to
   study the effect on survival with regard to HMV or LTOT alone in
   patients with respiratory insufficiency due to kyphoscoliosis.
   Methods: Swedish patients with nonparalytic kyphoscoliosis (ie,
   scoliosis not related to neuromuscular disorders) who started LTOT or
   HMV between 1-996 and 2004 were followed up prospectively until February
   14, 2006, with death as the primary outcome. Treatment modality,
   arterial blood gas levels, the presence of concomitant respiratory
   diseases, and age were recorded at the onset of treatment. No patient
   was lost to follow-up.
   Results: One hundred patients received HMV, and 144 patients received
   oxygen therapy alone. Patients treated with HMV experienced better
   survival, even when adjusting for age, gender, concomitant respiratory
   diseases, and blood gas levels, with a hazard ratio of 0.30 (95%
   confidence interval, 0.18 to 0.51).
   Conclusion: The survival of patients with kyphoscoliosis receiving HMV
   was better than that of patients treated with LTOT alone. We suggest HMV
   and not oxygen therapy alone as the primary therapy for patients with
   respiratory failure due to kyphoscoliosis, regardless of gender, age,
   and the occurrence of concomitant respiratory diseases.
RI Ranstam, Jonas/A-4386-2009
OI Ranstam, Jonas/0000-0002-8287-7273
TC 27
ZB 5
Z8 0
ZS 0
Z9 27
SN 0012-3692
UT WOS:000242876200034
PM 17167004
ER

PT J
AU Mueller, B.
   Prat, C.
TI Markers of acute inflammation in assessing and managing lower
   respiratory tract infections: focus on procalcitonin
SO CLINICAL MICROBIOLOGY AND INFECTION
VL 12
BP 8
EP 16
DI 10.1111/j.1469-0691.2006.01654.x
SU 9
PD DEC 2006
PY 2006
AB This review describes the pathophysiological basis for using
   procalcitonin to help diagnose infections, and the strengths and
   weaknesses of implementing the test rationally in a routine clinical
   setting. Meta-analyses of observational studies and intervention studies
   both suggest that as a surrogate marker, procalcitonin allows an
   improved diagnostic assessment of a variety of infections, e.g.,
   respiratory tract infections, meningitis, acute infectious endocarditis
   and pancreatitis. Measuring procalcitonin is not a substitute for
   careful clinical assessment and obtaining appropriate cultures in all
   patients. However, used appropriately, procalcitonin allows an earlier
   diagnosis of infection and can inform physicians about the course and
   prognosis of the disease better than more commonly used clinical and
   laboratory markers. With use of a sensitive assay, a procalcitonin-based
   therapeutic strategy can safely and markedly reduce antibiotic usage in
   those respiratory tract infections that are mostly viral, and in viral
   meningitis. More sensitive procalcitonin assays, with a functional
   sensitivity within the normal reference range of <0.03 mu g/L, should be
   available soon. There is a need for more intervention studies in other
   sites of infection to tackle the existing vicious cycle of antibiotic
   overuse and emerging multiresistance. Furthermore, as procalcitonin is a
   hormokine mediator, its immunoneutralisation might open new treatment
   options for sepsis.
TC 13
ZB 5
Z8 0
ZS 0
Z9 13
SN 1198-743X
UT WOS:000243673600003
ER

PT J
AU Orlikowski, David
   Sharshar, Tarek
   Porcher, Raphael
   Annane, Djillali
   Raphael, Jean Claude
   Clair, Bernard
TI Prognosis and risk factors of early onset pneumonia in ventilated
   patients with Guillain-Barre syndrome
SO INTENSIVE CARE MEDICINE
VL 32
IS 12
BP 1962
EP 1969
DI 10.1007/s00134-006-0332-1
PD DEC 2006
PY 2006
AB Objective: Invasive mechanical ventilation is required in 30% of
   patients with Guillain-Barre syndrome (GBS) and is associated with
   pneumonia and increased mortality. Our objective was to determine the
   incidence, characteristics, outcomes, and risk factors of pneumonia in
   GBS patients receiving mechanical ventilation. Design and setting: Study
   of a prospective database in an intensive care unit of a university
   hospital. Patients: The study included 81 patients who required
   intubation for GBS. Neurological findings, vital capacity, and signs of
   respiratory distress were recorded at admission and at intubation. A
   score predicting the risk of intubation (0-4) was calculated for each
   patient. Pneumonia was diagnosed based on predefined criteria and
   retrospectively confirmed by two observers. Early-onset pneumonia was
   defined as pneumonia diagnosed within 5 days after intubation.
   Measurements and results: Mean vital capacity was 57 +/- 22% of
   predicted at admission and 33 +/- 11% at intubation. Pneumonia developed
   in 63 patients (78%), including 48 with early-onset pneumonia. Bacteria
   were consistent with aspiration. Of the 63 patients with pneumonia 11
   (18%) had septic shock, 6 (10%) had acute respiratory distress syndrome,
   and 9 (14%) died. In the univariate analysis milder weakness, a lower
   risk of intubation (score < 2), and time from admission to intubation
   longer than 2 days were associated with early-onset pneumonia. Time from
   admission to intubation was the only independent predictor in the
   multivariate logistic regression model. Conclusions: Early-onset
   pneumonia is a common and severe complication that is related to
   aspiration in patients with GBS. Delaying intubation may increase the
   risk of early-onset pneumonia.
TC 12
ZB 5
Z8 0
ZS 0
Z9 12
SN 0342-4642
UT WOS:000242361900011
PM 17019557
ER

PT J
AU Durand, Marie-Christine
   Porcher, Raphael
   Orlikowski, David
   Aboab, Jerome
   Devaux, Christian
   Clair, Bernard
   Annane, Djillali
   Gaillard, Jean-Louis
   Lofaso, Frederic
   Raphael, Jean-Claude
   Sharshar, Tarek
TI Clinical and electrophysiological predictors of respiratory failure in
   Guillain-Barre syndrome: a prospective study
SO LANCET NEUROLOGY
VL 5
IS 12
BP 1021
EP 1028
DI 10.1016/S1474-4422(06)70603-2
PD DEC 2006
PY 2006
AB Background Respiratory failure is the most serious short-term
   complication of Guillain-Barre syndrome and can require invasive
   mechanical ventilation in 20-30% of patients. We sought to identify
   clinical and electrophysiological predictors of respiratory failure in
   the disease.
   Methods We prospectively assessed electrophysiological data and clinical
   factors, including identified predictors of delay between disease onset
   and admission, inability to lift head, and vital capacity, in patients
   admitted with Guillain-Barre syndrome. We related these factors to
   subsequent need for ventilatory support. Neurophysiological findings
   were classified as demyelinating, axonal, equivocal, unexcitable, or
   normal. Predictive values of clinical and electrophysiological. data
   were tested using classification trees to build up a predictive model.
   This model was initially built up in a two-third (fitting set) then
   validated in a one-third (validation set) of the total sample. The
   fitting and validation sets were randomly selected. We also assessed the
   predictive value of this model for disability at 6 months.
   Findings From 1998, to 2006, 154 patients with Guillain-Barre syndrome
   were included in the study and 34 (22%) were subsequently ventilated.
   Demyelinating Guillain-Barre syndrome was more common in patients who
   went on to be ventilated than in those who were not (85% vs 51%, p =
   0.0003). Vital capacity and the proximal/distal compound muscular
   amplitude potential (p/dCMAP) ratio of the common peroneal nerve were
   retained in the tree model, with a probability of needing ventilation of
   less than 2.5% in patients with a ratio of greater than 55.6% and a
   vital capacity more than 81% of predicted. A p/dCMAP ratio of the
   peroneal nerve less than 55.6% and age older than 40 years were retained
   as independent predictors of disability at 6 months.
   Interpretation Neurophysiological testing is helpful for assessing risk
   of respiratory failure, which is highest in patients with evidence of
   demyelination and very low in those without both 55.6% conduction block
   of the common peroneal nerve and a 20% reduction in vital capacity.
TC 36
ZB 14
Z8 1
ZS 0
Z9 38
SN 1474-4422
UT WOS:000242266100031
PM 17110282
ER

PT J
AU Maramattom, Bobby Varkey
   Wijidicks, Eelco F. M.
TI Acute neuromuscular weakness in the intensive care unit
SO CRITICAL CARE MEDICINE
VL 34
IS 11
BP 2835
EP 2841
DI 10.1097/01.CCM.0000239436.63452.81
PD NOV 2006
PY 2006
AB Introduction. Patients in the intensive care unit develop generalized
   weakness due to a number of factors. Neuromuscular weakness is a common
   cause of failure to wean from the ventilator and decreased limb
   movements. A rational approach to evaluation of weakness will help to
   identify most of the common causes of neuromuscular weakness in the
   intensive care unit.
   Aims: This review provides an analysis of neuromuscular weakness and a
   practical algorithm to assist in diagnostic evaluation.
   Conclusions: The most common acquired causes of weakness in the
   critically ill patient in the intensive care unit are critical illness
   polyneuropathy and critical illness myopathy. In the intensive care unit
   setting, electrophysiological studies, biopsies, and imaging studies are
   often necessary to complement the clinical impression.
TC 16
ZB 8
Z8 1
ZS 1
Z9 19
SN 0090-3493
UT WOS:000241639900018
PM 16932235
ER

PT J
AU Atkinson, Stephanie B
   Carr, Rebecca Lamb
   Maybee, Patricia
   Haynes, Donna
TI The challenges of managing and treating Guillain-Barre syndrome during
   the acute phase.
SO Dimensions of critical care nursing : DCCN
VL 25
IS 6
BP 256
EP 63
DI 10.1097/00003465-200611000-00003
PD 2006 Nov-Dec
PY 2006
AB Guillain-Barre syndrome (GBS) is a randomly acquired inflammatory
   disease that affects approximately 2 persons in 100,000 annually. There
   have been no discriminating risk factors identified including age, sex,
   or race. The syndrome results in the demyelination of peripheral nerves,
   which leads to progressive motor weakness and paralysis. The critical
   care nurse should gain from this article an overview of Guillain-Barre
   syndrome during the acute phase. Included is the pathophysiology of the
   syndrome, clinical presentation, acute phase nursing assessment and
   management, and currently available treatment options.
TC 3
ZB 0
Z8 0
ZS 0
Z9 3
SN 0730-4625
UT MEDLINE:17122655
PM 17122655
ER

PT J
AU Visser, L. H.
TI Critical illness polyneuropathy and myopathy: clinical features, risk
   factors and prognosis
SO EUROPEAN JOURNAL OF NEUROLOGY
VL 13
IS 11
BP 1203
EP 1212
DI 10.1111/j.1468-1331.2006.01498.x
PD NOV 2006
PY 2006
AB Acquired neuromuscular weakness due to critical illness polyneuropathy
   and myopathy (CIPNM) frequently develops in patients hospitalized in the
   intensive care unit for more than 1 week. CIPNM may present with muscle
   weakness and failure to wean from mechanical ventilation, but is
   discovered more often and earlier by electrophysiological examination.
   In this review, the incidence, clinical and electrophysiological
   features, differential diagnosis and prognosis of CIPNM will be
   described. Risk factors for CIPNM are sepsis or systemic inflammatory
   response syndrome and the severity of multi-organ failure. Presence of
   CIPNM is associated with higher mortality rate, prolonged duration of
   mechanical ventilation and prolonged rehabilitation. The majority of
   survivors with CIPNM have persistent functional disabilities and a
   reduced quality of life. There is need for new therapeutic strategies to
   prevent or minimize CIPNM in critically ill patients.
TC 30
ZB 8
Z8 3
ZS 0
Z9 33
SN 1351-5101
UT WOS:000241236300009
PM 17038033
ER

PT J
AU Giannini, Alberto
   Pinto, Anna Maria
   Rossetti, Giordano
   Prandi, Edi
   Tiziano, Danilo
   Brahe, Christina
   Nardocci, Nardo
TI Respiratory failure in infants due to spinal muscular atrophy with
   respiratory distress type 1
SO INTENSIVE CARE MEDICINE
VL 32
IS 11
BP 1851
EP 1855
DI 10.1007/s00134-006-0346-8
PD NOV 2006
PY 2006
AB Background: Spinal muscular atrophy with respiratory distress type 1
   (SMARD1) is a rare autosomal recessive neuromuscular disease of unknown
   prevalence characterized by degeneration of anterior horn
   alpha-motoneurons and manifesting in the first 6 months of life as
   life-threatening irreversible diaphragmatic paralysis associated with
   progressive symmetrical muscular weakness (distal lower limbs mainly
   involved), muscle atrophy, and peripheral sensory neuropathy. Setting:
   Pediatric intensive care unit of tertiary care hospital. Patients: We
   present two new cases of SMARD1 and report two new mutations in the gene
   IGHMBP2 which encodes immunoglobulin mu-binding protein 2 on chromosome
   11q13. Conclusions: SMARD1 is a poor-prognosis disease that should be
   considered when acute respiratory insufficiency, of suspected
   neuromuscular or unclear cause, develops during the first 6 months of
   life. Diaphragmatic paralysis, manifesting as dyspnea and paradoxical
   respiration, is the most prominent presenting sign and diaphragmatic
   motility should be investigated early by fluoroscopy or ultrasound.
   Electromyography and nerve conduction studies revealing peripheral motor
   and sensory neuropathy then suggest the diagnosis which should be
   confirmed by genetic analysis.
RI Tiziano, Francesco/A-7260-2010
OI Tiziano, Francesco/0000-0002-5545-6158
TC 18
ZB 11
Z8 1
ZS 0
Z9 19
SN 0342-4642
UT WOS:000241453400028
PM 16964485
ER

PT J
AU Khan, Jaffar
   Harrison, Taylor B.
   Rich, Mark M.
   Moss, Marc
TI Early development of critical illness myopathy and neuropathy in
   patients with severe sepsis
SO NEUROLOGY
VL 67
IS 8
BP 1421
EP 1425
DI 10.1212/01.wnl.0000239826.63523.8e
PD OCT 24 2006
PY 2006
AB Objectives: To characterize the prevalence, time of onset, and cause of
   neuromuscular dysfunction in patients with severe sepsis. Methods: We
   conducted a prospective cohort study in which participants with severe
   sepsis underwent weekly neurologic examinations and nerve conduction
   studies (NCSs) within 72 hours of developing severe sepsis until
   intensive care unit (ICU) discharge. Electromyography was preformed if
   clinical weakness developed or if there was a significant reduction in
   nerve conduction response amplitudes. Results: Abnormal NCS were present
   upon enrollment in 63% of patients (31/48). The presence of abnormal
   baseline NCS was predictive of hospital mortality (55% vs 0% for
   patients with normal baseline NCS; p < 0.001). Development of acquired
   neuromuscular dysfunction could be predicted by NCS done on day 7.
   Twenty patients remained in the ICU long enough to have serial NCSs; 50%
   of these patients developed acquired neuromuscular dysfunction. Most
   patients with acquired neuromuscular dysfunction had electrophysiologic
   evidence of both critical illness myopathy and critical illness
   neuropathy. Conclusion: Changes in nerve conduction studies occur in the
   majority of patients early in the course of severe sepsis and predict
   the development of acquired neuromuscular dysfunction and mortality in
   intensive care unit patients. Most patients with acquired neuromuscular
   dysfunction after sepsis have both critical illness myopathy and
   critical illness neuropathy.
TC 70
ZB 26
Z8 4
ZS 0
Z9 74
SN 0028-3878
UT WOS:000241494800019
PM 17060568
ER

PT J
AU Kramer, J.
   Hennig, H.
   Lensing, C.
   Kruger, S.
   Helmchen, U.
   Steinhoff, J.
   Dodt, C.
TI Multi-organ affecting CMV-associated cryoglobulinemic vasculitis
SO CLINICAL NEPHROLOGY
VL 66
IS 4
BP 284
EP 290
PD OCT 2006
PY 2006
AB We report on a 67-year-old female patient who was admitted to our
   intensive care unit with acute renal failure and severe hypoxemia.
   Transiently, the patient had to be treated with kidney replacement
   therapies and artificial ventilation. The actual illness started with
   general weakness, recurrent bloody diarrhea and intermittent dermatitis
   of the lower legs. Skin symptoms were initially observed 2 years before
   the actual clinical findings. The bloody diarrhea was attributed to an
   inflammatory stenosis of the sigma. The life-threatening clinical
   aggravation was due to diffuse alveolar hemorrhage and alveolitis. In
   the search for the cause of the systemic disease, both a monoclonal
   gamma-globulinemia, causing a cryoglobulinernia type 11 and an acute
   cytornegalovirus infection were diagnosed. Additionally, the course of
   the disease was complicated by a secondary antibody deficiency as well
   as an endocarditis of the aortic valve caused by Enterococcus faecium. A
   cryoglobulinemic vasculitis type 11 was histologically found in biopsy
   specimen of the kidney. Thus, the present case reports on a coincidence
   of a monoclonal gammopathy causing a cryoglobulinernia type 11 with
   extensive organ involvement and a florid CMV infection. We hypothesize
   that the CMV infection has triggered the cryoglobulinemia and its
   particular severe organ involvement.
TC 10
ZB 3
Z8 0
ZS 1
Z9 10
SN 0301-0430
UT WOS:000241194700009
PM 17063996
ER

PT J
AU Smith, J. Chadwick
   Moore, W. Allen
   Goldberg, Stephen J.
   Shall, Mary S.
TI Contractile properties and myosin heavy chain composition of rat tongue
   retrusor musculature show changes in early adulthood after 19 days of
   artificial rearing
SO JOURNAL OF APPLIED PHYSIOLOGY
VL 101
IS 4
BP 1053
EP 1059
DI 10.1182/japplphysiol.00029.2006
PD OCT 2006
PY 2006
AB Previously, we showed that artificial rearing using the "pup in a cup"
   model results in decreased tongue activity and caused some minor
   alterations in the tongue retrusor musculature. However, the artificial
   rearing time frame previously chosen was brief (11 days). The purpose of
   the present investigation was to extend the artificial rearing period
   from postnatal days 3 to 21 (P21) to determine whether significant
   alterations occur as a result of this reduced tongue use. Several
   changes in contractile properties due to the artificial rearing process
   were observed, which fully recovered by postnatal days 41 to 42 (P41-2).
   These changes included a shorter twitch contraction time, shorter twitch
   half-relaxation time, and decreased fatigue resistance. Styloglossus
   muscle exhibited more neonatal myosin heavy chain (MHC) isoform at P21
   for the artificially reared (AR) group. Changes that were persistent at
   P41-2 were also observed. Maximum tetanic tension was lower for the AR
   group at P21 and P41-2 compared with their dam-reared counterparts.
   Twitch tension was also lower by P41-2 in the AR group. At P41-2, the AR
   group exhibited an increase in MHC IIa and a decrease in MHC IIb for the
   styloglossus muscle. In addition, the AR group exhibited a decreased MHC
   IIb for the long head of the biceps brachii at P41-2. Our results are
   similar to other models of hindlimb immobilization and suspension. By
   extending our artificial rearing period, this reduced tongue activity
   induced acute changes and alterations in the tongue retrusor musculature
   that persisted into early adulthood.
TC 1
ZB 0
Z8 0
ZS 0
Z9 1
SN 8750-7587
UT WOS:000240510000009
PM 16809631
ER

PT J
AU Norman, H.
   Nordquist, J.
   Andersson, P.
   Ansved, T.
   Tang, X.
   Dworkin, B.
   Larsson, L.
TI Impact of post-synaptic block of neuromuscular transmission, muscle
   unloading and mechanical ventilation on skeletal muscle protein and mRNA
   expression
SO PFLUGERS ARCHIV-EUROPEAN JOURNAL OF PHYSIOLOGY
VL 453
IS 1
BP 53
EP 66
DI 10.1007/s00424-006-0110-5
PD OCT 2006
PY 2006
AB To analyse mechanisms of muscle wasting in intensive care unit patients,
   we developed an experimental model where rats were pharmacologically
   paralysed by post-synaptic block of neuromuscular transmission (NMB) and
   mechanically ventilated for 9 2 days. Specific interest was focused on
   the effects on protein and mRNA expression of sarcomeric proteins, i.e.,
   myosin heavy chain (MyHC), actin, myosin-binding protein C (MyBP-C) and
   myosin-binding protein H (MyBP-H) in fast- and slow-twitch limb,
   respiratory and masticatory muscles. Muscle-specific differences were
   observed in response to NMB at both the protein and mRNA levels. At the
   protein level, a decreased MyHC-to-actin ratio was observed in all
   muscles excluding the diaphragm, whereas at the mRNA level a decreased
   expression of the dominating MyHC isoform(s) was observed in the hind
   limb and intercostal muscles, but not in the diaphragm and masseter
   muscles. MyBP-C mRNA expression was decreased in the limb muscles, but
   it otherwise remained unaffected. MyBP-H conversely increased in all
   muscles. Furthermore, we found myofibrillar protein and mRNA expression
   to be affected differently when comparing NMB; animals with peripherally
   denervated (DEN) ambulatory rats. We report that NMB; has both a larger
   and different impact on muscle, at the protein and mRNA levels, than DEN
   has.
TC 19
ZB 15
Z8 0
ZS 0
Z9 19
SN 0031-6768
UT WOS:000242343400006
PM 16868767
ER

PT J
AU Gill, Inder
   Eagle, Michelle
   Mehta, Jwalant S.
   Gibson, Michael J.
   Bushby, K.
   Bullock, R.
TI Correction of neuromuscular scoliosis in patients with preexisting
   respiratory failure
SO SPINE
VL 31
IS 21
BP 2478
EP 2483
DI 10.1097/01.brs.0000239215.87174.8f
PD OCT 1 2006
PY 2006
AB Study Design. A prospective observational study in scoliosis patients
   who were on noninvasive night ventilation for respiratory failure.
   Objective. To report the results of spinal deformity correction in a
   group of patients with progressive scoliosis and rare forms of muscular
   dystrophy/myopathy with respiratory failure who were on nocturnal
   ventilatory support at the time of surgery.
   Summary of Background Data. This is the first study on the results of
   deformity correction in a series of patients on ventilatory support.
   Materials and Methods. Eight patients (6 males, 2 females) presented
   with progressive scoliosis and respiratory failure. The mean age at
   surgery was 12 years (range, 8-15 years). The mean follow-up was 48
   months (range, 12-80 months). Outcome measures include lung function
   (spirometry), overnight pulse oximetry, Cobb angles, duration of stay in
   Intensive care (ICU), and the total hospital stay.
   Results. The mean stay in the ICU was 2.7 days (range, 2-5 days). The
   mean hospital stay was 14.2 days (range, 10-21 days). The mean
   preoperative Cobb angle was 70.2 (55-85). This changed to 32 (16-65)
   after surgery (P = 0.0002). The mean vital capacity at the time of
   surgery was 20% (range, 13%-28%). The mean vital capacity of patients at
   last follow-up was 18% (range, 10% -31%). The desaturation noted on the
   preventilation overnight oximetry was reversed by nocturnal ventilation.
   All patients recovered well following surgery with no major cardiac or
   pulmonary complications.
   Conclusion. Patients with preexisting respiratory failure on nocturnal
   noninvasive ventilation can be safely operated for deformity correction.
   This can help to significantly improve their quality of life.
TC 23
ZB 6
Z8 0
ZS 0
Z9 23
SN 0362-2436
UT WOS:000241077400012
PM 17023858
ER

PT J
AU Marlow, N
   Greenough, A
   Peacock, J L
   Marston, L
   Limb, E S
   Johnson, A H
   Calvert, S A
TI Randomised trial of high frequency oscillatory ventilation or
   conventional ventilation in babies of gestational age 28 weeks or less:
   respiratory and neurological outcomes at 2 years.
SO Archives of disease in childhood. Fetal and neonatal edition
VL 91
IS 5
BP F320
EP 6
DI 10.1136/adc.2005.079632
PD 2006-Sep
PY 2006
AB BACKGROUND: The long term outcome of children entered into neonatal
   trials of high frequency oscillatory ventilation (HFOV) or conventional
   ventilation (CV) has been rarely studied.
   OBJECTIVE: To evaluate respiratory and neurodevelopmental outcomes for
   children entered into the United Kingdom Oscillation Study, which was
   designed to evaluate these outcomes.
   METHODS: Surviving infants were followed until 2 years of age corrected
   for prematurity. Study forms were completed by local paediatricians at
   routine assessments, and parents were asked to complete a validated
   neurodevelopmental questionnaire.
   RESULTS: Paediatricians' forms were returned for 73% of the 585
   surviving infants. Respiratory symptoms were common in all infants, and
   41% had received inhaled medication. Mode of ventilation had no effect
   on frequency of any symptoms. At 24 months of age, severe
   neurodevelopmental disability was present in 9% and other disabilities
   in 38% of children, but the prevalence of disability was similar in
   children who received HFOV or CV (relative risk 0.93; 95% confidence
   interval 0.74 to 1.16). The prevalence of disability did not vary by
   gestational age, but boys were more likely to have overall disability.
   Developmental scores were unaffected by mode of ventilation (relative
   risk 1.13; 95% confidence interval 0.78 to 1.63) and were lower in
   infants born before 26 weeks gestation compared with babies born at
   26-28 weeks.
   CONCLUSIONS: Initial mode of ventilation in very preterm infants has no
   impact on respiratory or neurodevelopmental morbidity at 2 years. HFOV
   and CV appear equally effective for the early treatment of respiratory
   distress syndrome.
RI Marston, Louise/A-8535-2012
OI Marston, Louise/0000-0002-9973-1131
TC 15
ZB 6
Z8 0
ZS 0
Z9 15
SN 1359-2998
UT MEDLINE:16690640
PM 16690640
ER

PT J
AU Chiang, Ling-Ling
   Wang, Li-Ying
   Wu, Chin-Pyng
   Wu, Huey-Dong
   Wu, Ying Tai
TI Effects of physical training on functional status in patients with
   prolonged mechanical ventilation
SO PHYSICAL THERAPY
VL 86
IS 9
BP 1271
EP 1281
DI 10.2522/ptj.20050036
PD SEP 2006
PY 2006
AB Background and Purpose. Patients requiring prolonged mechanical
   ventilation (PMV) are frequently deconditioned because of respiratory
   failure precipitated by the underlying disease, the adverse effects of
   medications, and a period of prolonged immobilization. The, effects of 6
   weeks of physical training on the strength of respiratory and limb
   muscles, on ventilator-free time, and on functional status in patients
   requiring PMV. were examined. Subjects. Thirty-nine patients with PMV
   were initially enrolled in the study and were assigned to either a
   treatment group (n=20) or a control group (n=19). Three subjects in the
   treatment group and 4 subjects in the control group died during the
   6-week intervention period and thus their data were excluded from the
   final analysis. Methods. Subjects in the treatment group received
   physical training 5 days a week for 6 weeks. Strength of respiratory,
   and limb muscles, ventilator-free time, and functional status, which was
   measured by the Barthel Index of Activities of Daily Living (BI) and
   Functional Independence Measure (FIM), were examined at baseline and at
   the third and sixth weeks of the study period. Results. Respiratory and
   limb muscle strength improved significantly at the third and sixth weeks
   in the treatment group compared with baseline measurements. Total BI and
   FIM scores increased significantly in the treatment group and remained
   unchanged in the control group. Effect sizes of the BI and FIM scores
   were 2.02 and 1.93, respectively, at the sixth week. Discussion and
   Conclusion. The results show that a 6-week physical training program may
   improve limb muscle strength and ventilator-free time and thus improve
   functional outcomes in patients requiring PMV.
TC 52
ZB 9
Z8 1
ZS 9
Z9 62
SN 0031-9023
UT WOS:000240301600009
PM 16959675
ER

PT J
AU Dhand, Rajiv
   Johnson, Jeremy C.
TI Care of the chronic tracheostomy
SO RESPIRATORY CARE
VL 51
IS 9
SI SI
BP 984
EP 1001
PD SEP 2006
PY 2006
AB A minority of patients with neuromuscular disease require placement of a
   tracheostomy, usually for the purpose of providing mechanical
   ventilation. Often the tracheostomy is performed during a hospital
   admission for an acute illness. The debate about the appropriate timing
   of tracheostomy in critically ill patients has not been resolved;
   however, the weight of evidence now favors performing a tracheostomy
   early (within 7 d of translaryngeal intubation) if the period of
   mechanical ventilation is likely to be prolonged beyond 3 weeks. For
   patients with chronic progressive weakness who develop respiratory
   difficulty, the consensus of opinion is that tracheostomy should be
   performed in patients with severe bulbar involvement, inability to
   effectively cough up secretions despite mechanical aids for secretion
   clearance, or for those who are unable to tolerate or fail noninvasive
   ventilation. The decision to perform tracheostomy in patients with
   chronic neuromuscular weakness involves consideration of several
   factors, including complications, resources, quality of life, ethical
   issues, cosmetic issues, and cost. Complications from tracheostomy and
   physician-perceived poor quality of life often lead to a negative bias,
   such that some patients may be denied this life-saving procedure.
   Special training is needed to provide long-term tracheostomy care, and
   an organized approach should be followed to decannulate patients who
   recover from their acute illness. Appropriate and skilled care could
   significantly improve the longevity and quality of life of those
   patients with neuromuscular disease who have a tracheostomy for
   long-term ventilation.
TC 7
ZB 0
Z8 0
ZS 1
Z9 8
SN 0020-1324
UT WOS:000240390200001
PM 16934163
ER

PT J
AU Mehta, Sangeeta
TI Neuromuscular disease causing acute respiratory failure
SO RESPIRATORY CARE
VL 51
IS 9
SI SI
BP 1016
EP 1021
PD SEP 2006
PY 2006
AB In the developed world, Guillain-Barre syndrome and myasthenia gravis
   account for the majority of cases of acute respiratory failure
   associated with neuromuscular disease. The 4 components that contribute
   to respiratory failure are upper-airway dysfunction, inspiratory-muscle
   weakness, expiratory-muscle weakness, and the pulmonary complications
   associated with these conditions. Careful observation and objective
   monitoring are essential to determine the appropriate timing of
   intubation and mechanical ventilation. Pulmonary function tests that can
   help predict the need for mechanical ventilation include vital capacity,
   peak inspiratory pressure, and peak expiratory pressure. The morbidity
   and mortality of patients who require mechanical ventilation are not
   insubstantial. This paper will review the mechanisms underlying acute
   respiratory failure, the clinical assessment of patients, the predictors
   of the need for mechanical ventilation, and the intensive-care-unit
   morbidity and mortality of patients with Guillain-Barre syndrome or
   myasthenia gravis.
CT 37th Conference on Neuromuscular Disease in Respiratory and Critical
   Care Medicine
CY MAR 17-19, 2006
CL Ixtapa, MEXICO
TC 44
ZB 11
Z8 0
ZS 1
Z9 45
SN 0020-1324
UT WOS:000240390200005
PM 16934165
ER

PT J
AU Dhand, Upinder K.
TI Clinical approach to the weak patient in the intensive care unit
SO RESPIRATORY CARE
VL 51
IS 9
SI SI
BP 1024
EP 1040
PD SEP 2006
PY 2006
AB Motor weakness in a patient in the intensive care unit (ICU) may be
   related to (1) pre-existing neuromuscular disorder that leads to ICU
   admission, (2) new-onset or previously undiagnosed neurological
   disorder, or (3) complications of non-neuromuscular critical illness.
   Neuromuscular syndromes related to ICU treatment consist of critical
   illness polyneuropathy, critical illness myopathy, and prolonged
   neuromuscular blockade, and are now recognized as a frequent cause of
   newly acquired weakness in ICU patients. Clinical features include
   quadriparesis, muscle wasting, and difficulty weaning from the
   ventilator. Evaluation of these patients is based on knowledge of
   clinical setting and predisposing factors, focused neurological
   examination, detailed electrophysiological investigation, serum creatine
   kinase level, other laboratory studies as needed, and histological
   examination of muscle biopsy. If a central nervous system (brain or
   spinal cord) lesion is suspected, neuroimaging studies are required. In
   addition to conventional nerve conduction and needle electromyography,
   phrenic nerve conduction, diaphragm electromyography, blink reflex, and
   (recently) the technique of direct muscle stimulation have been
   employed. Critical illness polyneuropathy is an axonal motor and sensory
   neuropathy that often follows sepsis and multiorgan failure. Risk
   factors for critical illness myopathy are corticosteroids and
   neuromuscular blocking drugs, acute respiratory illness, and organ
   transplant. Three subtypes (acute necrotizing myopathy, thick myosin
   filament loss myopathy, and type II fiber atrophy) are recognized. Major
   differential diagnoses of critical illness related paralysis are
   incidental Guillain-Barre syndrome and unmasked myasthenia gravis.
   Rarely, atypical presentation of amyotrophic lateral sclerosis,
   polymyositis or other myopathies, and precipitation of porphyria or
   rhabdomyolysis due to drugs used in the ICU have been described.
   Recently a poliomyelitis-like flaccid paralysis due to West Nile virus
   infection was reported. A subgroup of patients with myasthenia gravis
   with muscle-specific tyrosine kinase antibody is noted to present as
   respiratory crisis. Muscle biopsy in ICU paralysis syndromes may be
   helpful in arriving at a specific diagnosis or to classify the type of
   critical illness myopathy. Nerve biopsy is only rarely indicated.
CT 37th Conference on Neuromuscular Disease in Respiratory and Critical
   Care Medicine
CY MAR 17-19, 2006
CL Ixtapa, MEXICO
TC 26
ZB 7
Z8 3
ZS 2
Z9 30
SN 0020-1324
UT WOS:000240390200007
PM 16934166
ER

PT J
AU Deem, Steven
TI Intensive-care-unit-acquired muscle weakness
SO RESPIRATORY CARE
VL 51
IS 9
SI SI
BP 1042
EP 1052
PD SEP 2006
PY 2006
AB Neuromuscular abnormalities culminating in skeletal-muscle weakness
   occur very commonly in critically ill patients. Intensive-care-unit
   (ICU) acquired neuromuscular abnormalities are typically divided into 2
   discrete classes: polyneuropathy and myopathy. However, it is likely
   that these 2 entities commonly coexist, with myopathy being the most
   common cause of weakness. Major risk factors for ICU-acquired
   neuromuscular abnormalities include sepsis, corticosteroid
   administration, and hyperglycemia, with other associated factors
   including neuromuscular blockade and increasing severity of illness. The
   pathogenesis of these disorders is not well defined, but probably
   involves inflammatory injury of nerve and/or muscle that is potentiated
   by functional denervation and corticosteroids. ICU-acquired
   neuromuscular abnormalities are associated with multiple adverse
   outcomes, including higher mortality, prolonged duration of mechanical
   ventilation, and increased length of stay. The only intervention proven
   to reduce the incidence of ICU-acquired neuromuscular abnormalities is
   intensive insulin therapy. Additional research is necessary to better
   delineate the causes and pathogenesis of these disorders and to identify
   potential preventive and therapeutic strategies. In addition, consensus
   guidelines for its classification and diagnosis are needed.
CT 37th Conference on Neuromuscular Disease in Respiratory and Critical
   Care Medicine
CY MAR 17-19, 2006
CL Ixtapa, MEXICO
TC 16
ZB 6
Z8 1
ZS 1
Z9 18
SN 0020-1324
UT WOS:000240390200009
PM 16934167
ER

PT J
AU Dhand, Rajiv
   Deem, Steven
   Dhand, Upinder
   Benditt, Joshua O.
   Mehta, Sangeeta
   Jubran, Amal
TI Intensive-care-unit-acquired muscle weakness - Discussion
SO RESPIRATORY CARE
VL 51
IS 9
SI SI
BP 1052
EP 1053
PD SEP 2006
PY 2006
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 0020-1324
UT WOS:000240390200010
ER

PT J
AU Jubran, Amal
TI Critical illness and mechanical ventilation: Effects on the diaphragm
SO RESPIRATORY CARE
VL 51
IS 9
SI SI
BP 1054
EP 1061
PD SEP 2006
PY 2006
AB Although life-saving, mechanical ventilation is associated with numerous
   complications. These include pneumonia, cardiovascular compromise,
   barotrauma, and ventilator-induced lung injury. Recent data from animal
   studies suggest that controlled mechanical ventilation can cause
   dysfunction of the diaphragm, decreasing its force-generating capacity-a
   condition referred to as ventilator-induced diaphragmatic dysfunction
   (VIDD). The decrease in diaphragmatic contractility is time-dependent
   and worsens as mechanical ventilation is prolonged. Evidence supporting
   the occurrence of comparable diaphragmatic dysfunction in critically ill
   patients is scarce, although most patients receiving mechanical
   ventilation display profound diaphragmatic weakness. Atrophy, fibers
   remodeling, oxidative stress, and structural injury have been implicated
   as potential mechanisms of VIDD. The decrease in diaphragmatic force
   that occurs during controlled mechanical ventilation is attenuated
   during assisted modes of ventilation. Whether the decrease in
   diaphragmatic contractility observed during controlled ventilation
   contributes to failure to wean from the ventilator is difficult to
   ascertain. Weaning-failure patients have reasons other than VIDD for
   respiratory-muscle weakness. Until we have further data, it seems
   prudent to avoid the use of controlled mechanical ventilation in
   patients with acute respiratory failure.
CT 37th Conference on Neuromuscular Disease in Respiratory and Critical
   Care Medicine
CY MAR 17-19, 2006
CL Ixtapa, MEXICO
TC 20
ZB 8
Z8 3
ZS 2
Z9 25
SN 0020-1324
UT WOS:000240390200011
PM 16934168
ER

PT J
AU Mestrovic, J
   Kardum, G
   Polic, B
   Mestrovic, M
   Markic, J
   Sustic, A
   Krzelj, V
TI The influence of chronic health conditions on susceptibility to severe
   acute illness of children treated in PICU
SO EUROPEAN JOURNAL OF PEDIATRICS
VL 165
IS 8
BP 526
EP 529
DI 10.1007/s00431-006-0114-3
PD AUG 2006
PY 2006
AB Objectives: Our study aimed to assess differences in the susceptibility
   to severe acute illness in children with and without chronic health
   conditions treated in a pediatric intensive care unit (PICU). Patients
   and methods: Data on age, gender, need for ventilator support, length of
   stay, as well as other parameters for the Paediatric Index of Mortality
   (PIM2) score were collected. Data were analyzed and compared across
   three patient groups: those with a neurodevelopmental disability, those
   with a chronic condition other than a neurodevelopmental disability, and
   those with no chronic condition. Reasons for admission of patients were
   classified according to the Australia and New Zealand Paediatric
   Intensive Care Registry (ANZPIC Registry) diagnostic codes. In the
   multidisciplinary, seven-bed, level I PICU of the Split University
   Hospital, the admission data were collected prospectively for 591
   consecutively admitted patients aged <= 18 years. Results: Patients with
   a neurodevelopmental disability had a significantly higher rate of
   respiratory-related admissions compared to patients with other chronic
   health conditions and those with no chronic condition (chi(2)=33.72, P <
   0.001). There was a significant difference in the age at admission
   (f=6.04, P=0.003), median length of stay (f=7.94, P < 0.001), need for
   ventilation during the first hour of admission (chi(2)=14.74, P < 0.001)
   and PICU mortality (chi(2)=9.91, P=0.007) of patients with
   neurodevelopmental disabilities, compared to the other two groups of
   patients. Conclusions: Children with neurodevelopmental disabilities are
   more susceptible to acute illness compared to children with other
   chronic health conditions and those with no chronic condition.
RI Markic, Josko/C-2044-2008; Polic, Branka/D-9732-2013
OI Markic, Josko/0000-0001-9469-9278; 
TC 9
ZB 4
Z8 0
ZS 2
Z9 10
SN 0340-6199
UT WOS:000238684400004
PM 16557402
ER

PT J
AU Vondracek, Petr
   Bednarik, Josef
TI Clinical and electrophysiological findings and long-term outcomes in
   paediatric patients with critical illness polyneuromyopathy
SO EUROPEAN JOURNAL OF PAEDIATRIC NEUROLOGY
VL 10
IS 4
BP 176
EP 181
DI 10.1016/j.ejpn.2006.05.006
PD JUL 2006
PY 2006
AB Background: Neuromuscular weakness in paediatric patients with sepsis
   and multiple organ dysfunction is increasingly reported. However, many
   aspects of neuromuscular involvement in critically ill children are not
   completely understood. As more patients survive the critical illness, an
   understanding of the long-term outcomes of this condition is needed.
   Aims: To describe clinical and electrophysiological features and
   evaluate the long-term outcomes in critically ill paediatric patients
   with neuromuscular complications.
   Methods: A case series of five critically ill children was observed
   prospectively for a 1-month period. Selected clinical and laboratory
   parameters were evaluated. Electrophysiological studies were performed
   during the first week and then 1 month later in order to detect signs of
   critical illness polyneuromyopathy (CIPM). Patients with neuromuscular
   involvement completed a 1-year follow-up.
   Results: Electrophysiological abnormalities were detected in two
   patients. Flaccid quadriplegia was a clinical presentation. Both
   children had electromyographic evidence of chronic partial denervation
   at follow-up, findings indicative of a preceding axonal neuropathy.
   Marked but incomplete recovery within 1 year after the onset of the
   disease occured in both patients. With a mild residual functional
   handicap the health-related quality of life was not significantly
   impaired (Barthel index> 80).
   Conclusions: In both our patients with CIPM, the long-term clinical
   outcome is markedly better than we expected when electromyography in the
   1-year follow-up demonstrated a persistent severe chronic partial
   denervation. These findings can have important implications for the
   management and rehabilitation of paediatric intensive care survivors.
   (C) 2006 European Paediatric Neurology Society. Published by Elsevier
   Ltd. All rights reserved.
RI Bednarik, Josef/H-1733-2014
OI Bednarik, Josef/0000-0001-7420-2383
TC 1
ZB 0
Z8 2
ZS 0
Z9 3
SN 1090-3798
UT WOS:000242087000003
PM 16843019
ER

PT J
AU Leurer, Michal Katz
   Be'eri, Eliezer
   Zilbershtein, Dorit
TI Discharge of respiratory-compromised children after respiratory
   rehabilitation
SO ISRAEL MEDICAL ASSOCIATION JOURNAL
VL 8
IS 7
BP 473
EP 476
PD JUL 2006
PY 2006
AB Background: There is a growing demand for respiratory rehabilitation
   services for children dependent on tracheostomy and/or chronic
   mechanical ventilation. Discharging these patients home following their
   rehabilitation can be an arduous process.
   Objectives, To define the length of time required to rehabilitate and
   discharge these patients, and to identify predictors of a prolonged or
   failed discharge process.
   Method. We conducted a retrospective chart review of patients admitted
   to the Respiratory Rehabilitation Unit at Alyn Hospital, Jerusalem, over
   a 4 year period.
   Results: Of the 48 patients identified, 31 (64.7%) were eventually
   discharged, 13 (27.1%) remained hospitalized long-term, and 4 (8.3%)
   died during their hospitalization. The median lenght of hospitalization
   was 10 months: 6 months for purposes of rehabilitation therapy, and 4
   months thereafter to resolve the logistics of discharge. Specific family
   characteristics - an unemployed father (odds ratio = 4.6, P = 0.02) and
   an additional family member with a disability (OR = 5.8, P = 0.03) - as
   well as ongoing mechanical ventilation at the time of discharge (OR =
   5.5, P < 0.01) were found to positively correlate with a prolonged or
   failed discharge process.
   Conclusions: Hospitalization in a pediatric respiratory rehabilitation
   unit may be prolonged for both, medical and non-medical reasons, with
   the process of discharge home being particularly difficult in certain
   subsets of patient's. A proactive discharge policy by hospitals,
   improved community support services, and legislation defining the rights
   of home-ventilated children may facilitate more efficient discharge home
   of these patients.
RI Benneyworth, Brian/A-4667-2009
OI Benneyworth, Brian/0000-0002-4692-5303
TC 1
ZB 0
Z8 0
ZS 0
Z9 1
SN 1565-1088
UT WOS:000239193100006
PM 16889162
ER

PT J
AU Laub, M
   Berg, S
   Midgren, B
TI Symptoms, clinical and physiological findings motivating home mechanical
   ventilation in patients with neuromuscular diseases
SO JOURNAL OF REHABILITATION MEDICINE
VL 38
IS 4
BP 250
EP 254
DI 10.1080/16501970600721033
PD JUL 2006
PY 2006
AB Objective: To clarify the relationship between symptoms, clinical signs
   and physiological abnormalities that were motivating the initiation of
   home mechanical ventilation in patients suffering from neuromuscular
   diseases.
   Methods: From The Swedish Home Mechanical Ventilation Register we
   identified 352 patients with neuromuscular diseases and we looked at
   circumstances ( acute vs elective) and clinical motives for starting
   ventilatory support.
   Results: Home mechanical ventilation was commenced electively in 268
   patients ( 76%) and among these daytime sleepiness was the most common
   motive, being reported in 56% of the patients. In the 24 children with
   spinal muscular atrophy, however, 96% started ventilation electively and
   cough insufficiency was the most common motive. The patients were
   moderately hypercapnic ( PaCO2: 7.0 kPa, SD 1.3). None of the clinical
   motives were related to the PaCO2 level. Average PaO2 was above 8 kPa in
   all groups, but lowest in the patients with post-polio and dystrophia
   myotonica. Mean vital capacity was close to 40% of predicted, but
   significantly lower in the Duchenne patients ( 26% of predicted).
   Conclusion: Daytime sleepiness was the most common clinical symptom
   motivating home mechanical ventilation in this group of patients with
   chronic hypercapnic respiratory insufficiency secondary to
   neuro/myopathies. Respiratory function testing is therefore suggested to
   be included in the diagnostic work up of daytime sleepiness in these
   patients.
TC 9
ZB 0
Z8 0
ZS 0
Z9 9
SN 1650-1977
UT WOS:000238610100008
PM 16801208
ER

PT J
AU Finsterer, Josef
TI Cardiopulmonary support in duchenne muscular dystrophy
SO LUNG
VL 184
IS 4
BP 205
EP 215
DI 10.1007/s00408-005-2584-x
PD JUL-AUG 2006
PY 2006
AB Duchenne muscular dystrophy (DMD) is an X-linked, rapidly progressive
   myopathy affecting the limb muscles, the respiratory muscles, the heart,
   the intestines, and the brain. Since about 90% of DMD patients die from
   muscular respiratory failure or cardiomyopathy, early and adequate
   therapy is essential. Ventilatory failure from muscle weakness requires
   mechanical support for ventilation and coughing as soon as there is
   symptomatic nocturnal hypoventilation. Today noninvasive
   positivepressure ventilation (NIPPV) is the method of choice for
   supportive long-term mechanical ventilation in DMD. For assisted
   coughing, various methods are available, among which the mechanical
   in-exsufflator is the most widely used device. There is large
   nonrandomized clinical trial evidence that NIPPV improves quality of
   life and prolongs the lives of DMD patients if medical, social,
   economic, and ethical issues, raised by the availability of long-term
   NIPPV, are adequately addressed. Cardiac involvement in DMD manifests as
   impulse generation or impulse conduction abnormalities or
   cardiomyopathy. Cardiac abnormalities in DMD respond well to adequate
   therapy. Though DMD is ultimately a fatal disease, quality of life and
   life expectancy can be markedly improved if cardiopulmonary
   manifestations are adequately treated.
TC 18
ZB 8
Z8 0
ZS 0
Z9 18
SN 0341-2040
UT WOS:000239961100003
PM 17006747
ER

PT J
AU Kang, Seong-Woong
TI Pulmonary rehabilitation in patients with neuromuscular disease
SO YONSEI MEDICAL JOURNAL
VL 47
IS 3
BP 307
EP 314
PD JUN 30 2006
PY 2006
AB in neuromuscular disease (NMD) patients with progressive muscle
   weakness, respiratory muscles are also affected and hypercapnia can
   increase gradually as the disease progresses. The fundamental
   respiratory problems NMD patients experience are decreased alveolar
   ventilation and coughing ability. For these reasons, it is necessary to
   precisely evaluate pulmonary function to provide the proper inspiratory
   and expiratot, muscle aids in order to maintain adequate respiratory
   function. As inspiratory muscle weakening progresses, NMD patients
   experience hypoventilation. At this point, respiratory support by
   mechanical ventilator should be initiated to relieve respiratory
   distress symptoms. Patients with adequate bulbar muscle strength and
   cognitive function who use a non-invasive ventilation aid, via a
   mouthpiece or a nasal mask, may have their hypercapnia and associated
   symptoms resolved. For a proper cough assist, it is necessary to provide
   additional insufflation to patients with inspiratory muscle weakness
   before using abdominal thrust. Another effective method for managing
   airway secretions is a device that performs mechanical
   insufflation-exsufflation. In conclusion, application of non-invasive
   respiratory aids, taking into consideration characterization of
   respiratory pathophysiology, have made it possible to maintain a better
   quality of life in addition to prolonging the life span of patients with
   NMD.
TC 8
ZB 2
Z8 0
ZS 2
Z9 8
SN 0513-5796
UT WOS:000238854900002
PM 16807978
ER

PT J
AU Boucher, VJ
   Ahmarani, C
   Ayad, T
TI Physiologic features of vocal fatigue: Electromyographic
   spectral-compression in laryngeal muscles
SO LARYNGOSCOPE
VL 116
IS 6
BP 959
EP 965
DI 10.1097/01.MLG.0000216824.07244.00
PD JUN 2006
PY 2006
AB Objectives: This study addresses the problem of defining observable
   attributes of "vocal fatigue" as a physiologic condition. The aim was to
   determine the applicability of electromyography (EMG) spectral
   compression in observing fatigue in laryngeal muscles arising from
   prolonged vocal effort. Study Design: Single institution, nonrandomized,
   prospective analysis of subjects evaluated in an academic, tertiary care
   center. Methods: In adapting EMG techniques, we report pretest
   observations that bear on the choice of voicing tasks serving to induce
   and estimate muscle fatigue and the selection of muscles that are
   particularly involved in effortful vocalization. On this basis, an
   experiment was designed where intramuscular EMG was used to record
   lateral cricoarytenoid potentials of seven subjects at regular intervals
   across a 12 to 14 hour period (50 samples per subject). Between each of
   these samples, the participants were required to produce loud speech for
   3 minutes with peaks of 74 dBA at 1 meter. Results: The results show
   fatigue-related spectral compression for all subjects and nonlinear
   changes across time indicating critical values beyond which fatigue is
   persistent. Conclusion: Spectral compression appears to present a robust
   attribute of fatigue-related changes in muscles involved in
   vocalization. There are several implications with respect to research on
   the prevention of acquired voice pathologies.
TC 8
ZB 5
Z8 0
ZS 0
Z9 9
SN 0023-852X
UT WOS:000238031200022
PM 16735908
ER

PT J
AU Khan, J.
   Burnham, E. L.
   Moss, M.
TI Acquired weakness in the ICU: critical illness myopathy and
   polyneuropathy
SO MINERVA ANESTESIOLOGICA
VL 72
IS 6
BP 401
EP 406
PD JUN 2006
PY 2006
AB Illnesses commonly encountered in the ICU, such as sepsis, have
   frequently been associated with neuromuscular weakness and may play a
   role in the development of CIM and CIP, whose incidence in the
   critically ill is greater than initially reported. Although difficult to
   diagnose from history and clinical/laboratory findings alone, the use of
   electromyographic and nerve conduction testing is helpful in
   establishing these diagnoses. information regarding prognosis of these
   disorders is limited, and there are no specific therapies that improve
   outcome. Acquired neuromuscular weakness in the ICU affects a
   significant number of patients and may continue to affect their quality
   of life long after discharge. Although diagnostic techniques are readily
   available, additional research is necessary to obtain adequate
   prognostic information and therapeutic options for these patients.
CT Symposium on Extension Anesthesia Resuscitation and Intensive Therapy
CY MAY 10-12, 2006
CL Milan, ITALY
TC 8
ZB 3
Z8 0
ZS 0
Z9 8
SN 0375-9393
UT WOS:000241918600010
PM 16682908
ER

PT J
AU Whetstone Foster, Janet G
   Clark, Angela P
TI Functional recovery after neuromuscular blockade in mechanically
   ventilated critically ill patients.
SO Heart & lung : the journal of critical care
VL 35
IS 3
BP 178
EP 89
DI 10.1016/j.hrtlng.2005.08.003
PD 2006 May-Jun
PY 2006
AB BACKGROUND: An estimated 24% to 70% of individuals have prolonged
   paralysis or severe weakness after receiving neuromuscular blocking
   agents (NMBAs) when therapy is terminated.
   OBJECTIVES: The purposes of this study were to (1) evaluate the
   relationship between recovery of neuromuscular transmission (NMT) and
   functional muscle activity after NMBA administration; (2) evaluate the
   relationship between delayed recovery of NMT or muscle activity and
   functional performance; and (3) determine the predictors of delayed
   recovery of NMT, muscle activity, and functional performance.
   METHODS: This was a multisite study using a prospective,
   nonexperimental, descriptive design with convenience sampling
   techniques. Instruments used included a five-point muscle score,
   Actigraph, and peripheral nerve stimulator.
   RESULTS: Key findings were as follows: (1) NMT returned promptly,
   whereas muscle activity remained severely depressed; (2) only two
   subjects (5%) recovered functional performance within 24 hours; (3)
   degree of muscle weakness immediately after neuromuscular blockade was
   associated with prolonged time to extubation and mobility; and (4)
   predictors of delayed recovery included cumulative dose of aminosteroid
   NMBAs, age, and renal function.
   CONCLUSION: Prolonged recovery of muscle activity and extreme weakness
   may occur despite brisk recovery of NMT after neuromuscular blockade.
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 0147-9563
UT MEDLINE:16701112
PM 16701112
ER

PT J
AU Teener, James W.
   Rich, Mark M.
TI Dysregulation of sodium channel gating in critical illness myopathy
SO JOURNAL OF MUSCLE RESEARCH AND CELL MOTILITY
VL 27
IS 5-7
BP 291
EP 296
DI 10.1007/s10974-006-9074-5
PD MAY 2006
PY 2006
AB Critical illness myopathy (CIM) is the most common caused of acquired
   weakness in critically ill patients. While atrophy of muscle fibers
   causes weakness, the primary cause of acute weakness is loss of muscle
   excitability. Studies in an animal model of CIM suggest that both
   depolarization of the resting potential and a hyperpolarized shift in
   the voltage dependence of sodium channel gating combine to cause
   inexcitability. In active adult skeletal muscle the only sodium channel
   isoform expressed is Nav1.4. In the animal model of CIM the Nav1.5
   sodium channel isoform is upregulated, but the majority of sodium
   current is still carried by Nav1.4 sodium channels. Experiments using
   toxins to selectively bock the Nav1.4 isoform demonstrated that the
   cause of the hyperpolarized shift in sodium channel inactivation is a
   hyperpolarized shift in inactivation of the Nav1.4 isoform. These data
   suggest that CIM represents a new type of ion channel disease in which
   altered gating of sodium channels is due to improper regulation of the
   channels rather than mutation of channels or changes in isoform
   expression. The hypothesis that dysregulation of sodium channel gating
   underlies inexcitability of skeletal muscle in CIM raises the
   possibility that there maybe dysregulation of sodium channel gating in
   other tissues in critically ill patients. We propose that there is a
   syndrome of reduced electrical excitability in critically ill patients
   that affects skeletal muscle, peripheral nerve, the heart and central
   nervous system. This syndrome manifests as CIM, critical illness
   polyneuropathy, reduced cardiac contractility and septic encephalopathy.
TC 27
ZB 12
Z8 0
ZS 0
Z9 27
SN 0142-4319
UT WOS:000240127700003
PM 16874452
ER

PT J
AU Canani, RB
   Cirillo, P
   Roggero, P
   Romano, C
   Malamisura, B
   Terrin, G
   Passariello, A
   Manguso, F
   Morelli, L
   Guarino, A
CA SIGENP Working Grp
TI Therapy with gastric acidity inhibitors increases the risk of acute
   gastroenteritis and community-acquired pneumonia in children
SO PEDIATRICS
VL 117
IS 5
BP E817
EP E820
DI 10.1542/peds.2005-1655
PD MAY 2006
PY 2006
AB OBJECTIVE. Gastric acidity ( GA) inhibitors, including histamine-2
   receptor antagonists ( H-2 blockers) and proton pump inhibitors ( PPIs),
   are the mainstay of gastroesophageal reflux disease ( GERD) treatment. A
   prolonged GA inhibitor-induced hypochlorhydria has been suggested as a
   risk factor for severe gastrointestinal infections. In addition, a
   number of papers and a meta-analysis have shown an increased risk of
   pneumonia in H-2-blocker-treated intensive care patients. More recently,
   an increased risk of community-acquired pneumonia associated with GA
   inhibitor treatment has been reported in a large cohort of adult
   patients. These findings are particularly relevant to pediatricians
   today because so many children receive some sort of GA-blocking agent to
   treat GERD. To test the hypothesis that GA suppression could be
   associated with an increased risk of acute gastroenteritis and pneumonia
   in children treated with GA inhibitors, we conducted a multicenter,
   prospective study.
   METHODS. The study was performed by expert pediatric gastroenterologists
   from 4 pediatric gastroenterology centers. Children ( aged 4-36 months)
   consecutively referred for common GERD-related symptoms ( for example,
   regurgitation and vomiting, feeding problems, effortless vomiting,
   choking), from December 2003 to March 2004, were considered eligible for
   the study. Exclusion criteria were a history of GA inhibitors therapy in
   the previous 4 months, Helicobacter pylori infection, diabetes, chronic
   lung or heart diseases, cystic fibrosis, immunodeficiency, food allergy,
   congenital motility gastrointestinal disorders, neuromuscular diseases,
   or malnutrition. Control subjects were recruited from healthy children
   visiting the centers for routine examinations. The diagnosis of GERD was
   confirmed in all patients by standard criteria. GA inhibitors ( 10 mg/
   kg ranitidine per day in 50 children or 1 mg/ kg omeprazole per day in
   50 children) were prescribed by the physicians for 2 months. All
   enrolled children were evaluated during a 4-month follow-up. The end
   point was the number of patients presenting with acute gastroenteritis
   or community-acquired pneumonia during a 4-month follow-up study period.
   RESULTS. We obtained data in 186 subjects: 95 healthy controls and 91
   GA-inhibitor users ( 47 on ranitidine and 44 on omeprazole). The 2
   groups were comparable for age, gender, weight, length, and incidence of
   acute gastroenteritis and pneumonia in the 4 months before enrollment.
   Rate of subjects presenting with acute gastroenteritis and
   community-acquired pneumonia was significantly increased in patients
   treated with GA inhibitors compared with healthy controls during the
   4-month follow-up period. In the GA inhibitor-treated group, the rate of
   subjects presenting with acute gastroenteritis and community-acquired
   pneumonia was increased when comparing the 4 months before and after
   enrollment. No differences were observed between H-2 blocker and PPI
   users in acute gastroenteritis and pneumonia incidence in the previous 4
   months and during the follow-up period. On the contrary, in healthy
   controls, the incidence of acute gastroenteritis and pneumonia remained
   stable.
   CONCLUSIONS. This is the first prospective study performed in pediatric
   patients showing that the use of GA inhibitors was associated with an
   increased risk of acute gastroenteritis and community-acquired pneumonia
   in GERD-affected children. It could be interesting to underline that we
   observed an increased incidence of intestinal and respiratory infection
   in otherwise healthy children taking GA inhibitors for GERD treatment.
   On the contrary, the majority of the previous data showed that the
   patients most at risk for pneumonia were those with significant comorbid
   illnesses such as diabetes or immunodeficiency, and this points to the
   importance of GA suppression as a major risk factor for infections. In
   addition, this effect seems to be sustained even after the end of
   therapy. The results of our study are attributable to many factors,
   including direct inhibitory effect of GA inhibitors on leukocyte
   functions and qualitative and quantitative gastrointestinal microflora
   modification. Additional studies are necessary to investigate the
   mechanisms of the increased risk of infections in children treated with
   GA inhibitors, and prophylactic measures could be considered in
   preventing them.
TC 124
ZB 64
Z8 5
ZS 1
Z9 130
SN 0031-4005
UT WOS:000237207300001
PM 16651285
ER

PT J
AU Steinberg, KP
   Hudson, LD
   Goodman, RB
   Hough, CL
   Lanken, PN
   Hyzy, R
   Thompson, BT
   Ancukiewicz, M
CA Natl Heart Lung Blood Inst Acute R
TI Efficacy and safety of corticosteroids for persistent acute respiratory
   distress syndrome
SO NEW ENGLAND JOURNAL OF MEDICINE
VL 354
IS 16
BP 1671
EP 1684
PD APR 20 2006
PY 2006
AB BACKGROUND:
   Persistent acute respiratory distress syndrome (ARDS) is characterized
   by excessive fibroproliferation, ongoing inflammation, prolonged
   mechanical ventilation, and a substantial risk of death. Because
   previous reports suggested that corticosteroids may improve survival, we
   performed a multicenter, randomized controlled trial of corticosteroids
   in patients with persistent ARDS.
   METHODs:
   We randomly assigned 180 patients with ARDS of at least seven days'
   duration to receive either methylprednisolone or placebo in a
   double-blind fashion. The primary end point was mortality at 60 days.
   Secondary end points included the number of ventilator-free days and
   organ-failure-free days, biochemical markers of inflammation and
   fibroproliferation, and infectious complications.
   RESULTS:
   At 60 days, the hospital mortality rate was 28.6 percent in the placebo
   group (95 percent confidence interval, 20.3 to 38.6 percent) and 29.2
   percent in the methylprednisolone group (95 percent confidence interval,
   20.8 to 39.4 percent; P=1.0); at 180 days, the rates were 31.9 percent
   (95 percent confidence interval, 23.2 to 42.0 percent) and 31.5 percent
   (95 percent confidence interval, 22.8 to 41.7 percent; P=1.0),
   respectively. Methylprednisolone was associated with significantly
   increased 60- and 180-day mortality rates among patients enrolled at
   least 14 days after the onset of ARDS. Methylprednisolone increased the
   number of ventilator-free and shock-free days during the first 28 days
   in association with an improvement in oxygenation, respiratory-system
   compliance, and blood pressure with fewer days of vasopressor therapy.
   As compared with placebo, methylprednisolone did not increase the rate
   of infectious complications but was associated with a higher rate of
   neuromuscular weakness.
   CONCLUSIONS:
   These results do not support the routine use of methylprednisolone for
   persistent ARDS despite the improvement in cardiopulmonary physiology.
   In addition, starting methylprednisolone therapy more than two weeks
   after the onset of ARDS may increase the risk of death.
TC 399
ZB 149
Z8 32
ZS 5
Z9 444
SN 0028-4793
UT WOS:000236893900004
PM 16625008
ER

PT J
AU Oddo, M
   Feihl, F
   Schaller, MD
   Perret, C
TI Management of mechanical ventilation in acute severe asthma: practical
   aspects
SO INTENSIVE CARE MEDICINE
VL 32
IS 4
BP 501
EP 510
DI 10.1007/s00134-005-0045-x
PD APR 2006
PY 2006
AB Background: Acute severe asthma induces marked alterations in
   respiratory mechanics, characterized by a critical limitation of
   expiratory flow and a heterogeneous and reversible increase in airway
   resistance, resulting in premature airway closure, lung, and chest wall
   dynamic hyperinflation and high intrinsic PEEP. Discussion: These
   abnormalities increase the work of breathing and can lead to respiratory
   muscle fatigue and life-threatening respiratory failure, in which case
   mechanical ventilation is life-saving. When instituting mechanical
   ventilation in this setting, a major concern is the risk of worsening
   lung hyperinflation (thereby provoking barotrauma) and inducing or
   aggravating hemodynamic instability. Guidelines for mechanical
   ventilation in acute severe asthma are not supported by strong clinical
   evidence. Controlled hypoventilation with permissive hypercapnia may
   reduce morbidity and mortality compared to conventional normocapnic
   ventilation. Profound pathological alterations in respiratory mechanics
   occur during acute severe asthma, which clinicians should keep in mind
   when caring for ventilated asthmatics. Conclusion: We focus on the
   practical management of controlled hypoventilation. Particular attention
   must be paid to ventilator settings, monitoring of lung hyperinflation,
   the role of extrinsic PEEP, and administering inhaled bronchodilators.
   We also underline the importance of deep sedation with respiratory
   drive-suppressing opioids to maintain patient-ventilator synchrony while
   avoiding as much as can be muscle paralysis and the ensuing risk of
   myopathy. Finally, the role of noninvasive positive pressure ventilation
   for the treatment of respiratory failure during severe asthma is
   discussed.
TC 48
ZB 10
Z8 5
ZS 4
Z9 56
SN 0342-4642
UT WOS:000236211700004
PM 16552615
ER

PT J
AU Lefaucheur, JP
   Nordine, T
   Rodriguez, P
   Brochard, L
TI Origin of ICU acquired paresis determined by direct muscle stimulation
SO JOURNAL OF NEUROLOGY NEUROSURGERY AND PSYCHIATRY
VL 77
IS 4
BP 500
EP 506
DI 10.1136/jnnp.2005.070813
PD APR 2006
PY 2006
AB Background: Acquired diffuse paresis in an intensive care unit (ICU) can
   result from critical illness myopathy or polyneuropathy. Clinical
   examination and conventional neurophysiological techniques may not
   distinguish between these entities.
   Objective: To assess the value of direct muscle stimulation (DMS) to
   differentiate myopathic from neuropathic process in critically ill
   patients with diffuse severe muscle weakness.
   Methods: 30 consecutive patients with ICU acquired diffuse motor
   weakness were studied. Responses of the right deltoid and tibialis
   anterior muscles to DMS and to motor nerve stimulation ( MNS) were
   studied and compared with results of conventional nerve conduction
   studies and concentric needle electromyography ( EMG). An original
   algorithm was used for differential diagnosis, taking into account first
   the amplitude of the responses to DMS, then the MNS to DMS amplitude
   ratio, and finally the amplitude of the sensory nerve action potentials
   recorded at the lower limbs.
   Results: Evidence of neuropathy and myopathy was found in 57% and 83% of
   the patients, respectively. Pure or predominant myopathy was found in 19
   patients. Other results were consistent with neuromyopathy (n = 5) and
   pure or predominant neuropathy (n = 2). Four patients had normal results
   with stimulation techniques, but spontaneous EMG activity and raised
   plasma creatine kinase suggesting necrotic myopathy.
   Conclusions: A neurophysiological approach combining DMS and
   conventional techniques revealed myopathic processes in a majority of
   ICU patients. Reduced muscle fibre excitability may be a leading cause
   for this. The diagnosis of myopathy in ICU acquired paralysis can be
   established by a combination of DMS, needle EMG, and plasma creatine
   kinase.
TC 55
ZB 25
Z8 6
ZS 0
Z9 60
SN 0022-3050
UT WOS:000236701400018
PM 16306155
ER

PT J
AU Munoz, X
   Crespo, A
   Marti, S
   Torres, F
   Ferrer, J
   Morell, F
TI Comparative study of two different modes of noninvasive home mechanical
   ventilation in chronic respiratory failure
SO RESPIRATORY MEDICINE
VL 100
IS 4
BP 673
EP 681
DI 10.1016/j.rmed.2005.08.008
PD APR 2006
PY 2006
AB Study objective: Two modes of noninvasive home mechanical ventilation
   (NIHMV) with volumetric ventilators were compared in patients with
   chronic respiratory failure.
   Design: Retrospective, parallel-group, comparative study.
   Setting: Third-level teaching Hospital in Barcelona (Spain).
   Patients and methods: We studied 110 patients with chronic hypercapnic
   respiratory failure secondary to neuromuscular disease, kyphoscoliosis
   or post-tuberculosis sequelae, starting NIHMV with volumetric
   ventilators. The assist/control (A/C) ventilation mode was used in 45
   patients and the control (C) mode in 65 patients. Clinical
   characteristics, pulmonary function results and arterial blood gas
   findings were assessed in each patient before establishing ventilation
   and at 6 and 12 months after. The patient's satisfaction with
   ventilation, the time required for adaptation, and compliance with the
   prescription were also assessed.
   Measurements and results: Significant improvements in PaO2 and PaCO2 (P
   < 0.001) were found at 6 and 12 months with both modes of mechanical
   ventilation. There were no significant differences between the two modes
   for pulmonary function or blood gas parameters with the exception of
   maximum inspiratory pressure (MIP) in patients receiving the C mode,
   which was significantly different as compared to the baseline value
   after 12 months of use (mean +/- SD: 36.6 +/- 14.8 and 44.7 +/- 24.2
   cmH(2)O, respectively; P = 0.010). No significant differences were found
   in adaptation, compliance with ventilation or patient satisfaction
   between the two modes studied.
   Conclusions: According to several factors analysed, results with the A/C
   or C mode used with volumetric ventilators appear to be comparable in
   patients with chronic respiratory disease receiving NIHMV. Choice of
   mode will depend on the acquired experience of the prescribing
   physicians in each centre. (c) 2005 Elsevier Ltd. All rights reserved.
RI Munoz, Xavier/I-9009-2014
TC 6
ZB 3
Z8 0
ZS 0
Z9 6
SN 0954-6111
UT WOS:000236643300012
PM 16194600
ER

PT J
AU Zanon, P
   Pattis, P
   Pittscheider, W
   Roscia, G
   de Giorgi, G
   Sacco, G
   Votter, K
   Stockner, I
   de Giorgi, F
   Wiedermann, CJ
TI Two cases of foodborne botulism with home-preserved asparagus
SO ANASTHESIOLOGIE INTENSIVMEDIZIN NOTFALLMEDIZIN SCHMERZTHERAPIE
VL 41
IS 3
BP 156
EP 159
DI 10.1055/s-2006-924967
PD MAR 2006
PY 2006
AB Botulism is a rare but potentially fatal disease caused by toxins
   produced by Clostridium botulinum. We report botulism in two adult
   females, one of them just tasting from "bad" asparagus and the other
   eating the full portion. Both patients survived after intermittent
   mechanical ventilation and trivalent antitoxin administration. The
   diagnosis was confirmed by detection of botulinum toxin. Acute onset of
   bilateral cranial neuropathies associated with symmetric descending
   weakness as well as some key features of the botulism syndrome including
   absence of fever, symmetric neurologic deficits, the patients remaining
   responsive and no sensory deficits, with the exception of blurred
   vision, led to the clinical diagnosis in the first presenting case which
   was then easily made in the second. Despite the fact that amount of
   toxin ingested, time-to-symptom development, and time-to-recovery
   markedly differed in the two patients, their maximal disease severity
   was similar.
TC 2
ZB 2
Z8 0
ZS 0
Z9 2
SN 0939-2661
UT WOS:000237163400005
PM 16557441
ER

PT J
AU Schulz, M
   Wild, L
   Konig, C
   Kiess, W
   Siekmeyer, W
TI An esophagobronchial fistula caused by an unusual foreign body in the
   esophagus leading to mediastinitis with fatal outcome
SO KLINISCHE PADIATRIE
VL 218
IS 2
BP 85
EP 87
DI 10.1055/s-2005-836597
PD MAR-APR 2006
PY 2006
AB An 8(10)/(12) year old girl with infantile cerebral paresis (ICP),
   severe mental retardation and seizure disorder was admitted to the
   intensive care unit (ICU) with clinical signs of aspiration and died ten
   days later. Final diagnosis was esophagobronchial fistula caused by a
   foreign body in the esophagus provoking aspiration pneumonia,
   mediastinitis and respiratory distress syndrome (ARDS). The foreign body
   was found to be part of a plastic toy. The clinical relevance of
   aspiration in mentally retarded children and the peculiar nature of the
   foreign body impacted in the esophagus in this case are discussed. We
   conclude that in cases of aspiration pneumonia in mentally retarded
   children the presence of unusual foreign bodies Should be suspected.
TC 1
ZB 0
Z8 0
ZS 0
Z9 1
SN 0300-8630
UT WOS:000236273400008
PM 16506109
ER

PT J
AU Euteneuer, Sara
   Windisch, Wolfram
   Suchi, Stefan
   Kohler, Dieter
   Jones, Paul W
   Schonhofer, Bernd
TI Health-related quality of life in patients with chronic respiratory
   failure after long-term mechanical ventilation.
SO Respiratory medicine
VL 100
IS 3
BP 477
EP 86
DI 10.1016/j.rmed.2005.06.008
PD 2006-Mar
PY 2006
AB STUDY OBJECTIVES: This study was aimed at assessing health-related
   quality of life (HRQL) in patients with chronic respiratory failure
   (CRF) and long-term survival following prolonged intensive care
   mechanical ventilation.
   DESIGN: Observational cohort study.
   SETTING: Patients with CRF who had been transferred to our specialized
   weaning centre due to prolonged mechanical ventilation (>14 days) and
   weaning failure.
   PATIENTS AND PARTICIPANTS: Out of 87 long-term survivors (>6 months), 73
   patients (mean age: 60.3+/-13.6 years, chronic obstructive pulmonary
   disease (COPD, 43%), thoraco-restrictive (21%) or neuromuscular
   disorders (15%), various chronic diseases (22%)) returned the MOS
   36-Item Short-Form Health Status Survey (SF-36) and the St. George's
   respiratory questionnaire (SGRQ).
   MEASUREMENTS AND RESULTS: The total ventilation time was 38.7+/-45.9
   days. The time between discharge from ICU and HRQL assessment was
   31.0+/-22.2 months. Physical health was markedly reduced compared to
   general population norm, but mental health was mildly impaired. HRQL was
   comparable to patients with stable CRF receiving non-invasive
   ventilation who did not need prolonged invasive MV. In addition, general
   HRQL was better in patients with restrictive respiratory disease
   compared to patients with neuromuscular diseases (P<0.05). Physiological
   parameters such as blood gases or lung function parameters were not
   correlated to any HRQL measurements.
   CONCLUSIONS: In patients with CRF surviving prolonged ventilation on
   ICU, the presence of CRF itself is the major determinant of HRQL. Here,
   the underlying cause of CRF is the major factor which determines the
   degree of HRQL impairment with patients suffering from restrictive
   ventilatory disorders reporting the best HRQL when compared to patients
   with COPD or neuromuscular diseases. Despite severe physical handicaps
   due to CRF mental health is only mildly compromised.
TC 18
ZB 1
Z8 0
ZS 3
Z9 20
SN 0954-6111
UT MEDLINE:16039838
PM 16039838
ER

PT J
AU Resatoglu, AG
   Tok, M
   Yemisci, M
   Yener, N
   Yener, A
TI Autoimmune myasthenia gravis after coronary artery bypass surgery
SO ANNALS OF THORACIC SURGERY
VL 81
IS 2
BP 725
EP 726
DI 10.1016/j.athoracsur.2004.10.027
PD FEB 2006
PY 2006
AB Myasthenia gravis is the most common disorder of neuromuscular
   transmission and is a heterogeneous disorder that is generally
   autoimmune, which is caused by an auto-antibody to the nicotinic
   acetylcholine receptor. We present a rare case of myasthenia gravis that
   occurred 8 weeks after a coronary artery bypass grafting operation. A
   64-year-old man with multivessel coronary artery disease underwent
   myocardial revascularization. Severe myasthenic symptoms began 8 weeks
   after the operation and emergent mechanical ventilation was needed
   because of myasthenic crises. The serum anti-acetylcholine receptor
   antibody level was high. The details of this unusual patient are
   discussed.
RI YEMISCI, MUGE/I-9928-2013
TC 4
ZB 1
Z8 0
ZS 0
Z9 4
SN 0003-4975
UT WOS:000235142400054
PM 16427886
ER

PT J
AU Arami, MA
   Yazdchi, M
   Khandaghi, R
TI Epidemiology and characteristics of Guillain-Barre syndrome in the
   northwest of Iran
SO ANNALS OF SAUDI MEDICINE
VL 26
IS 1
BP 22
EP 27
PD JAN-FEB 2006
PY 2006
AB BACKGROUND: Little is known about the incidence of Guillain-Barre
   syndrome (GBS) in Iran. We determined the incidence and evaluated
   prognostic factors for GBS in a prospective, population-based study.
   PATIENTS AND METHODS: We evaluated and followed all patients with a
   diagnosis of GBS admitted to three referral neurology centers in East
   Azerbaijan province over a 1-year period (2003). Clinical and
   electrophysiological characteristics of cases were reviewed and
   analyzed.
   RESULTS: A total of 76 patients were found, corresponding to a crude
   annual incidence rate of 2.11/100 000 population. Six patients (7.9%)
   died acutely within 21 days from the onset of the disease. Acute
   mortality was due to respiratory involvement, sepsis and acute autonomic
   system dysfunction. The persistence of disability after the acute phase
   was related to axonal involvement (OR = 319, 95% CI, 1.65 to 6.16).
   There was a significant correlation between a history of diarrhea and a
   further need for mechanical ventilation (P < 0.05). Mechanically
   ventilated patients had a low GBS disability score on discharge compared
   with patients not mechanically ventilated (P = 0.05).
   CONCLUSIONS: The incidence rates of GBS in our province is similar to
   that in other countries. Acute mortality in GBS was mostly due to poor
   respiratory care of patients and infective complications, but disability
   and probably late mortality were due to axonal nerve injury.
TC 13
ZB 4
Z8 1
ZS 0
Z9 15
SN 0256-4947
UT WOS:000235506800005
PM 16521871
ER

PT J
AU Rady, Mohamed Y.
   Johnson, Daniel J.
   Patel, Bhavesh
   Larson, Joel
   Helmers, Richard
TI Corticosteroids influence the mortality and morbidity of acute critical
   illness
SO CRITICAL CARE
VL 10
IS 4
AR R101
DI 10.1186/cc4971
PD 2006
PY 2006
AB Introduction Use of corticosteroids for adrenal supplementation and
   attenuation of the inflammatory and immune response is widespread in
   acute critical illness. The study hypothesis was that exposure to
   corticosteroids influences the mortality and morbidity in acute critical
   illness.
   Methods This case-control retrospective study was performed in a single
   multidisciplinary intensive care unit at a tertiary care institution and
   consisted of 10,285 critically ill patients admitted between 1 January
   1999 and 31 December 2004. Demographics, comorbidities, acute illness
   characteristics including severity measured by Sequential Organ Failure
   Assessment, concurrent medications, therapeutic interventions and
   incidence of infections were obtained from electronic medical records,
   were examined with multiple regression analysis and were adjusted for
   propensity of corticosteroid exposure. The primary outcome was hospital
   death, and the secondary outcome was transfer to a care facility at
   hospital discharge.
   Results Corticosteroid exposure in 2,632 (26%) patients was
   characterized by younger age, more females, higher Charlson comorbidity
   and maximal daily Sequential Organ Failure Assessment scores compared
   with control patients. Corticosteroids potentiated metabolic and
   neuromuscular sequels of critical illness with increased requirements
   for diuretics, insulin, protracted weaning from mechanical ventilation,
   need for tracheostomy and discharge to a care facility. Early exposure
   to corticosteroids predisposed to recurrent and late onset of
   polymicrobial and fungal hospital-acquired infections. Corticosteroids
   increased the risk for death or disability after adjustments for
   comorbidities and acute illness characteristics.
   Conclusion Corticosteroids increased the risk for death or disability in
   critical illness. Hospital-acquired infections and metabolic and
   neuromuscular sequels of critical illness were exacerbated by
   corticosteroids. Careful appraisal of the indications for use of
   corticosteroids is necessary to balance the benefits and risks from
   exposure in acute critical illness.
TC 15
ZB 6
Z8 0
ZS 1
Z9 17
SN 1466-609X
UT WOS:000247712300004
PM 16846529
ER

PT J
AU Pereira, Asha A
TI Mycotic aneurysm as a result of severe salmonella infection in the adult
   intensive care unit: two case studies.
SO Dynamics (Pembroke, Ont.)
VL 17
IS 4
BP 16
EP 8
PD 2006
PY 2006
AB Salmonella infections are relatively common and are generally associated
   with contaminated food products. Common clinical manifestations include
   fever, bacteremia, and chronic permanent asymptomatic colonization of
   the bowel (Schneider, Krulls-Munch, & Knorig, 2004). However, a small
   percentage of all patients with salmonella bacteremia may present with
   vascular infections in the form of an aneurysm (Cohen, O'Brien,
   Schoenbaum, and Medeiros, 1978; Shimoni et al., 1999). While it is
   extremely rare for those who work in the intensive care unit (ICU) to
   care for such patients, it is essential for health care professionals to
   recognize this disease in order to make a rapid diagnosis to prevent
   complications, such as mycotic aneurysm. This article is framed around
   two patients who presented to the same ICU following surgical
   intervention. The etiology of salmonella bacteremia, mycotic aneurysm,
   the risk factors, diagnosis, and treatment are discussed.
TC 2
ZB 0
Z8 0
ZS 0
Z9 2
SN 1497-3715
UT MEDLINE:17285881
PM 17285881
ER

PT J
AU Cybulski, Pamela
   Zantinge, Johanna
   Abbott-McNeil, Deanna
TI Embracing technology? Using change management strategies to improve the
   use of continuous lateral rotation therapy.
SO Dynamics (Pembroke, Ont.)
VL 17
IS 3
BP 28
EP 32
PD 2006
PY 2006
AB The purpose of this quality improvement initiative was to improve the
   utilization of continuous lateral rotation therapy (CLRT) in a nine-bed
   community hospital ICU within the context of a nurse-driven protocol.
   Nursing focus groups, analyzed using a strength, weakness, opportunity,
   threat (SWOT) approach, resulted in the implementation of four
   interventions over seven weeks. Change management strategies guided all
   aspects of the project. Results showed a modest increase in the
   utilization of CLRT. This initiative demonstrates that change management
   strategies may assist with the incorporation of technology into nursing
   practice by increasing empowerment and creating an attachment to and
   responsibility for outcomes.
TC 1
ZB 0
Z8 0
ZS 0
Z9 1
SN 1497-3715
UT MEDLINE:17009572
PM 17009572
ER

PT J
AU Nishikawa, Masashi
   Mizutani, Taro
   Nakao, Tomohei
   Kamoda, Tomohiro
   Takahashi, Shinji
   Toyooka, Hidenori
TI Respiratory failure due to morbid obesity in a patient with Prader-Willi
   syndrome: an experience of long-term mechanical ventilation.
SO Journal of anesthesia
VL 20
IS 4
BP 300
EP 3
DI 10.1007/s00540-006-0416-7
PD 2006
PY 2006
AB Prader-Willi syndrome (PWS) is characterized by obesity, mild mental
   retardation or learning disability, and behavior problems, especially in
   association with food and eating. A 19 year-old man, 150 cm, 140 kg
   (body mass index [BMI], 62.2 kg.m(-2)), whose condition had been
   diagnosed as PWS, received 41-day mechanical ventilation because of
   respiratory failure, chiefly due to morbid obesity. Because the patient
   frequently developed bronchoconstriction, metered-dose inhalers of a
   corticosteroid (beclomethasone dipropionate) and a beta2 agonist
   (salbutamol) were needed. To achieve adequate sedation, which was also
   crucial to control the bronchoconstriction, the concurrent use of
   midazolam, fentanyl, ketamine, and propofol was required.
   Pressure-control ventilation was useful to avoid high airway pressure
   due to low respiratory system compliance associated with the morbid
   obesity. Because it appeared that the basic problem leading to
   respiratory failure in this patient was morbid obesity, body weight
   reduction was considered to be mandatory. Thus, caloric intake was
   limited to 1000 kcal.day(-1), resulting in body weight reduction by 50
   kg during the patient's stay in the intensive care unit (ICU). The
   patient was successfully extubated on ICU day 35.
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 0913-8668
UT MEDLINE:17072695
PM 17072695
ER

PT J
AU Yilmaz, Murat
   Dosemeci, Levent
   Cengiz, Melike
   Sanli, Suat
   Gajic, Ognjen
   Ramazanoglu, Atilla
TI Repeat percutaneous tracheostomy in the neurocritically ill patient
SO NEUROCRITICAL CARE
VL 5
IS 2
BP 120
EP 123
DI 10.1385/Neurocrit.Care2006;05:120-123
PD 2006
PY 2006
AB Introduction: Percutaneous tracheostomy is a widely used and accepted
   method for long-term mechanical ventilation and airway protection.
   Neurocritically ill patients sometimes require repeat tracheostomy,
   which is traditionally considered a relative contraindication for
   percutaneous procedure. The aim of this study was to determine the
   safety of repeat percutaneous tracheostomy in neurocritically ill
   patients with a history of previous tracheostomy.
   Methods: In the 16-bed academic neurointensive care unit, we
   prospectively enrolled patients who needed new tracheostomy placement
   for airway protection or prolonged mechanical ventilation and had
   previously undergone percutaneous tracheostomy placement. We collected
   data on indications, procedure, periprocedural complications, and
   outcome of repeated tracheostomy.
   Results: Between January 2001 and October 2005, we enrolled 12
   consecutive patients (mean age 35.4 +/- 7.0 years) who underwent repeat
   percutaneous tracheostomy. Head injury was the most. common underlying
   diagnosis (seven patients, 58%). Tracheostomy tube placement was easy
   and successful in all patients, and none of the patients needed
   conversion to surgical tracheostomy. In three patients,
   ultrasound-guided needle aspiration was used before the procedure to
   confirm the position of the trachea. No patients died or experienced
   serious complication related to the procedure. Two patients (17%) had a
   minor periprocedural bleeding, which was controlled with local
   compression. Long-term outcome was poor, with only two patients alive
   and off the ventilator at hospital discharge, both with serious
   disability.
   Conclusion: Repeat percutaneous tracheostomy can be performed safely in
   neurocritically ill patients who have undergone previous tracheostomy.
TC 4
ZB 1
Z8 0
ZS 0
Z9 4
SN 1541-6933
UT WOS:000241562400008
PM 17099258
ER

PT J
AU Carnevale, Franco A
   Alexander, Eren
   Davis, Michael
   Rennick, Janet
   Troini, Rita
TI Daily living with distress and enrichment: the moral experience of
   families with ventilator-assisted children at home.
SO Pediatrics
VL 117
IS 1
BP e48
EP 60
PD 2006-Jan
PY 2006
AB OBJECTIVE: The growing shift toward home care services assumes that
   "being home is good" and that this is the most desirable option.
   Although ethical issues in medical decision-making have been examined in
   numerous contexts, home care decisions for technology-dependent children
   and the moral dilemmas that this population confronts remain virtually
   unknown. This study explored the moral dimension of family experience
   through detailed accounts of life with a child who requires assisted
   ventilation at home. This study involved an examination of moral
   phenomena inherent in (1) the individual experiences of the
   ventilator-assisted child, siblings, and parents and (2) everyday family
   life as a whole.
   METHODS: A qualitative method based on Richard Zaner's interpretive
   framework was selected for this study. The population of interest for
   this study was the families of children who are supported by a
   ventilator or a positive-pressure device at home. Twelve families (38
   family members) were recruited through the Quebec Program for Home
   Ventilatory Assistance. Children in the study population fell into 4
   diagnostic groups: (1) abnormal ventilatory control (eg, central
   hypoventilation syndrome), (2) neuromuscular disorders, (3) spina
   bifida, and (4) craniofacial or airway abnormalities resulting in upper
   airway obstruction. All 4 of these diagnostic groups were included in
   this study. Among the 12 children recruited, 4 received ventilation via
   tracheostomies, and 8 received ventilation with face masks. All of the
   latter received ventilation only at night, except for 1 child, who
   received ventilation 24 hours a day. Family moral experiences were
   investigated using semistructured interviews and fieldwork observations
   conducted in the families' homes.
   RESULTS: Data analysis identified 6 principal themes. The themes raised
   by families whose children received ventilation invasively via a
   tracheostomy were not systematically different or more distressed than
   were families of children with face masks. The principal themes were (1)
   confronting parental responsibility: parental responsibility was
   described as stressful and sometimes overwhelming. Parents needed to
   devote extraordinary care and attention to their children's needs. They
   struggled with the significant emotional strain, physical and
   psychological dependence of the child, impact on family relationships,
   living with the daily threat of death, and feeling that there was "no
   free choice" in the matter: they could not have chosen to let their
   child die. (2) Seeking normality: all of the families devoted
   significant efforts toward normalizing their experiences. They created
   common routines so that their lives could resemble those of "normal"
   families. These efforts seemed motivated by a fundamental striving for a
   stable family and home life. This "striving for stability" was sometimes
   undermined by limitations in family finances, family cohesion, and
   unpredictability of the child's condition. (3) Conflicting social
   values: families were offended by the reactions that they faced in their
   everyday community. They believe that the child's life is devalued,
   frequently referred to as a life not worth maintaining. They felt like
   strangers in their own communities, sometimes needing to seclude
   themselves within their homes. (4) Living in isolation: families
   reported a deep sense of isolation. In light of the complex medical
   needs of these children, neither the extended families nor the medical
   system could support the families' respite needs. (5) What about the
   voice of the child? The children in this study (patients and siblings)
   were generally silent when asked to talk about their experience. Some
   children described their ventilators as good things. They helped them
   breathe and feel better. Some siblings expressed resentment toward the
   increased attention that their ventilated sibling was receiving. (6)
   Questioning the moral order: most families questioned the "moral order"
   of their lives. They contemplated how "good things" and "bad things" are
   determined in their world. Parents described their life as a very unfair
   situation, yet there was nothing that they could do about it. Finally,
   an overarching phenomenon that best characterizes these families'
   experiences was identified: daily living with distress and enrichment.
   Virtually every aspect of the lives of these families was highly
   complicated and frequently overwhelming. An immediate interpretation of
   these findings is that families should be fully informed of the demands
   and hardships that would await them, encouraging parents perhaps to
   decide otherwise. This would be but a partial reading of the findings,
   because despite the enormous difficulties described by these families,
   they also reported deep enrichments and rewarding experiences that they
   could not imagine living without. Life with a child who requires
   assisted ventilation at home involves living every day with a complex
   tension between the distresses and enrichments that arise out of this
   experience. The conundrum inherent in this situation is that there are
   no simple means for reconciling this tension. This irreconcilability is
   particularly stressful for these families. Having their child
   permanently institutionalized or "disconnected" from ventilation (and
   life) would eliminate both the distresses and the enrichments. These
   options are outside the realm of what these families could live with,
   aside from the 1 family whose child is now permanently hospitalized, at
   a tremendous cost of guilt to the family.
   CONCLUSIONS: These findings make important contributions by (1)
   advancing our understanding of the moral experiences of this group of
   families; (2) speaking to the larger context of other
   technology-dependent children who require home care; (3) relating home
   care experiences to neonatal, critical care, and other hospital
   services, suggesting that these settings examine their approaches to
   this population that may impose preventable burdens on the lives of
   these children and their families; and (4) examining a moral problem
   with an empirical method. Such problems are typically investigated
   through conceptual analyses, without directly examining lived
   experience. These findings advance our thinking about how we ought to
   care for these children, through a better understanding of what it is
   like to care for them and the corresponding major distresses and
   rewarding enrichments. These findings call for an increased
   sensitization to the needs of this population among staff in critical
   care, acute, and community settings. Integrated community support
   services are required to help counter the significant distress endured
   by these families. Additional research is required to examine the
   experience of other families who have decided either not to bring home
   their child who requires ventilation or withdraw ventilation and let the
   child die.
TC 57
ZB 6
Z8 0
ZS 3
Z9 59
UT MEDLINE:16396848
PM 16396848
ER

PT J
AU Symington, A
   Pinelli, J
TI Developmental care for promoting development and preventing morbidity in
   preterm infants.
SO The Cochrane database of systematic reviews
IS 2
BP CD001814
EP CD001814
PD 2006 Apr 19
PY 2006
AB BACKGROUND: Preterm infants experience a range of morbidity related to
   the immaturity of their organ systems and to concurrent disease states.
   There is concern that an unfavourable environment in the neonatal
   intensive care unit (NICU) may compound this morbidity. Modification of
   the environment could minimize the iatrogenic effects. Developmental
   care is a broad category of interventions designed to minimize the
   stress of the NICU environment. These interventions may include elements
   such as control of external stimuli (vestibular, auditory, visual,
   tactile), clustering of nursery care activities, and positioning or
   swaddling of the preterm infant. Individual strategies have also been
   combined to form programs, such as the 'Newborn Individualized
   Developmental Care and Assessment Program' (NIDCAP) (Als 1986).
   OBJECTIVES: In preterm infants, do developmental care interventions
   reduce neurodevelopmental delay, poor weight gain, length of hospital
   stay, length of mechanical ventilation, physiological stress and other
   clinically relevant adverse outcomes?
   SEARCH STRATEGY: The Neonatal Review Group search strategy was utilized.
   Searches were made of MEDLINE from 1966 to June, 2005 and of CINAHL, The
   Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane
   Library, Issue 1, 2005), and conference and symposia proceedings in the
   English language from 1990 to June, 2005. A search of EMBASE was also
   made from 2003 to June 2005. A list of all relevant articles was sent to
   two experts in the field to identify any omissions or additional
   unpublished studies.
   SELECTION CRITERIA: Randomized trials in which elements of developmental
   care are compared to routine nursery care for infants < 37 weeks
   gestation and that measured clinically relevant outcomes. Reports were
   in English or a language for which a translator was available.
   Computerized searches were conducted and all potentially relevant titles
   and abstracts were extracted. Retrieved articles were assessed for
   relevance independently by two reviewers, based on predetermined
   criteria. Articles that met all criteria for relevance were assessed for
   methodological quality based on predetermined criteria. Articles judged
   to have the appropriate quality by both reviewers were included in the
   analysis.
   DATA COLLECTION AND ANALYSIS: Data were extracted independently by the
   two authors. Meta-analyses were conducted for each intervention where
   the same outcome measures and/or instruments were used within comparable
   time points.
   MAIN RESULTS: This review detected 36 eligible randomized controlled
   trials involving four major groups of developmental care interventions,
   19 sub-groups and multiple clinical outcomes. In addition, the long-term
   outcomes of a previously included trial were added to the review. The
   results of the review indicate that developmental care interventions
   demonstrate limited benefit to preterm infants with respect to:
   decreased moderate-severe chronic lung disease, decreased incidence of
   necrotizing enterocolitis and improved family outcome. Conversely, an
   increase in mild lung disease and an increase in the length of stay were
   demonstrated in infants receiving developmental care compared to
   controls. There is also very limited evidence of the long-term positive
   effect of NIDCAP on behavior and movement at 5 years corrected age but
   no effect on cognition. Other individualized developmental care
   interventions have also demonstrated some effect in enhancing
   neurodevelopmental outcome. Although a limited number of other benefits
   were demonstrated, those results were from single studies with small
   sample sizes. The lack of blinding of the assessors was a significant
   methodological flaw in half of the studies. The cost of the
   interventions and personnel was not considered in any of the studies.
   AUTHORS' CONCLUSIONS: Because of the inclusion of multiple interventions
   in most studies, the determination of the effect of any single
   intervention is difficult. Although there is evidence of limited benefit
   of developmental care interventions overall, and no major harmful
   effects reported, there were a large number of outcomes for which no or
   conflicting effects were demonstrated. The single trials that did show a
   significant effect of an intervention on a major clinical outcome were
   based on small sample sizes, and the findings were often not supported
   in other small trials. Before a clear direction for practice can be
   supported, evidence demonstrating more consistent effects of
   developmental care interventions on important short- and long-term
   clinical outcomes is needed. The economic impact of the implementation
   and maintenance of developmental care practices should be considered by
   individual institutions.
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
UT MEDLINE:16625548
PM 16625548
ER

PT J
AU Fauroux, B
   Lofaso, F
TI Non-invasive mechanical ventilation: when to start for what benefit?
SO THORAX
VL 60
IS 12
BP 979
EP 980
DI 10.1136/THX.2005.040394
PD DEC 2005
PY 2005
RI Benneyworth, Brian/A-4667-2009
OI Benneyworth, Brian/0000-0002-4692-5303
TC 9
ZB 3
Z8 0
ZS 4
Z9 13
SN 0040-6376
UT WOS:000233368400002
PM 16299111
ER

PT J
AU Keren, R
   Zaoutis, TE
   Bridges, CB
   Herrera, G
   Watson, BM
   Wheeler, AB
   Licht, DJ
   Luan, XQ
   Coffin, SE
TI Neurological and neuromuscular disease as a risk factor for respiratory
   failure in children hospitalized with influenza infection
SO JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION
VL 294
IS 17
BP 2188
EP 2194
DI 10.1001/jama.294.17.2188
PD NOV 2 2005
PY 2005
AB Context The Advisory Committee on Immunization Practices (ACIP)
   recommends annual influenza vaccination for children with certain
   chronic medical conditions to prevent serious complications of influenza
   infection. Little is known about the relative contribution of each of
   these chronic medical conditions to the development of serious
   influenza-associated complications.
   Objective To identify chronic medical conditions that are associated
   with respiratory failure in children hospitalized with
   community-acquired laboratory-confirmed influenza.
   Design, Setting, and Patients A retrospective cohort study of patients
   aged 21 years or younger hospitalized at The Children's Hospital of
   Philadelphia with community-acquired laboratory-confirmed influenza
   during 4 consecutive influenza seasons (June 2000 through May 2004). We
   examined 9 ACIP-designated high-risk chronic medical conditions and 3
   additional chronic medical conditions (neurological and neuromuscular
   disease [NNMD], gastroesophageal reflux disease [GERD], and history of
   prematurity) that in recent studies have been associated with influenza
   hospitalization and severe influenza-related complications.
   Main Outcome Measures Rate and odds ratio (OR) of respiratory failure,
   defined as need for mechanical ventilation.
   Results Of 745 children hospitalized with community-acquired
   laboratory-confirmed influenza, 322 (43%) had 1 or more ACIP-designated
   high-risk chronic medical conditions. Neurological and neuromuscular
   disease, GERD, and history of prematurity were present in 12%, 14%, and
   3%, of children, respectively. Thirty-two children (4.3%) developed
   respiratory failure. In multivariate logistic regression analyses,
   conditions associated with respiratory failure included NNMID (OR, 6.0
   95% confidence interval [CI], 2.7-13.5), chronic pulmonary disease other
   than asthma (OR, 4.8; 95% Cl, 1.5-15.1), and cardiac disease (OR, 4.0;
   95% Cl, 1.6-10.2). The predicted probabilities of respiratory failure
   derived from the multivariate model were 12% (95% Cl, 7%-20%), 9% (95%
   Cl, 3%-23%), and 8% (95% Cl, 4%-18%) for children with NNMD, chronic
   pulmonary disease, and cardiac disease, respectively.
   Conclusions These results support the ACIP's recent decision to add
   NNMID to the list of conditions for which annual influenza vaccine is
   recommended in children. Neurologists and primary care pediatricians
   should be alerted to the increased risk of respiratory failure and the
   importance of influenza vaccination in children with NNMD.
RI Licht, Daniel/I-3370-2013
OI Licht, Daniel/0000-0002-4080-843X
TC 79
ZB 57
Z8 0
ZS 0
Z9 85
SN 0098-7484
UT WOS:000232957700021
PM 16264160
ER

PT J
AU Rabinstein, Alejandro A
TI Update on respiratory management of critically ill neurologic patients.
SO Current neurology and neuroscience reports
VL 5
IS 6
BP 476
EP 82
DI 10.1007/s11910-005-0037-9
PD 2005-Nov
PY 2005
AB Respiratory failure complicates a number of acute neurologic conditions,
   most notably neuromuscular diseases (eg, Guillain-Barre syndrome and
   myasthenia gravis) and stroke. In addition, pulmonary complications,
   particularly pneumonia and atelectasis, are fairly common in patients
   with these diagnoses; their prevention and early recognition are crucial
   to avoid detrimental consequences. This review discusses recent studies
   related to predictors of respiratory failure and pneumonia, strategies
   of respiratory care and ventilatory support, functional prognosis, and
   withdrawal of mechanical ventilation in patients with acute
   neuromuscular respiratory failure and stroke.
TC 10
ZB 3
Z8 0
ZS 0
Z9 10
SN 1528-4042
UT MEDLINE:16263060
PM 16263060
ER

PT J
AU Yuan, N
   Skaggs, DL
   Dorey, F
   Keens, TG
TI Preoperative predictors of prolonged postoperative mechanical
   ventilation in children following scoliosis repair
SO PEDIATRIC PULMONOLOGY
VL 40
IS 5
BP 414
EP 419
DI 10.1002/ppul.20291
PD NOV 2005
PY 2005
AB Scoliosis is associated with progressive restrictive lung disease and an
   increased risk of pulmonary complications following surgical correction.
   Identification of higher risks for prolonged postoperative mechanical
   ventilation (MV) improves postoperative care. Our objective was to
   determine if preoperative pulmonary function tests (PFT) predict
   prolonged postoperative MV (defined as MV >= 3 days). We correlated
   preoperative PFT (forced expired volume in 1 sec, FEV1; vital capacity,
   VC; inspiratory capacity, IC; maximal inspiratory pressure, MIP; total
   lung capacity, TLC; and residual volume, RV) and postoperative MV days
   in 125 patients who had scoliosis surgery (aged 13.7 +/- 3.0 (SD) years)
   from January 1990-July 2001. We had 71 male and 54 female patients.
   Scoliosis types were 13 congenital, 27 idiopathic, 57 neuromuscular, 23
   syndrome/tumor, and 5 kyphoscoliosis. Forty patients (32%) had
   postoperative MV >= 3 days. Independent factors likely requiring
   postoperative MV >= 3 days were neuromuscular scoliosis (P < 0.001) and
   FEV1 <40% predicted. Independent factors most likely were: neuromuscular
   scoliosis with preoperative FEV1 <40% predicted (P < 0.01). Independent
   factors most unlikely were: idiopathic scoliosis (P < 0.002). VC <60%
   predicted, IC <30 ml/kg, TLC <60% predicted, and MIP <60 cm H2O
   correlated with postoperative MV >= 3 days (P < 0.05). We found no
   association between RV and postoperative MV FEV1 <40% predicted, VC <60%
   predicted, IC <30 ml/kg, TLC <60% predicted, MIP <60 cm H2O, and
   neuromuscular disease each correlated with prolonged postoperative MV.
   Neuromuscular disease or a preoperative FEV1 <40% predicted were more
   likely, and older children with neuromuscular disease and FEV1 <40%
   predicted were most likely to require prolonged postoperative MV (P <
   0.01). Clearly FEV1, and possibly VC, IC, TLC, and MIP, may increase
   accuracy in predicting the need for prolonged postoperative MV.
TC 15
ZB 7
Z8 1
ZS 1
Z9 16
SN 8755-6863
UT WOS:000232861100007
PM 16145695
ER

PT J
AU Martin, UJ
   Hincapie, L
   Nimchuk, M
   Gaughan, J
   Criner, GJ
TI Impact of whole-body rehabilitation in patients receiving chronic
   mechanical. ventilation
SO CRITICAL CARE MEDICINE
VL 33
IS 10
BP 2259
EP 2265
DI 10.1097/01.CCM.0000181730.02238.9B
PD OCT 2005
PY 2005
AB Objective: To evaluate the prevalence and magnitude of weakness in
   patients receiving chronic mechanical ventilation and the impact of
   providing aggressive whole-body rehabilitation on conventional weaning
   variables, muscle strength, and overall functional status.
   Design: Retrospective analysis of 49 consecutive patients.
   Setting: Multidisciplinary ventilatory rehabilitation unit in an
   academic medical center.
   Patients: Forty-nine consecutive chronic ventilator-dependent patients
   referred to a tertiary care hospital ventilator rehabilitation unit.
   Interventions: None.
   Measurement and Main Results: Patients were 58 +/- 7 yrs old with
   multiple etiologies for respiratory failure. On admission, all patients
   were bedridden and had severe weakness of upper and lower extremities
   measured by a 5-point muscle strength score and a 7-point Functional
   Independence Measurement. Postrehabilitation, patients had increases in
   upper and lower extremity strength (p <.05) and were able to stand and
   ambulate. All weaned from mechanical ventilation, but three required
   subsequent intermittent support. Six patients died before hospital
   discharge. Upper extremity strength on admission inversely correlated
   with time to wean from mechanical ventilation (R =.72, p <.001).
   Conclusions: Patients receiving chronic ventilation are weak and
   deconditioned but respond to aggressive whole-body and respiratory
   muscle training with an improvement in strength, weaning outcome, and
   functional status. Whole-body rehabilitation should be considered a
   significant component of their therapy.
TC 61
ZB 10
Z8 1
ZS 10
Z9 74
SN 0090-3493
UT WOS:000235875600016
PM 16215380
ER

PT J
AU Henderson, R
   Sandroni, P
   Wijdicks, EFM
TI Chronic inflammatory demyelinating polyneuropathy and respiratory
   failure
SO JOURNAL OF NEUROLOGY
VL 252
IS 10
BP 1235
EP 1237
DI 10.1007/s00415-005-0848-2
PD OCT 2005
PY 2005
AB Neuromuscular respiratory failure is not considered to be a clinical
   feature of chronic inflammatory demyelinating polyneuropathy (CIDP). We
   present 4 patients with CIDP who required respiratory assistance and
   mechanical ventilation. Two patients needed emergent intubation and one
   patient lapsed in a stupor from hypercapnia. Respiratory failure in CIDP
   should be considered exceptional, but more formal studies in CIDP may be
   needed to assess its prevalence.
TC 6
ZB 2
Z8 0
ZS 0
Z9 6
SN 0340-5354
UT WOS:000232615000014
PM 15940387
ER

PT J
AU Ginz, HF
   Iaizzo, PA
   Girard, T
   Urwyler, A
   Pargger, H
TI Decreased isometric skeletal muscle force in critically ill patients
SO SWISS MEDICAL WEEKLY
VL 135
IS 37-38
BP 555
EP 561
PD SEP 17 2005
PY 2005
AB Question under study: Critically ill patients can develop muscle
   weakness that prolongs recovery. The aim of this study was to evaluate
   contractile parameters of the involuntary isometric skeletal muscle
   forces as measures of muscle weakness in critically ill patients.
   Methods: Prospective, controlled trial performed in an intensive care
   unit (ICU) of a university hospital. Subjects: 19 critically ill
   patients (diagnoses: intracranial bleeding n = 9; sepsis n = 6; others n
   = 4), who were ventilated and completely immobilised for one week. 20
   healthy volunteers served as controls. We measured peak torques (PT),
   contraction times, half-relaxation times, peak rates of torque
   development and decay and torque latencies of the ankle dorsiflexors of
   the foot after peroneal nerve stimulation.
   Results: Patients (median Acute Physiology and Chronic Health Evaluation
   II score 21) had reduced PTs, medians 3.3 Nm (interquartile range 2.5
   Nm) vs 4.1 Nm (2.0 Nm) in controls (P = 0.0003) for single pulse, 4.9
   (4.7) vs 8.1 Nm (3.8) (P = 0.0001) for 2-pulse, 6.1 (6.3) vs 10.3 Nm
   (3.9) (P = 0.0009) for 3-pulse and 7.3 (6.4) vs 11.6 Nm (7.8), (P =
   0.006) for 4-pulse stimulations, respectively. Contraction times were
   reduced and half-relaxation times increased compared with controls.
   Conclusions: Assessment of involuntary isometric skeletal muscle forces
   can be readily measured in critically ill patients. After one week of
   critical illness, these patients have decreased force compared with
   healthy controls. This assessment approach will be further evaluated in
   a long-term study with a larger patient population.
TC 8
ZB 4
Z8 1
ZS 0
Z9 9
SN 1424-7860
UT WOS:000233288700003
PM 16333766
ER

PT J
AU Fredriksson, K
   Radell, P
   Eriksson, LI
   Hultenby, K
   Rooyackers, O
TI Effect of prolonged mechanical ventilation on diaphragm muscle
   mitochondria in piglets
SO ACTA ANAESTHESIOLOGICA SCANDINAVICA
VL 49
IS 8
BP 1101
EP 1107
DI 10.1111/j.1399-6576.2005.00718.x
PD SEP 2005
PY 2005
AB Background: Respiratory muscle weakness is a common problem in the
   intensive care unit and could be involved in difficulties in weaning
   from the ventilator after prolonged mechanical ventilation. Animal
   models have shown that mechanical ventilation itself impairs diaphragm
   muscle function. In this study we investigated whether diaphragm
   contractile impairment caused by mechanical ventilation and
   immobilization in piglets is associated with a derangement in diaphragm
   mitochondria.
   Methods: Seven piglets received controlled mechanical ventilation during
   5 days. A control group of eight piglets were anaesthetized and
   surgically manipulated in the same way, but were mechanically ventilated
   for 4-6 h. After mechanical ventilation, diaphragm muscle biopsies were
   taken for measurements of mitochondria content, mitochondrial
   respiratory enzymes and markers of oxidative stress.
   Results: Diaphragm mitochondrial content, as assessed by citrate
   synthase activities and volume density, was not different between the
   control and ventilated piglets. Activity of complex IV of the
   mitochondrial respiratory chain decreased by 21% (P = 0.02) when
   expressed per muscle weight and by 11% (P = 0.03) when expressed per
   citrate synthase activity. There were no changes in the markers of
   oxidative stress between the two groups.
   Conclusion: Five days of mechanical ventilation and immobilization
   decreased the activity of complex IV of the mitochondrial respiratory
   chain in the diaphragm muscle of the piglets.
TC 12
ZB 11
Z8 1
ZS 0
Z9 13
SN 0001-5172
UT WOS:000231152300012
PM 16095451
ER

PT J
AU Yoshikawa, H
   Yamazaki, S
   Abe, T
TI Acute respiratory distress syndrome in children with severe motor and
   intellectual disabilities
SO BRAIN & DEVELOPMENT
VL 27
IS 6
BP 395
EP 399
DI 10.1016/j.braindev.2004.09.009
PD SEP 2005
PY 2005
AB We report 13 severely disabled children with acute respiratory distress
   syndrome, who were treated at the Department of Pediatrics, Niigata City
   General Hospital between 1995 and 2002. The children ranged in age from
   1 year to 16 years. All were non-ambulant. Chronic aspiration and
   gastro-esophageal reflux were recognized in 12 patients. Patients had
   the rapid onset of dyspnea refractory to oxygen therapy. Diffuse
   bilateral lung infiltrates were present on chest X-ray. Predisposing
   events included sepsis (3 patients), pneumomia (7 patients),
   pancreatitis (1 patient) and two children with other infections. All
   required mechanical ventilation for periods of 3-26 days and received
   oxygen for 5-64 days. Steroid therapy and surfactant therapy were given
   to eight and three patients, respectively. Only one patient developed an
   air leak complication. Despite intensive care, three children died, one
   underwent tracheostomy and nine recovered completely. Acute respiratory
   distress syndrome is a commonly recognized cause of acute respiratory
   failure following a variety of insults. It is characterized by the acute
   onset of dyspnea refractory to oxygen therapy, and diffuse lung
   infiltrates. Children with severe motor and intellectual disabilities
   had various complications. In this study, chronic aspiration and
   gastro-esophageal reflux are considered to be one of predisposing
   factors triggering acute respiratory distress syndrome in children With
   severe motor and intellectual disabilities. Although acute respiratory
   distress syndrome was considered to be a not infrequent occurrence; its
   mortality rate might be low despite the severity of the disease in
   children with severe motor and intellectual disabilities. Acute
   respiratory distress syndrome can be a complication seen in severely
   disabled children. (c) 2004 Elsevier B.V. All rights reserved.
TC 2
ZB 1
Z8 0
ZS 0
Z9 2
SN 0387-7604
UT WOS:000232066900001
PM 16122625
ER

PT J
AU Holloway, RG
   Benesch, CG
   Burgin, WS
   Zentner, JB
TI Prognosis and decision making in severe stroke
SO JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION
VL 294
IS 6
BP 725
EP 733
PD AUG 10 2005
PY 2005
AB Context An increasing number of deaths following severe stroke are due
   to terminal extubations. Variation in withdrawal-of-care practices
   suggests the possibility of unnecessary prolongation of suffering or of
   unwanted deaths.
   Objectives To review the available evidence on prognosis in mechanically
   ventilated stroke patients and to provide an overall framework to
   optimize decision making for clinicians, patients, and families.
   Data Sources Search of MEDLINE from 1980 through March 2005 for
   English-language articles addressing prognosis in mechanically
   ventilated stroke patients. From 689 articles identified, we selected 17
   for further review. We also identified factors that influence, and
   decision-making biases that may result, in overuse or underuse of
   life-sustaining therapies, with a particular emphasis on mechanical
   ventilation.
   Evidence Synthesis Overall mortality among mechanically ventilated
   stroke patients is high, with a 30-day death rate approximating 58%
   (range in literature, 46%-75%). Although data are limited, among
   survivors as many as one third may have no or only slight disability,
   yet many others have severe disability. One can further refine prognosis
   according to knowledge of stroke syndromes, early patient
   characteristics, use of clinical prediction rules, and the need for
   continuing interventions. Factors influencing preferences for
   life-sustaining treatments include the severity and pattern of future
   clinical deficits, the probability of these deficits, and the burdens of
   treatments. Decision-making biases that may affect with
   drawal-of-treatment decisions include erroneous prognostic estimates,
   inappropriate methods of communicating evidence, misunderstanding
   patient values and expectations, and failing to appreciate the extent to
   which patients can physically and psychologically adapt.
   Conclusions Although prognosis among mechanically ventilated stroke
   patients is generally poor, a minority do survive without severe
   disability. Prognosis can be assessed according to clinical presentation
   and patient characteristics. There is an urgent need to better
   understand the marked variation in the care of these patients and to
   reliably measure and improve the patient-centeredness of such decisions.
TC 42
ZB 17
Z8 0
ZS 0
Z9 42
SN 0098-7484
UT WOS:000231068600026
PM 16091575
ER

PT J
AU Christ-Crain, M
   Muller, B
TI Procalcitonin in bacterial infections - hype, hope, more or less?
SO SWISS MEDICAL WEEKLY
VL 135
IS 31-32
BP 451
EP 460
PD AUG 6 2005
PY 2005
AB An ideal marker for bacterial infections should allow an early
   diagnosis, inform about the course and prognosis of the disease and
   facilitate therapeutic decisions. Procalcitonin (ProCT) covers these
   features better as compared to other, more commonly used biomarkers, and
   thus, the current hype on ProCT has a solid scientific basis. A superior
   diagnostic accuracy of ProCT has been shown for a variety of infections,
   eg respiratory tract infections, meningitis, acute infectious
   endocarditis and pancreatitis. Importantly, a ProCT-based therapeutic
   strategy can safely and markedly reduce antibiotic usage in lower
   respiratory tract infections, the major cause of sepsis. Being a
   hormokine mediator, immunoneutralisation of ProCT might offer new hope
   for more effective treatment options in sepsis. It is now evidence-based
   that ProCT provides more information and, thereby, questions the
   currently used "gold standards" for the diagnosis of clinically relevant
   bacterial infections. Yet, ProCT is less than a perfect marker. ProCT
   can be increased in non-infectious conditions, and may remain low in
   infections. The diagnosis of bacterial infections will continue to
   require a critical clinical awareness, careful patient history,
   dedicated physical examination, and appropriate cultures. This review
   aims to help the clinician to understand the physiopathological basis,
   to appreciate strengths and weaknesses of this biomarker, and thereby to
   promote a rational implementation of ProCT in a routine setting.
TC 138
ZB 69
Z8 17
ZS 0
Z9 158
SN 1424-7860
UT WOS:000232177000001
PM 16208582
ER

PT J
AU Chang, AT
   Boots, RJ
   Brown, MG
   Paratz, J
   Hodges, PW
TI Reduced inspiratory muscle endurance following successful weaning from
   prolonged mechanical ventilation
SO CHEST
VL 128
IS 2
BP 553
EP 559
DI 10.1378/chest.128.2.553
PD AUG 2005
PY 2005
AB Study objectives: Respiratory muscle weakness and decreased endurance
   have been demonstrated following mechanical ventilation. However, its
   relationship to the duration of mechanical ventilation is not known. The
   aim of this study was to assess respiratory muscle endurance and its
   relationship to the duration of mechanical ventilation.
   Design: Prospective study.
   Setting: Tertiary teaching hospital ICU.
   Patients: Twenty subjects were recruited for the study who had received
   mechanical ventilation for a 48 h and had been discharged from the ICU.
   Measurements: FEV1 FVC, and maximal inspiratory pressure (Pimax) at
   functional residual capacity were recorded. The Pimax attained following
   resisted inspiration at 30% of the initial Pimax for 2 min was recorded,
   and the fatigue resistance index (FRI) [Pimax final/Pimax initial] was
   calculated. The duration of ICU length of stay (ICULOS), duration of
   mechanical ventilation (MVD), duration of weaning (WD), and Charlson
   comorbidities score (CCS) were also recorded. Relationships between
   fatigue and other parameters were analyzed using the Spearman
   correlations (p). Results: Subjects were admitted to the ICU for a mean
   duration of 7.7 days (SD, 3.7 days) and required mechanical ventilation
   for a mean duration of 4.6 days (SD, 2.5 days). The mean FRI was 0.88
   (SD, 0.13), indicating a 12% fall in Pimax, and was negatively
   correlated with MVD (r = -0.65; p = 0.007). No correlations were found
   between the FRI and FEV1, FVC, ICULOS, WD, or CCS.
   Conclusions: Patients who had received mechanical ventilation for > 48 h
   have reduced inspiratory muscle endurance that worsens with the duration
   of mechanical ventilation and is present following successful weaning.
   These data suggest that patients needing prolonged mechanical
   ventilation are at risk of respiratory muscle fatigue and may benefit
   from respiratory muscle training.
RI Hodges, Paul/B-6578-2008; Boots, Robert/G-2209-2010; Boots, Rob/K-1159-2013
OI Boots, Robert/0000-0002-3901-4077; 
TC 16
ZB 3
Z8 1
ZS 3
Z9 21
SN 0012-3692
UT WOS:000231198900014
PM 16100137
ER

PT J
AU Latronico, N
   Shehu, I
   Seghelini, E
TI Neuromuscular sequelae of critical illness
SO CURRENT OPINION IN CRITICAL CARE
VL 11
IS 4
BP 381
EP 390
DI 10.1097/01.ccx.0000168530.30702.3e
PD AUG 2005
PY 2005
AB Purpose of review: To investigate the impact of critical illness
   polyneuropathy and critical illness myopathy on short-term and long-term
   patient outcome.
   Recent findings: In acute-care setting, critical illness polyneuropathy
   and critical illness myopathy are important causes of acute paralysis in
   critically ill comatose patients and may cause inappropriately
   pessimistic prognoses. Duration of wearing from artificial ventilation
   is 2 to 7 times greater in patients with critical illness
   polyneuropathy. After intensive care unit and hospital discharge, many
   patients diagnosed with critical illness polyneuropathy or critical
   illness myopathy are reported to complain of profund muscle weakness.
   Chronic disability was a common finding among them. Complete functional
   recovery with patients regaining the ability to breathe spontaneously
   and to walk independently was reported in 74 patients (28.1%).
   Persisting milder functional recovery, and included reduced or absent
   deep tendon reflexes, stocking and glove sensory loss, muscle atrophy,
   painful hyperesthesia, and foot drop. An association of critical illness
   polyneuropathy and critical illness myopathy with increased intensive
   care unit and hospital mortality has been demonstrated only in selected
   intensive care unit population; data are insufficient to demonstrate any
   association with long-term mortality.
   Summary: Intensive care unit acquired critical illness polyneuropathy
   and critical illness myopathy influence the evaluation of acutely ill
   comatose patients and may instigate unreasonably pessimistic prognosis.
   Critical illness polyneuropathy and critical illness myopathy are an
   important cause of difficult wearing of patients from the ventilator and
   of persisting muscle weakness and disability after intensive care unit
   discharge.
RI Latronico, Nicola/F-1557-2010
OI Latronico, Nicola/0000-0002-2521-5871
TC 73
ZB 26
Z8 1
ZS 3
Z9 77
SN 1070-5295
UT WOS:000232199600016
PM 16015120
ER

PT J
AU Bolton, CF
TI Neuromuscular manifestations of critical illness
SO MUSCLE & NERVE
VL 32
IS 2
BP 140
EP 163
DI 10.1002/mus.20304
PD AUG 2005
PY 2005
AB Critical illness, more precisely defined as the systemic inflammatory
   response syndrome (SIRS), occurs in 20%-50% of patients who have been on
   mechanical ventilation for more than 1 week in an intensive care unit.
   Critical illness polyneuropathy (CIP) and myopathy (CIM), singly or in
   combination, occur commonly in these patients and present as limb
   weakness and difficulty in weaning from the ventilator. Critical illness
   myopathy can be subdivided into thick-filament (myosin) loss, cachectic
   myopathy, acute rhabdomyolysis, and acute necrotizing myopathy of
   intensive care. SIRS is the predominant underlying factor in CIP and is
   likely a factor in CIM even though the effects of neuromuscular blocking
   agents and steroids predominate in CIM. Identification and
   characterization of the polyneuropathy and myopathy depend upon
   neurological examination, electrophysiological studies, measurement of
   serum creatine kinase, and, if features suggest a myopathy, muscle
   biopsy. The information is valuable in deciding treatment and prognosis.
TC 143
ZB 54
Z8 5
ZS 0
Z9 147
SN 0148-639X
UT WOS:000230862200002
PM 15825186
ER

PT J
AU Van Gammeren, D
   Falk, DJ
   DeRuisseau, KC
   Sellman, JE
   Decramer, M
   Powers, SK
TI Reloading the diaphragm following mechanical ventilation does not
   promote injury
SO CHEST
VL 127
IS 6
BP 2204
EP 2210
DI 10.1378/chest.127.6.2204
PD JUN 2005
PY 2005
AB Study objective: Mechanical ventilation (MV) is used clinically to treat
   patients who are incapable of maintaining adequate alveolar ventilation.
   Prolonged MV is associated with diaphragmatic atrophy and a decrement in
   maximal specific force production (Po). Collectively, these alterations
   may predispose the diaphragm to injury on the return to spontaneous
   breathing (ie, reloading). Therefore, these experiments tested the
   hypothesis that reloading the diaphragm following MV exacerbates
   MV-induced diaphragmatic contractile dysfunction, while causing muscle
   fiber membrane damage and inflammation.
   Methods: To test this postulate, Sprague-Dawley rats were randomly
   assigned to the following groups: (1) control; (2) 24 h of controlled
   MV; and (3) 24 h of controlled MV followed by 2 h of anesthetized
   spontaneous breathing. Controls were anesthetized in the short term but
   were not exposed to MV, whereas MV animals were anesthetized,
   tracheostomized, and ventilated. Reloaded animals remained under
   anesthesia, but were removed from MV and returned to spontaneous
   breathing for 2 h.
   Results: Compared to the situation with control animals, MV resulted in
   a 26 % decrement in diaphragmatic specific Po without muscle fiber
   membrane damage, as measured by an increase in membrane permeability
   (using the procion orange technique). Further, there were no increases
   in neutrophil or macrophage influx. Two hours of reloading did not
   exacerbate MV-induced diaphragmatic contractile dysfunction or cause
   fiber membrane damage, but increased neutrophil infiltration,
   myeloperoxidase activity, and muscle edema.
   Conclusion: We conclude that the return to spontaneous breathing
   following 24 h of controlled MV does not exacerbate MV-induced diaphragm
   contractile dysfunction or result in fiber membrane damage, but
   increases neutrophil infiltration.
TC 14
ZB 7
Z8 0
ZS 2
Z9 16
SN 0012-3692
UT WOS:000229767300050
PM 15947338
ER

PT J
AU Roeleveld, P P
   Hoeve, L J
   Joosten, K F M
   de Hoog, M
TI Short use of muscle relaxants following single stage
   laryngotracheoplasty in children.
SO International journal of pediatric otorhinolaryngology
VL 69
IS 6
BP 751
EP 5
DI 10.1016/j.ijporl.2005.01.006
PD 2005-Jun
PY 2005
AB OBJECTIVE: The postoperative management of children undergoing single
   stage laryngotracheoplasty (SSLTP) includes intubation and muscle
   paralysis to secure the airway and protect the wound. We reduced the
   period of postoperative muscle paralysis in an attempt to decrease the
   incidence of pulmonary complications. The objective of this study was to
   evaluate the influence of the duration of muscle paralysis on pulmonary
   complications and outcome.
   METHODS: Medical records of all children admitted, between 1994 and
   2002, to the pediatric intensive care unit following SSLTP were
   analysed. Children were grouped according to the number of days muscle
   paralysis was used.
   RESULTS: Thirty-six children (15 male, 21 female, mean age 32 months
   (9-162 months)) underwent SSLTP for laryngeal stenosis. Prior to surgery
   29 needed a tracheotomy (mean duration 11.1 months). Shorter muscle
   paralysis leads to shorter intubation and mechanical ventilation and
   therefore PICU and hospital length of stay were 12.4 and 9.9days shorter
   in the group with short use of muscle paralysis (p<0.001 and p=0.002,
   respectively). There was no significant difference in postoperative
   complications, but a trend towards fewer atelectases in children with
   short muscle paralysis could be recognised. Postoperatively we observed
   no auto-extubations in either group and success rate of SSLTP was
   comparable in both groups (94 and 95%).
   CONCLUSION: Children undergoing SSLTP can safely benefit from a
   postoperative strategy using a short duration of muscle relaxants. They
   have fewer days on mechanical ventilation with a concomitant decrease in
   duration of hospital stay.
TC 3
ZB 0
Z8 0
ZS 0
Z9 3
SN 0165-5876
UT MEDLINE:15885327
PM 15885327
ER

PT J
AU Aly, H
TI Mechanical ventilation and cerebral palsy
SO PEDIATRICS
VL 115
IS 6
BP 1765
EP 1767
DI 10.1542/peds.2005-0665
PD JUN 2005
PY 2005
TC 9
ZB 4
Z8 0
ZS 1
Z9 10
SN 0031-4005
UT WOS:000229504800038
PM 15930240
ER

PT J
AU Miller, Douglas K
   Chibnall, John T
   Videen, Susan D
   Duckro, Paul N
TI Supportive-affective group experience for persons with life-threatening
   illness: reducing spiritual, psychological, and death-related distress
   in dying patients.
SO Journal of palliative medicine
VL 8
IS 2
BP 333
EP 43
DI 10.1089/jpm.2005.8.333
PD 2005-Apr
PY 2005
AB BACKGROUND: Attention to psycho-socio-spiritual needs is considered
   critical by patients with life-threatening illnesses and their
   caregivers. Palliative care interventions that address these
   needs--particularly spirituality--are lacking.
   OBJECTIVE: To evaluate the effects of an innovative program to address
   psycho-socio-spiritual needs in patients with life-threatening
   illnesses.
   DESIGN: A group intervention entitled Life-Threatening Illness
   Supportive-Affective Group Experience (LTI-SAGE) was developed for
   reducing patient spiritual, emotional, and death-related distress.
   SETTING/SUBJECTS: African American and Caucasian patients (n = 69) from
   two hospitals in St. Louis, Missouri, with life-threatening medical
   conditions (cancer; human immunodeficiency virus/acquired immune
   deficiency syndrome [HIV/AIDS]; geriatric frailty; liver, kidney,
   pulmonary, or cardiovascular disease) were randomly assigned to
   intervention or control groups. Intervention patients participated in a
   maximum of 12 LTI-SAGE groups over a 12-month period. Control patients
   received standard care.
   MEASUREMENTS: Outcome measures were depression symptoms, anxiety,
   spiritual well-being, and death-related emotional distress.
   RESULTS: After attrition, 51 (73.9%) patients completed the trial. At
   the end of the trial, after factoring in compliance, intervention
   patients had significantly fewer depression symptoms and death-related
   feelings of meaninglessness and significantly better spiritual
   well-being than did control patients.
   CONCLUSIONS: The use of the LTI-SAGE model for enhancing the end-of-life
   illness experience is promising.
TC 25
ZB 6
Z8 1
ZS 0
Z9 26
SN 1096-6218
UT MEDLINE:15890044
PM 15890044
ER

PT J
AU Field, D
   Elbourne, D
   Truesdale, A
   Grieve, R
   Hardy, P
   Fenton, AC
   Subhedar, N
   Ahluwalia, J
   Halliday, HL
   Stocks, J
   Tomlin, K
   Normand, C
CA INNOVO Trial Collaborating Grp
TI Neonatal ventilation with inhaled nitric oxide versus ventilatory
   support without inhaled nitric oxide for preterm infants with severe
   respiratory failure: The INNOVO multicentre randomised controlled trial
   (ISRCTN 17821339)
SO PEDIATRICS
VL 115
IS 4
BP 926
EP 936
DI 10.1542/peds.2004-1209
PD APR 2005
PY 2005
AB Background. Although inhaled nitric oxide (iNO) may be a promising
   treatment for newborn infants with severe respiratory failure, the
   results from 3 previous small trials were inconclusive.
   Methods. Infants of < 34 weeks' gestation, < 28 days old, and with
   severe respiratory failure requiring ventilatory support were randomized
   to receive or not receive iNO. The study was not blinded.
   Findings. Recruited were 108 infants ( 55 allocated to receive iNO and
   53 not allocated to receive iNO) from 15 neonatal units in the United
   Kingdom and Republic of Ireland. Fifty-nine percent ( 64 of 108) died,
   and 84% of the survivors ( 37 of 44) had signs of some impairment or
   disability, 9 (20%) of them classified as severely disabled. There was
   no evidence of an effect of iNO on the primary outcomes: death or severe
   disability at 1 year corrected age ( relative risk [RR]: 0.99; 95%
   confidence interval [CI]: 0.76 to 1.29); death or supplemental oxygen on
   expected date of delivery ( RR: 0.84; 95% CI: 0.68 to 1.02); or death or
   supplemental oxygen at 36 weeks' postmenstrual age ( RR: 0.98; 95% CI:
   0.87 to 1.12). There was a trend for infants allocated to the iNO group
   to spend more time on the ventilator ( log rank: 3.6), on supplemental
   oxygen ( log rank: 1.4), and in hospital ( log rank: 3.5) than those
   allocated to receive no iNO. This pattern predominantly reflected the
   infants who died. Mean total costs at 1 year corrected age were
   significantly higher in the iNO group, partly because of the costs of
   the gas but mainly because of the difference in initial hospitalization
   costs.
   Interpretation. Evidence of prolongation of intensive care and increased
   costs of such care, without clear beneficial effects, implies that iNO
   cannot be recommended for preterm infants with severe hypoxic
   respiratory failure.
RI Stocks, Janet/C-1892-2008
TC 65
ZB 34
Z8 3
ZS 0
Z9 69
SN 0031-4005
UT WOS:000228107900034
PM 15805366
ER

PT J
AU van der Steen, JT
   Ooms, ME
   van der Wal, G
   Ribbe, MW
TI Withholding or starting antibiotic treatment in patients with dementia
   and pneumonia: Prediction of mortality with physicians' judgment of
   illness severity and with specific prognostic models
SO MEDICAL DECISION MAKING
VL 25
IS 2
BP 210
EP 221
DI 10.1177/0272989X05275400
PD MAR-APR 2005
PY 2005
AB Background. To help decision makers plan treatment, the authors assessed
   clinical predictors of mortality m a nursing, fro home-acquired
   pneumonia in with deirientia.
   Methods. Pneumonia patients treated with out (n = 165)or with
   antibiotics (n = 541) were enrolled in a prospective cohort Study in 61
   nursing homes.
   Results. In both groups, clinical judgment of illness severity was a
   strong predictor for 1-week mortality. Despite large differences in
   frailty and mortality (83% in untreated patients and 15% in treated
   patients), separate multivariable logistic models included similar
   specific predictors.
   Discussion. Despite profound differences between the 2 independent
   groups, predictors for short-term mortality were largely similar. We
   found that, when combined with physicians' clinical judgment, 3 readily
   assessed predictors (respiratory rate, fluid intake, and eating
   dependency) helped predict mortality. Our results, if confirmed in an
   independent population, can help make decision making, about antibiotic
   treatment of pneumonia in patients with dementia more evidence-based.
TC 24
ZB 7
Z8 0
ZS 0
Z9 24
SN 0272-989X
UT WOS:000228014000009
PM 15800305
ER

PT J
AU Laptook, AR
   O'Shea, TM
   Shankaran, S
   Bhaskar, B
CA NICHD Neonatal Network
TI Adverse neurodevelopmental outcomes among extremely low birth weight
   infants with a normal head ultrasound: Prevalence and antecedents
SO PEDIATRICS
VL 115
IS 3
BP 673
EP 680
DI 10.1542/peds.2004-0667
PD MAR 2005
PY 2005
AB Objective. Severe abnormalities of the head ultrasound (HUS) are
   important predictors of cerebral palsy (CP) and mental retardation, and
   a normal HUS usually ensures the absence of major impairments. With the
   increasing survival of extremely low birth weight (ELBW) infants (birth
   weight <1000 g), the prognostic significance of a normal HUS may differ.
   This study examined the prevalence of and risk factors for CP and
   impaired mental development among ELBW infants with a normal HUS.
   Methods. Study infants were ELBW infants who were cared for in Neonatal
   Research Network centers in the years 1995-1999, had a normal early and
   late HUS, survived to discharge, and returned for follow-up assessments
   at 18 to 22 months' corrected age. The outcomes of interest were a score
   <70 on the Bayley Scales of Infant Development-II Mental Developmental
   Index (MDI) and CP. Risk factors included maternal demographics; infant
   characteristics; and interventions or morbidities related to the lung,
   infection, and nutrition. Logistic regression was used to estimate odds
   ratios (ORs) and 95% confidence intervals (CIs). A time-oriented
   approach was used to select variables for inclusion in logistic models.
   Results. Of 1749 infants with a normal early and late HUS (performed at
   a mean age of 6 and 47 days, respectively), 1473 (84%) returned for
   follow-up assessment. Infants had a birth weight of 792 +/- 134 g (mean
   +/- SD) and gestational age of 26 +/- 2 weeks. Rates of CP and MDI <70
   were 9.4% and 25.3%, respectively, and 29.2% of infants had either CP or
   MDI <70. In multivariate analyses, factors associated with CP were male
   gender (OR: 1.8; 95% CI: 1.2-2.6), multiple birth, (OR: 1.6; 95% CI:
   1.1-2.5), decreasing birth weight (OR: 1.3 for each 100-g decrease; 95%
   CI: 1.1-1.5), pneumothorax (OR: 2.3; 95% CI: 1.2-4.4), and days of
   conventional ventilation (OR: 1.2 for each additional 10 days; 95% CI:
   1.1-1.3). With the exception of pneumothorax, these same factors were
   associated with MDI <70, in addition to less maternal education (OR:
   1.4; 95% CI: 1.0-1.9) and Medicaid or lack of coverage for maternal
   insurance (OR: 1.7; 95% CI: 1.2-2.4).
   Conclusions. Nearly 30% of ELBW infants with a normal HUS had either CP
   or a low MDI. Risk factors that are associated with this high rate of
   adverse outcomes include pneumothorax, prolonged exposure to mechanical
   ventilation, and educational and economic disadvantage. Improvements in
   pulmonary care to reduce duration of ventilation and avoid air leaks
   might improve neurodevelopmental outcome for ELBW infants.
TC 131
ZB 84
Z8 2
ZS 2
Z9 136
SN 0031-4005
UT WOS:000227596900026
PM 15741371
ER

PT J
AU Zhang, XX
   Snijders, A
   Segraves, R
   Zhang, XQ
   Niebuhr, A
   Albertson, D
   Yang, HM
   Gray, J
   Niebuhr, E
   Bolund, L
   Pinkel, D
TI High-resolution mapping of genotype-phenotype relationships in cri du
   chat syndrome using array comparative genomic hybridization
SO AMERICAN JOURNAL OF HUMAN GENETICS
VL 76
IS 2
BP 312
EP 326
DI 10.1086/427762
PD FEB 2005
PY 2005
AB We have used array comparative genomic hybridization to map DNA
   copy-number changes in 94 patients with cri du chat syndrome who had
   been carefully evaluated for the presence of the characteristic cry,
   speech delay, facial dysmorphology, and level of mental retardation
   (MR). Most subjects had simple deletions involving 5p (67 terminal and
   12 interstitial). Genotype-phenotype correlations localized the region
   associated with the cry to 1.5 Mb in distal 5p15.31, between bacterial
   artificial chromosomes (BACs) containing markers D5S2054 and D5S676;
   speech delay to 3.2 Mb in 5p15.32-15.33, between BACs containing D5S417
   and D5S635; and the region associated with facial dysmorphology to 2.4
   Mb in 5p15.2-15.31, between BACs containing D5S208 and D5S2887. These
   results overlap and refine those reported in previous publications. MR
   depended approximately on the 5p deletion size and location, but there
   were many cases in which the retardation was disproportionately severe,
   given the 5p deletion. All 15 of these cases, approximately two-thirds
   of the severely retarded patients, were found to have copy-number
   aberrations in addition to the 5p deletion. Restriction of consideration
   to patients with only 5p deletions clarified the effect of such
   deletions and suggested the presence of three regions, MRI-III, with
   differing effect on retardation. Deletions including MRI, a 1.2-Mb
   region overlapping the previously defined cri du chat critical region
   but not including MRII and MRIII, produced a moderate level of
   retardation. Deletions restricted to MRII, located just proximal to MRI,
   produced a milder level of retardation, whereas deletions restricted to
   the still-more proximal MRIII produced no discernible phenotype.
   However, MR increased as deletions that included MRI extended
   progressively into MRII and MRIII, and MR became profound when all three
   regions were deleted.
TC 67
ZB 59
Z8 6
ZS 0
Z9 75
SN 0002-9297
UT WOS:000226215100016
PM 15635506
ER

PT J
AU Nilsestuen, Jon O
   Hargett, Kenneth D
TI Using ventilator graphics to identify patient-ventilator asynchrony.
SO Respiratory care
VL 50
IS 2
BP 202
EP 34; discussion 232-4
PD 2005-Feb
PY 2005
AB Patient-ventilator interaction can be described as the relationship
   between 2 respiratory pumps: (1) the patient's pulmonary system, which
   is controlled by the neuromuscular system and influenced by the
   mechanical characteristics of the lungs and thorax, and (2) the
   ventilator, which is controlled by the ventilator settings and the
   function of the flow valve. When the 2 pumps function in synchrony,
   every phase of the breath is perfectly matched. Anything that upsets the
   harmony between the 2 pumps results in asynchrony and causes patient
   discomfort and unnecessarily increases work of breathing. This article
   discusses asynchrony relative to the 4 phases of a breath and
   illustrates how asynchrony can be identified with the 3 standard
   ventilator waveforms: pressure, flow, and volume. The 4 phases of a
   breath are: (1) The trigger mechanism (ie, initiation of the
   inspiration), which is influenced by the trigger-sensitivity setting,
   patient effort, and valve responsiveness. (2) The inspiratory-flow
   phase. During both volume-controlled and pressure-controlled ventilation
   the patient's flow demand should be carefully evaluated, using the
   pressure and flow waveforms. (3) Breath termination (ie, the end of the
   inspiration). Ideally, the ventilator terminates inspiratory flow in
   synchrony with the patient's neural timing, but frequently the
   ventilator terminates inspiration either early or late, relative to the
   patient's neural timing. During volume-controlled ventilation we can
   adjust variables that affect inspiratory time (eg, peak flow, tidal
   volume). During pressure-controlled or pressure-support ventilation we
   can adjust variables that affect when the inspiration terminates (eg,
   inspiratory time, expiratory sensitivity). (4) Expiratory phase.
   Patients with obstructive lung disease are particularly prone to
   developing intrinsic positive end-expiratory pressure (auto-PEEP) and
   therefore have difficulty triggering the ventilator. Bedside evaluation
   for the presence of auto-PEEP should be routinely performed and
   corrective adjustments made when appropriate.
TC 42
ZB 5
Z8 1
ZS 2
Z9 44
SN 0020-1324
UT MEDLINE:15691392
PM 15691392
ER

PT J
AU MacIntyre, Neil R
TI Respiratory mechanics in the patient who is weaning from the ventilator.
SO Respiratory care
VL 50
IS 2
BP 275
EP 86; discussion 284-6
PD 2005-Feb
PY 2005
AB Ventilator management of the patient recovering from acute respiratory
   failure must balance competing objectives. On the one hand, aggressive
   efforts to promptly discontinue support and remove the artificial airway
   reduce the risk of ventilator-induced lung injury, nosocomial pneumonia,
   airway trauma from the endotracheal tube, and unnecessary sedation. On
   the other hand, overly aggressive, premature discontinuation of
   ventilatory support or removal of the artificial airway can precipitate
   ventilatory muscle fatigue, gas-exchange failure, and loss of airway
   protection. To help clinicians balance these concerns, 2 important
   research projects were undertaken in 1999-2001. The first was a
   comprehensive evidence-based literature review of the
   ventilator-discontinuation process, performed by the McMaster University
   research group on evidence-based medicine. The second was the
   development (by the American Association for Respiratory Care, American
   College of Chest Physicians, and Society of Critical Care Medicine) of a
   set of evidence-based guidelines based on the latter literature review.
   From those 2 projects, several themes emerged. First, frequent
   patient-assessment is required to determine whether the patient needs
   continued ventilatory support, from both the ventilator and the
   artificial airway. Second, we should continuously re-evaluate the
   overall medical management of patients who continue to require
   ventilatory support, to assure that we address all factors contributing
   to ventilator-dependence. Third, ventilatory support strategies should
   be aimed at maximizing patient comfort and unloading the respiratory
   muscles. Fourth, patients who require prolonged ventilatory support
   beyond the intensive care unit should go to specialized facilities that
   can provide gradual reduction of support. Fifth, many of these
   management objectives can be effectively carried out with protocols
   executed by nonphysicians.
TC 16
ZB 2
Z8 1
ZS 2
Z9 18
SN 0020-1324
UT MEDLINE:15691396
PM 15691396
ER

PT J
AU Geleijns, K
   Schreuder, GMT
   Jacobs, BC
   Sintnicolaas, K
   van Koningsveld, R
   Meulstee, J
   Laman, JD
   van Doorn, PA
TI HLA class II alleles are not a general susceptibility factor in
   Guillain-Barre syndrome
SO NEUROLOGY
VL 64
IS 1
BP 44
EP 49
PD JAN 11 2005
PY 2005
AB Objective: To assess whether human leukocyte antigen (HLA)-DRB1 and
   HLA-DQB1 alleles confer susceptibility to Guillain-Barre syndrome (GBS)
   or are related to specific clinical or serologic subgroups of GBS.
   Methods: The HLA-DRB1 and HLA-DQB1 loci were genotyped by PCR
   amplification with sequence-specific primers in 164 well-documented
   Dutch patients with GBS and 207 healthy Dutch controlsubjects. Patients
   with GBS were divided into subgroups based on clinical features,
   severity of disease, antecedent infection,a nd anti-ganglioside
   antibodies. Data were compared with those of all case-control HLA
   studies in GBS performed previously. Results: In this case-control
   study, HLA-DRB1 and HLA-DQB1 alleles did not differ between GBS pateints
   and control subjects. The frequencyof HLA-DRB1*01 was increased in
   patients who needed mechanical ventilation (odds ratio 4.2; 95% CI 1.9
   to 9.6; p(c)=0.02). Multivariate logistic regression analysis showed
   that this association was independent of the severity of paresis and the
   presence of cranial nerve involvement (all p < 0.05). There was a
   tendency toward an association between certain HLA alleles and several
   anti-ganglioside antibodies. Conclusions: Human leukocyte antigen (HLA)
   class II antigens are not a general susceptibility factor in
   Guillain-Barre (GBS).However, HLA class II alleles may be a determinant
   in distinct subgroups of GBS, indicating the need for further
   exploration in large-scale studies.
TC 38
ZB 26
Z8 0
ZS 0
Z9 38
SN 0028-3878
UT WOS:000226216000010
PM 15642902
ER

PT S
AU Jennett, B
BE Laureys, S
TI Thirty years of the vegetative state: clinical, ethical and legal
   problems
SO BOUNDARIES OF CONSCIOUSNESS: NEUROBIOLOGY AND NEUROPATHOLOGY
SE Progress in Brain Research
VL 150
BP 537
EP 543
DI 10.1016/S0079-6123(05)50037-2
PD 2005
PY 2005
AB The vegetative state is the rarest form of disability in patients now
   frequently rescued from lifethreatening severe brain damage by
   resuscitation and intensive care. Many doctors have never seen such
   cases, yet it provokes great interest among professionals and the public
   because of the paradox of a person who is awake yet not aware. The
   commonest cause is head injury and it is more common in countries with a
   high incidence of severe head injury. The most consistent brain damage
   is in the subcortical white matter of the cerebral hemispheres and in
   the thalami; although the cerebral cortex is often severely damaged, it
   may be relatively spared. Diagnosis depends on prolonged expert
   observation to determine that there is no evidence of awareness in spite
   of a wide range of reflex responses, some of which may involve cortical
   activity. Functional imaging confirms that there is some residual
   cortical function in many vegetative patients. Mistaken diagnosis is
   less likely since the recent definition of clinical criteria for the
   vegetative state and for the minimally conscious state. Many patients
   recover consciousness and even regain independence after a month in a
   vegetative state after head injury, but few do so after non-traumatic
   insult. The longer the state persists the less likely the recovery, and
   eventually permanence can be declared. Patients can survive for many
   years in a vegetative state. Many consider that indefinite survival in a
   vegetative state is of no benefit to the patient and that there is no
   moral or legal obligation to continue lifesustaining treatment,
   including artificial nutrition and hydration. Ethical issues include how
   to respect the autonomy of the legally incompetent patient, and uphold
   the right to refuse unwanted treatment. Many cases have been brought to
   court in several North American, Northern European and some other
   jurisdictions where it has been ruled that it is legally permissible to
   withdraw life-sustaining treatment once a patient is declared
   permanently vegetative, and such withdrawal seems likely to be what that
   person would want done.
CT 8th Conference of the
   Association-for-the-Scientific-Study-of-Consciousness
CY JUN 26-28, 2004
CL Univ Antwerp, Antwerp, BELGIUM
HO Univ Antwerp
SP Assoc Sci Study Consciousness
TC 28
ZB 12
Z8 3
ZS 0
Z9 31
SN 0079-6123
BN 0-444-51851-7
UT WOS:000234202300038
PM 16186047
ER

PT J
AU Leone, M
   Delliaux, S
   Bourgoin, A
   Albanese, J
   Garnier, F
   Boyadjiev, I
   Antonini, F
   Martin, C
TI Risk factors for late-onset ventilator-associated pneumonia in trauma
   patients receiving selective digestive decontamination
SO INTENSIVE CARE MEDICINE
VL 31
IS 1
BP 64
EP 70
DI 10.1007/s00134-004-2514-z
PD JAN 2005
PY 2005
AB Objective: To determine the independent risk factors for late-onset
   ventilator-associated pneumonia (VAP) in trauma patients receiving
   selective digestive decontamination (SDD). Design: A 4-year, prospective
   cohort study of trauma patients meeting the following criteria: injury
   severity score > 15, and duration of mechanical ventilation > 5 days.
   Predictors of late-onset VAP occurrence were assessed by logistic
   regression analysis. Population: All patients received SDD consisting of
   polymixin E, gentamicin, and amphotericin B applied in nostrils, mouth,
   and gut with a 3-day course of parenteral cefazolin. VAP was suspected
   on clinical and radiological signs, and confirmed by the presence of at
   least one microorganism at a concentration of at least 10(4) CFU/ml on
   the broncho-alveolar lavage. Measurement: Independent risk factors for
   late-onset VAP. Results: A late-onset VAP was diagnosed in 90 (56%) out
   of 159 patients. Predicting factors for late-onset VAP were: use of
   non-depolarizing muscle relaxant agents for intubation [3.4 (CI 1.08 -
   10.73)], duration of intubation [1.06 (CI 1.01 - 1.17)], length of
   intensive care unit (ICU) stay [1.05 ( CI 1.02 - 1.09)], and prior
   tracheal colonization [1.03 ( CI 1.02 - 1.21)]. Exposure to prior
   antimicrobial treatment, except SDD, conferred protection [0.3 (0.12 -
   0.74)]. Conclusion: This study confirms the role of duration of
   intubation, length of ICU stay, and prior tracheal colonization in the
   development of late-onset VAP. The results also highlight the importance
   of the initial management on the development of late-onset VAP. The type
   of neuromuscular blocking agents to intubate trauma patients should be
   evaluated in future studies.
TC 16
ZB 5
Z8 0
ZS 1
Z9 16
SN 0342-4642
UT WOS:000226313700010
PM 15578155
ER

PT J
AU Campillo, C
   Raurich, JM
   Ibanez, J
TI Length of weaning from mechanical ventilation
SO INTENSIVE CARE MEDICINE
VL 31
IS 1
BP 162
EP 162
DI 10.1007/s00134-004-2498-8
PD JAN 2005
PY 2005
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 0342-4642
UT WOS:000226313700025
PM 15536524
ER

PT J
AU Lindahl, B
   Sandman, PO
   Rasmussen, BH
TI On becoming dependent on home mechanical ventilation
SO JOURNAL OF ADVANCED NURSING
VL 49
IS 1
BP 33
EP 42
DI 10.1111/j.1365-2648.2004.03261.x
PD JAN 2005
PY 2005
AB Aim. The aim of this paper is to illuminate meanings of becoming
   dependent on home mechanical ventilator treatment.
   Background. People suffering from chronic alveolar hypoventilation and
   requiring home mechanical ventilation represent a small but increasing
   group in society, and are some of the most vulnerable individuals with
   chronic disabilities.
   Method. Thirteen people about to begin ventilator treatment at home were
   interviewed. Data were tape-recorded and analysed according to a
   phenomenological-hermeneutic method.
   Findings. Findings revealed two contrasting meanings of being in the
   process of becoming dependent on a ventilator, interpreted as getting
   breath or holding breath. This interpretation is presented in two
   composite stories.
   Conclusions. The findings imply possibilities and deficiencies in
   meeting patients' existential needs, such as helping them to breathe
   spiritually by supporting them as they get their breath after such a
   life-changing event as becoming dependent on a ventilator.
TC 21
ZB 0
Z8 0
ZS 0
Z9 21
SN 0309-2402
UT WOS:000225952200004
PM 15610379
ER

PT J
AU Rabinstein, AA
   Mueller-Kronast, N
TI Risk of extubation failure in patients with myasthenic crisis
SO NEUROCRITICAL CARE
VL 3
IS 3
BP 213
EP 215
DI 10.1385/Neurocrit.Care2005;03:213-215
PD 2005
PY 2005
AB Introduction: Weaning patients with myasthenic crisis (MC) from
   mechanical ventilation is often difficult, and the ideal time for
   extubation is often uncertain. However, little is known about the risk
   of extubation failure and the factors that may affect its occurrence.
   The goals of this study were to assess the risk of extubation failure in
   patients with MC and to determine which clinical variables may predict
   unsuccessful extubation.
   Materials and Methods: Retrospective review of consecutive patients
   admitted for MC. Weaning method was categorized as T-piece or continuous
   positive airway pressure (i.e., T-piece trials not performed).
   Extubation failure was defined as need for reintubation or tracheostomy
   due to persistent neuromuscular insufficiency. Functional outcome was
   assessed using the modified Rankin score.
   Results: We identified 26 episodes of MC in 20 patients. Median age was
   42.1 years (range 14-83 years). Most patients were treated with
   immunomodulatory therapy (73%). There were seven episodes of extubation
   failure (prevalence rate 27%). Median time to reintubation was 36 hours.
   Older age (p = 0.05), atelectasis (p < 0.01), and pneumonia (p = 0.02)
   were significantly associated with extubation failure. Patients with
   failed extubation had considerably prolonged intensive care unit stays
   (median 28 versus 7 days; p < 0.01) and hospital stays (median 40 versus
   12 days; p < 0.01).
   Conclusion: Extubation failure may often complicate MC. Older age and
   development of pulmonary complications during mechanical ventilation
   increase the risk of extubation failure.
TC 9
ZB 4
Z8 1
ZS 1
Z9 10
SN 1541-6933
UT WOS:000234115700003
PM 16377831
ER

PT J
AU Cools, F
   Offringa, M
TI Neuromuscular paralysis for newborn infants receiving mechanical
   ventilation.
SO The Cochrane database of systematic reviews
IS 2
BP CD002773
EP CD002773
PD 2005 Apr 18
PY 2005
AB BACKGROUND: Ventilated newborn infants breathing in asynchrony with the
   ventilator are at risk for complications during mechanical ventilation,
   such as pneumothorax or intraventricular hemorrhage, and are exposed to
   more severe barotrauma, which consequently could impair their clinical
   outcome. Neuromuscular paralysis, which eliminates spontaneous breathing
   efforts of the infant, has potential advantages in this respect.
   However, a number of complications have been reported with muscle
   relaxation in infants, so that concerns exist regarding the safety of
   prolonged neuromuscular paralysis in newborn infants.
   OBJECTIVES: To determine whether routine neuromuscular paralysis of
   newborn infants receiving mechanical ventilation compared with no
   routine paralysis results in clinically important benefits or harms.
   SEARCH STRATEGY: The Cochrane Central Register of Controlled Trials
   (CENTRAL, The Cochrane Library, Issue 1, 2004), MEDLINE (from 1966 to
   April 2004) and EMBASE (from 1988 to April 2004) were searched.
   References of review articles were hand searched. Language restriction
   was not imposed.
   SELECTION CRITERIA: All trials using random or quasi-random patient
   allocation, in which the routine use of neuromuscular blocking agents
   during mechanical ventilation was compared to no paralysis or selective
   paralysis in newborn infants. Methodological quality was assessed
   blindly and independently by the two authors.
   DATA COLLECTION AND ANALYSIS: Data were abstracted using standard
   methods of the Cochrane Collaboration and its Neonatal Review Group,
   with independent evaluation of trial quality, and abstraction and
   synthesis of data by both authors. Treatment effect was analysed using
   relative risk, risk difference and weighted mean difference.
   MAIN RESULTS: Ten possibly eligible trials were identified, of which six
   were included in the review. All the included trials studied preterm
   infants ventilated for respiratory distress syndrome, and used
   pancuronium as the neuromuscular blocking agent. In the analysis of the
   results of all trials, no significant difference was found in mortality,
   air leak or chronic lung disease, but there was a significant reduction
   in intraventricular hemorrhage and a trend towards less severe
   intraventricular hemorrhages. In the subgroup analysis of trials
   studying a selected population of ventilated infants with evidence of
   asynchronous respiratory efforts, a significant reduction in
   intraventricular hemorrhage (any grade and severe IVH) was found, and a
   trend towards less air leak. In the subgroup analysis of trials studying
   an unselected population of ventilated infants, no significant
   differences were found for any of the outcomes.
   AUTHORS' CONCLUSIONS: For ventilated preterm infants with evidence of
   asynchronous respiratory efforts, neuromuscular paralysis with
   pancuronium seems to have a favourable effect on intraventricular
   hemorrhage and possibly on air leak. Uncertainty remains, however,
   regarding the long term pulmonary and neurologic effects, and regarding
   the safety of prolonged use of pancuronium in ventilated newborn
   infants. There is no evidence from randomized trials on the effects of
   neuromuscular blocking agents other than pancuronium. The routine use of
   pancuronium or any other neuromuscular blocking agent in ventilated
   newborn infants cannot be recommended based on current evidence.
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
UT MEDLINE:15846639
PM 15846639
ER

PT J
AU Chisolm, Theresa H
   Abrams, Harvey B
   McArdle, Rachel
   Wilson, Richard H
   Doyle, Patrick J
TI The WHO-DAS II: psychometric properties in the measurement of functional
   health status in adults with acquired hearing loss.
SO Trends in amplification
VL 9
IS 3
BP 111
EP 26
DI 10.1177/108471380500900303
PD 2005
PY 2005
AB The World Health Organization's (WHO) Disability Assessment Scale II
   (WHO-DAS II) is a generic health-status instrument firmly grounded in
   the WHO's International Classification of Functioning, Disability and
   Health (WHO-ICF). As such, it assesses functioning for six domains:
   communication, mobility, self-care, interpersonal, life activities, and
   participation. Domain scores aggregate to a total score. Because the
   WHO-DAS II contains questions relevant to hearing and communication, it
   has good face validity for use as an outcome measure for audiologic
   intervention. The purpose of the present study was to determine the
   psychometric properties of the WHO-DAS II on a sample of individuals
   with adult-onset hearing loss, including convergent validity, internal
   consistency, and test-retest stability. Convergent validity was
   established by examining correlations between the WHO-DAS II (domain and
   total scores) and the Abbreviated Profile of Hearing Aid Benefit (APHAB)
   and the Hearing Aid Handicap for the Elderly (HHIE), two
   disease-specific measures, as well as with the Short Form-36 for
   veterans (SF-36V), a second generic measure. Data on all four measures
   were collected from 380 older individuals with adult-onset hearing loss
   who were not hearing aid users. The results of the convergent validity
   analysis revealed that the WHODAS II communication domain score was
   moderately and significantly correlated with scores on the APHAB and the
   HHIE. WHO-DAS II interpersonal and participation domain scores and the
   total scores were also moderately and significantly correlated with HHIE
   scores. These findings support the validity of using the WHO-DAS II for
   assessing activity limitations and participation restrictions of
   adult-onset hearing loss. Several WHO-DAS II domain scores and the total
   score were also significantly and moderately-markedly correlated with
   scores from the SF-36V. These findings support the validity of the
   WHO-DAS II as a generic health-status instrument. Internal consistency
   reliability for all the domain scores was adequate for all but the
   interpersonal domain. Test-retest stability for all the domain scores
   was adequate. Critical difference values were calculated for use in
   clinical application of the WHO-DAS II. From these findings, we
   concluded that the WHO-DAS II communication, participation, and total
   scores can be used to examine the effects of adult-onset hearing loss on
   functional health status. Further work examining the utility of the
   WHO-DAS II as an outcome measure for hearing aid intervention is
   warranted.
TC 48
ZB 13
Z8 1
ZS 0
Z9 49
SN 1084-7138
UT MEDLINE:16244758
PM 16244758
ER

PT J
AU Spears, K
   Cheney, C
   Zerzan, J
TI Low plasma retinol concentrations increase the risk of developing
   bronchopulmonary dysplasia and long-term respiratory disability in
   very-low-birth-weight infants
SO AMERICAN JOURNAL OF CLINICAL NUTRITION
VL 80
IS 6
BP 1589
EP 1594
PD DEC 2004
PY 2004
AB Background: The effect of inadequate vitamin A during the neonatal
   period on lung status is still unknown.
   Objective: We tested the hypothesis that low plasma retinol
   concentrations during the first month of life are independently
   associated with bronchopulmonary dysplasia (BPD) and long-term
   respiratory morbidity at 6 mo gestationally corrected age (ie, the age
   the infant would be had the pregnancy gone to term).
   Design: Respiratory outcome information was obtained to 6 mo corrected
   age for a historical cohort of very-low-birth-weight neonates (< 1250 g)
   who were admitted to intensive care over a 7-y period. Neonates with one
   or more plasma measurements of retinol concentrations < 0.35 mumol/L
   (<100 mug/L) on days 1-28 were classified as having low vitamin A. BPD
   was defined at day 28 by clinical and radiologic criteria and by use of
   supplemental oxygen at 36 wk postmenstrual age (PMA). Dependence on
   supplemental oxygen was used to identify long-term respiratory
   disability at 6 mo corrected age. Multivariate logistic regression
   analyses were conducted.
   Results: Of the 350 study infants, 192 (55%) had low vitamin A status.
   BPD occurred in 52% of survivors at day 28 (173/331) and at 36 wk PMA
   (147/285). Fourteen percent (33/244) required oxygen support at 6 mo
   corrected age. Adjusted odds ratios of BPD with low vitamin A were 3.5
   (95% CI: 1.7, 7.2) at day 28 and 1.7 (1.0, 2.7) at 36 wk PMA. At 6 mo
   corrected age, the adjusted odds ratio was 2.6 (1.1, 6.4) for
   respiratory disability with low vitamin A.
   Conclusion: Poor vitamin A status during the first month of life
   significantly increased the risk of developing BPD and long-term
   respiratory disability.
TC 19
ZB 13
Z8 3
ZS 0
Z9 23
SN 0002-9165
UT WOS:000225626900019
PM 15585773
ER

PT J
AU Young, GB
   Hammond, RR
TI A stronger approach to weakness in the intensive care unit
SO CRITICAL CARE
VL 8
IS 6
BP 416
EP 418
DI 10.1186/cc2961
PD DEC 2004
PY 2004
AB ICU-acquired limb and respiratory muscle weakness is a common, serious
   ICU syndrome, increasing in frequency with prolonged ICU stay and
   sepsis. A systematic approach facilitates precise localization of the
   problem within central or peripheral nervous system. Most cases relate
   to critical illness polyneuropathy or myopathy or a combination of both
   ( critical illness neuromyopathy). Within the latter entity, the
   relative contribution of neuropathy versus myopathy varies considerably
   among affected patients. Muscle enzyme testing, electromyography-nerve
   conduction and muscle biopsy are valuable investigative tests. Nerve
   biopsy is less commonly needed, but is useful when vascultis is
   suspected.
TC 10
ZB 3
Z8 0
ZS 0
Z9 11
SN 1466-609X
UT WOS:000226232100029
PM 15566605
ER

PT J
AU Steer, P
   Flenady, V
   Shearman, A
   Charles, B
   Gray, PH
   Henderson-Smart, D
   Bury, G
   Fraser, S
   Hegarty, J
   Rogers, Y
   Reid, S
   Horton, L
   Charlton, M
   Jacklin, R
   Walsh, A
CA Caffeine Collaborat Study Grp Stee
TI High dose caffeine citrate for extubation of preterm infants: a
   randomised controlled trial
SO ARCHIVES OF DISEASE IN CHILDHOOD
VL 89
IS 6
SI SI
BP F499
EP F503
DI 10.1136/adc.2002.023432
PD NOV 2004
PY 2004
AB Objective: To compare two dosing regimens for caffeine citrate in the
   periextubation period for neonates born at less than 30 weeks gestation
   in terms of successful extubation and adverse effects.
   Design: A multicentre, randomised, double blind, clinical trial.
   Setting: Four tertiary neonatal units within Australia.
   Patients: Infants born less than 30 weeks gestation ventilated for more
   than 48 hours.
   Interventions: Two dosing regimens of caffeine citrate ( 20 v 5
   mg/kg/day) for periextubation management. Treatment started 24 hours
   before a planned extubation or within six hours of an unplanned
   extubation.
   Main outcome measure: Failure to extubate within 48 hours of caffeine
   loading or reintubation and ventilation or doxapram within seven days of
   caffeine loading.
   Results: A total of 234 neonates were enrolled. A significant reduction
   in failure to extubate was shown for the 20 mg/kg/day dosing group
   (15.0% v 29.8%; relative risk 0.51; 95% confidence interval (CI) 0.31 to
   0.85; number needed to treat 7 ( 95% CI 4 to 24)). A significant
   difference in duration of mechanical ventilation was shown for infants
   of less than 28 weeks gestation receiving the high dose of caffeine (
   mean (SD) days 14.4 (11.1) v 22.1 (17.1); p = 0.01). No difference in
   adverse effects was detected in terms of mortality, major neonatal
   morbidity, death, or severe disability or general quotient at 12 months.
   Conclusions: This trial shows short term benefits for a 20 mg/kg/day
   dosing regimen of caffeine citrate for neonates born at less than 30
   weeks gestation in the periextubation period, without evidence of harm
   in the first year of life.
RI Charles, Bruce/G-4411-2010; Charles, Bruce/A-3828-2012; Gray, Peter/A-1425-2008; Flenady, Vicki/O-9609-2014
TC 26
ZB 13
Z8 0
ZS 0
Z9 26
SN 0003-9888
UT WOS:000224973000011
PM 15499141
ER

PT J
AU Brooks, Dina
   King, Audrey
   Tonack, Mark
   Simson, Helen
   Gould, Maria
   Goldstein, Roger
TI User perspectives on issues that influence the quality of daily life of
   ventilator-assisted individuals with neuromuscular disorders.
SO Canadian respiratory journal : journal of the Canadian Thoracic Society
VL 11
IS 8
BP 547
EP 54
PD 2004 Nov-Dec
PY 2004
AB OBJECTIVES: To identify user perspectives on the issues that impact the
   quality of the daily lives of ventilator-assisted individuals living in
   the community.
   METHODS: Semistructured interviews were held with 26 Canadian
   ventilator-assisted individuals (mean age 44+/-14 [SD] years, range 23
   to 60 years; mean ventilator experience 18+/-13 years, range three to 53
   years) whose disability from neuromuscular conditions necessitated
   assistance with activities of daily living. Participants described their
   daily life experiences and perceptions of the factors that limited or
   enhanced their quality. Interviews were tape-recorded, transcribed and
   analyzed for emergent codes and themes.
   RESULTS: Ventilator users characterized important issues in terms of
   personal successes and limitations, as well as dependencies on others
   for daily living. Personal support services, income security, health
   care and transportation were important positive contributors to their
   quality of life. Dependency on others was clearly a negative
   contributor. The ventilator was regarded as a form of assistive
   technology, similar to a wheelchair. Ventilator users perceived that
   ventilation was associated with a stigma and negative assumptions about
   disability, particularly if suctioning was required.
   CONCLUSIONS: The majority of participants considered home mechanical
   ventilation to be a positive benefit for independent living, enhancing
   their overall health. They were clear as to the issues of importance to
   them, and formulated recommendations for health care providers and
   policy makers that could improve the quality of their daily lives. Many
   of the issues identified in the present report are faced by the growing
   community of ventilator users.
TC 13
ZB 1
Z8 0
ZS 0
Z9 13
SN 1198-2241
UT MEDLINE:15611803
PM 15611803
ER

PT J
AU van der Schaaf, M
   Beelen, A
   de Vos, R
TI Functional outcome in patients with critical illness polyneuropathy
SO DISABILITY AND REHABILITATION
VL 26
IS 20
BP 1189
EP 1197
DI 10.1080/09638280410001724861
PD OCT 21 2004
PY 2004
AB Purpose: To evaluate the functional outcome of intensive care patients
   with critical illness polyneuropathy (CIP), 6 and 12 months after the
   onset.
   Methods: Design: A prospective observational cohort study and a
   cross-sectional study. Setting: University hospital in the Netherlands.
   Patients: Eight consecutive intensive care patients with CIP for the
   prospective study and eight patients diagnosed with CIP in the past 6
   months for the cross-sectional study. Main outcome measures: Functional
   outcome regarding body functions and structure, activities,
   participation and perceived quality of life.
   Results: Nine patients (56%) died within one year. Functional outcome,
   participation and subjective health status in survivors varied widely at
   6 and 12 months. After 12 months, physical functioning was improved in
   all patients. However activities related to mobility outdoors, autonomy,
   participation and quality of life were restricted in most patients.
   Conclusions: The majority of survivors have persistent functional
   disabilities in activities, reduced quality of life and restrictions in
   autonomy and participation one year after the onset of CIP. Prolonged
   rehabilitation treatment is necessary for an increasing number of
   intensive care patients who develop CIP, in order to reduce handicaps
   and achieve optimal autonomy and social participation.
TC 32
ZB 9
Z8 0
ZS 1
Z9 33
SN 1464-5165
UT WOS:000223772200003
PM 15371019
ER

PT J
AU Bregeon, F
   Delpierre, S
   Roch, A
   Kajikawa, O
   Martin, TR
   Autillo-Touati, A
   Jammes, Y
TI Persistence of diaphragmatic contraction influences the pulmonary
   inflammatory response to mechanical ventilation
SO RESPIRATORY PHYSIOLOGY & NEUROBIOLOGY
VL 142
IS 2-3
BP 185
EP 195
DI 10.1016/j.resp.2004.06.012
PD SEP 15 2004
PY 2004
AB Because we already showed (Bregeon, F., Roch, A., Delpierre, S., Ghigo,
   E., Autillo-Touati, A., Kajikawa, O., Martin, T., Pugin, J., Portugal,
   H., Auffray, J., Jammes, Y., 2002. Conventional mechanical ventilation
   of healthy lungs induced proinflammatory cytokine gene transcription,
   Respir. Physiol. Neurobiol. 132, 191-203) that non-injurious mechanical
   ventilation (MV) elicited inflammatory signal in paralyzed rabbits
   having normal lungs, we examined the role of neuromuscular blockade in
   the pulmonary inflammatory response. In the bronchoalveolar lavage fluid
   (BALF), leukocyte count, MCP-1 and IL-8 cytokine concentrations (ELISA)
   and mRNAs (reverse transcription polymerase chain reaction, RT-PCR) were
   measured in paralyzed (P) or non-paralyzed (NP) rabbits ventilated for a
   6-h period. Compared to the P group and despite the tidal volume was the
   same, we measured in the NP one a lower compliance of the respiratory
   system (Crs,stat), a longer inspiratory time (Ti), a negative
   inspiratory tracheal pressure (Ptr) wave preceding the pump-induced
   positive pressure wave, and a higher peak tracheal pressure. Moreover,
   in NP animals, gross autopsy showed negligible lung abnormalities, and
   marked reduction of leukocyte count and lung cytokines (P < 0.05). Thus,
   the absence of neuromuscular blockade decreased the pulmonary
   chemotactic response to MV suggesting that the total suppression of
   negative pressure waves elicited by the diaphragmatic (di) contractions
   could be involved in this lung response to positive pressure MV. (C)
   2004 Elsevier B.V. All rights reserved.
TC 5
ZB 3
Z8 0
ZS 0
Z9 5
SN 1569-9048
UT WOS:000224505200007
PM 15450479
ER

PT J
AU Lin, VW
   Hsiao, I
   Deng, XM
   Lee, YS
   Sasse, S
TI Functional magnetic ventilation in dogs
SO ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION
VL 85
IS 9
BP 1493
EP 1498
DI 10.1016/j.apmr.2003.10.025
PD SEP 2004
PY 2004
AB Objective: To investigate the efficacy of the magnetic stimulation of
   inspiratory muscles as an alternative to mechanical ventilation and
   functional electric stimulation.
   Design: A prospective before-after trial.
   Setting: Functional magnetic stimulation laboratory in a Veterans
   Administration health care system.
   Animals: Six male mongrel dogs, each weighing between 25 and 35kg.
   Interventions: Commercially available magnetic stimulators with a round
   magnetic coil were used. The center of the magnetic coil was placed
   posteriorly over the C5-7 vertebrae of the spinal cord transected dogs.
   Magnetic stimulation parameters were set at 80% intensity, 20Hz, and a
   1.2-second on and 3.8-second off pulse train.
   Main Outcome Measures: The major outcomes were changes in tidal volume
   (V-T), tracheal pressure (P-lr), and arterial partial pressure of carbon
   dioxide (PaCO2) and oxygen sustained by magnetic stimulation over time.
   Results: The average V-T and P-lr produced during functional magnetic
   ventilation (FMV) were .47 +/- .07L and -4.7 +/- .51 cmH(2)O,
   respectively. Blood gas data showed that PaCO2 increased from a baseline
   of 33 to 75mmHg, whereas pH decreased from 7.33 to 6.99 at the end of
   the 1-hour FMV period.
   Conclusions: FMV was achieved for 2 hours in dogs with C2 spinal cord
   transection. Additional refinements in magnetic stimulation are needed
   to improve ventilation in animals.
TC 3
ZB 1
Z8 4
ZS 0
Z9 7
SN 0003-9993
UT WOS:000223736400018
PM 15375823
ER

PT J
AU Graham, Robert J
   Dumas, Helene M
   O'Brien, Jane E
   Burns, Jeffery P
TI Congenital neurodevelopmental diagnoses and an intensive care unit:
   defining a population.
SO Pediatric critical care medicine : a journal of the Society of Critical
   Care Medicine and the World Federation of Pediatric Intensive and
   Critical Care Societies
VL 5
IS 4
BP 321
EP 8
DI 10.1097/01.PCC.0000128892.38431.2B
PD 2004-Jul
PY 2004
AB OBJECTIVE: To identify and describe the population of children with
   congenital or perinatally acquired neurodevelopmental diagnoses in a
   pediatric intensive care unit and to assess the nature and extent of
   their utilization of critical care resources.
   DESIGN: Twelve-month, inception cohort study.
   SETTING: Intensive care unit at an urban, tertiary care pediatric
   hospital.
   PATIENTS AND METHODS: All pediatric intensive care unit admissions were
   screened for preexisting neurodevelopmental diagnoses. Computerized and
   chart-based medical records were reviewed for demographic, clinical, and
   outcome data.
   RESULTS: A total of 309 children with congenital neurodevelopmental
   diagnoses accounted for 427 pediatric intensive care unit admissions.
   This represented 23% of the total 1,820 admissions in 1 yr. Trisomy 21
   was the most identifiable developmental abnormality (n = 25, 8%).
   Eighty-five percent of the children were cared for at home before
   hospitalization. A total of 220 of the admissions (52%) demonstrated a
   preexisting technology dependence. Fewer children admitted from the
   home-care setting had tracheostomies or were ventilator dependent. The
   majority of admissions were scheduled surgical admissions (45%) or for
   management of acute respiratory illness (26%). Of the patients with
   preexisting tracheostomy, nonrespiratory conditions accounted for 70% of
   acute admitting diagnoses. Two hundred twenty-three of the admissions
   (52%) required noninvasive or transtracheal ventilatory support, yet the
   length of stay and mortality rate were consistent with those reported in
   other general pediatric intensive care unit populations. The average and
   median length of stay were 5.4 and 2.0 days, respectively. Mortality
   rate was 3%. Technology support needs at discharge increased
   significantly from admission for enterostomy support (p =.008) and
   mechanical ventilation (p =.008).
   CONCLUSIONS: Children with congenital or perinatally acquired
   neurodevelopmental diagnoses represented nearly one quarter of all
   pediatric intensive care unit admissions at a tertiary academic center.
   This population has substantial ongoing medical needs, requiring
   utilization of intensive care resources. More rigorous investigations
   are needed to determine the effect of this burgeoning population in
   pediatric critical care, to optimize their care, and to meet the
   comprehensive needs of their families.
RI Benneyworth, Brian/A-4667-2009
OI Benneyworth, Brian/0000-0002-4692-5303
TC 22
ZB 6
Z8 0
ZS 0
Z9 22
SN 1529-7535
UT MEDLINE:15215000
PM 15215000
ER

PT J
AU MacIntyre, Neil R
TI Evidence-based ventilator weaning and discontinuation.
SO Respiratory care
VL 49
IS 7
BP 830
EP 6
PD 2004-Jul
PY 2004
AB Ventilator management of a patient who is recovering from acute
   respiratory failure must balance competing objectives. Discontinuing
   mechanical ventilation and removing the artificial airway as soon as
   possible reduces the risk of ventilator-induced lung injury, nosocomial
   pneumonia, airway trauma from the endotracheal tube, and unnecessary
   sedation, but premature ventilator-discontinuation or extubation can
   cause ventilatory muscle fatigue, gas exchange failure, and loss of
   airway protection. In 1999 the McMaster University Outcomes Research
   Unit conducted a comprehensive evidence-based review of the literature
   on ventilator-discontinuation. Using that literature review, the
   American College of Chest Physicians, the Society of Critical Care
   Medicine, and the American Association for Respiratory Care created
   evidence-based guidelines, which include the following principles: 1.
   Frequent assessment is required to determine whether ventilatory support
   and the artificial airway are still needed. 2. Patients who continue to
   require support should be continually re-evaluated to assure that all
   factors contributing to ventilator dependence are addressed. 3. With
   patients who continue to require support, the support strategy should
   maximize patient comfort and provide muscle unloading. 4. Patients who
   require prolonged ventilatory support beyond the intensive care unit
   should go to specialized facilities that can provide more gradual
   support reduction strategies. 5. Ventilator-discontinuation and weaning
   protocols can be effectively carried out by nonphysician clinicians.
TC 25
ZB 4
Z8 2
ZS 1
Z9 29
SN 0020-1324
UT MEDLINE:15222913
PM 15222913
ER

PT J
AU De Jonghe, B
   Bastuji-Garin, S
   Sharshar, T
   Outin, H
   Brochard, L
TI Does ICU-acquired paresis lengthen weaning from mechanical ventilation?
SO INTENSIVE CARE MEDICINE
VL 30
IS 6
BP 1117
EP 1121
DI 10.1007/s00134-004-2174-z
PD JUN 2004
PY 2004
AB Objective. To determine whether ICU-acquired paresis (ICUAP) is an
   independent risk factor of prolonged weaning. Design. Second study of a
   prospective cohort of 95 patients who were enrolled in an incidence and
   risk factor study of ICUAP. Setting. Three medical and two surgical ICUs
   in four hospitals. Patients and participants. Ninety-five patients
   without pre-existing neuromuscular disease recovering from the acute
   phase of critical illness after greater than or equal to7 days of
   mechanical ventilation. Interventions. None. Measurements and results.
   Duration of weaning from mechanical ventilation was defined as the
   duration of mechanical ventilation between awakening (day 1) and
   successful weaning. Muscle strength was evaluated at day 7 after
   awakening using the Medical Research Council (MRC) score. Patients with
   an MRC <48 were considered to have ICUAP. Among the 95 patients (mean
   age 62.0+/-15.3 years, SAPS 2 on admission 48.7+/-17.4) who regained
   satisfactory awakening after 7 or more days of mechanical ventilation,
   67 (70.5%) were hospitalized in a medical ICU and 28 (29.5%) in a
   surgical ICU. Median duration (25th-75th percentiles) of weaning was
   longer in patients with ICUAP than in those without ICUAP: 6 days (1-22
   days) vs 3 days (1-7 days); p=0.01; log-rank analysis. In multivariate
   analysis, the two independent predictors of prolonged weaning were ICUAP
   [hazard ratio (HR): 2.4; 95% confidence interval (CI): 1.4-4.2] and
   chronic obstructive pulmonary disease (HR: 2.7; 95% CI: 1.6-4.5)
   Conclusions. ICU-acquired paresis is an independent predictor of
   prolonged weaning. Prevention of ICU-acquired neuromuscular
   abnormalities in patients recovering from severe acute illness should
   result in shorter weaning duration.
TC 122
ZB 35
Z8 0
ZS 1
Z9 125
SN 0342-4642
UT WOS:000221730300018
PM 14767593
ER

PT J
AU Darras, Basil T
   Jones, H Royden Jr
TI Neuromuscular problems of the critically ill neonate and child.
SO Seminars in pediatric neurology
VL 11
IS 2
BP 147
EP 68
DI 10.1016/j.spen.2004.04.003
PD 2004-Jun
PY 2004
AB This review presents insights gained over 24 years of clinical and
   laboratory evaluations of children, newborn to 18 years of age, who
   present with acute weakness in the intensive care setting. The
   differential diagnosis of neuromuscular disorders in these cases begins
   with recognition of three categories-the infant and toddler, the older
   child and adolescent, and the child with critical illness-within which
   predisposition to specific disorders may be identified. Disorders
   originating from anterior horn cell, peripheral nerve, neuromuscular
   junction, and muscle cell are discussed with emphasis on presentation
   and electrophysiologic findings. Nerve conduction studies,
   electromyography, electroencephalography, cerebrospinal fluid analysis,
   and magnetic resonance imaging each play important diagnostic roles in
   the differentiation of neuromuscular disorders in the critically ill
   child. Case studies suggest the wide range of presentations these
   disorders may make to the pediatrician or pediatric neurologist.
TC 2
ZB 1
Z8 0
ZS 0
Z9 2
SN 1071-9091
UT MEDLINE:15259868
PM 15259868
ER

PT J
AU Kadilak, PR
   Vanasse, S
   Sheridan, RL
TI Favorable short-and long-term outcomes of prolonged translaryngeal
   intubation in critically ill children
SO JOURNAL OF BURN CARE & REHABILITATION
VL 25
IS 3
BP 262
EP 265
DI 10.1097/01.BCR.0000124786.68570.7C
PD MAY-JUN 2004
PY 2004
AB In those children who require protracted mechanical ventilation, we use
   long-term intubation in order to avoid the consequences of tracheostomy
   in young children. A retrospective 9-year review was performed to
   document the efficacy and safety of this practice. A retrospective
   review of children admitted from January 1, 1991, to December 31, 1998,
   who required mechanical ventilatory support for at least 7 consecutive
   days was performed. Data are presented as mean +/- standard deviation.
   There were 98 children, ventilated for a total of 1967 days, who
   satisfied review criteria. They had an average age of 6.1 +/- 5.3 years
   (range, 3 months to 17 years) a total body surface area burn of 53 +/-
   25% (range, 0-100%), and 71 of 98 (72%) had suffered an inhalation
   injury. They were ventilated for 19.7 +/- 16.8 days (range, 7-92 days)
   and were hospitalized for 67.8 +/- 48.9 days (range, 9-211 days).
   Ninety-three percent (91 of 98) of the patients were maintained on
   morphine infusions at a mean hourly rate of 0.35 +/- 0.33 mg/kg/hr
   (range, 0.01-4.38) and 78% (76 of 98) on midazolam infusions at a mean
   hourly rate of 0.14 +/- 0.17 mg/kg/hr (range, 0.01-1.82). Neuromuscular
   blocking agents were administered in 39% (38 of 98) of patients during
   all or part of 355 (18%) of the 1967 ventilator days. Patients were
   ventilated with an oral endotracheal (ET) tube in 82% of ventilator days
   and nasal ET tube in 18% of ventilator days. Two patients (2%) required
   tracheostomies for long-term management, and five patients (5.1%) died
   during the study period unrelated to airway issues. There were five
   unplanned extubation events, for an incidence rate of 2.54 per 1000
   ventilator days. All patients were reintubated successfully. Thirteen ET
   tubes needed to be changed for issues such as leaking cuffs. Patients
   were followed up for a mean of 2.99 +/- 2.24 years (range, 1 month to 8
   years). Possible sequelae related to prolonged intubation were noted in
   follow-up visits in 8 patients, including sinusitis (one; resolved
   without treatment), subglottic stenosis (one; required reconstructive
   surgery), persistent cough (three; all resolved spontaneously),
   occipital breakdown because of ET ties (one; healed after 1 month), soft
   voice (two; resolved spontaneously), and decreased pharyngeal sensation
   (one; resolved without treatment). Translaryngeal intubation is a safe
   and effective method to provide long-term ventilatory support in
   children.
TC 19
ZB 6
Z8 0
ZS 1
Z9 19
SN 0273-8481
UT WOS:000221428600008
PM 15273467
ER

PT J
AU Rubino, FA
TI Perioperative management of patients with neurologic disease
SO NEUROLOGIC CLINICS
VL 22
IS 2
BP 261
EP +
DI 10.1016/j.ncl.2003.12.005
PD MAY 2004
PY 2004
AB There is little in the medical literature on perioperative management of
   patients who have neurologic diseases. Most likely this is because
   perioperative management of patients who have neurologic diseases does
   not differ much from management of patients who do not have neurologic
   diseases, except in certain situations, such as patients who have
   neuromuscular diseases, especially myasthenia gravis (MG). There are,
   however, problems that can occur in patients who harbor central nervous
   system disorders and also in patients who have peripheral nervous system
   disorders. Even though age is not a neurologic disease, age must be
   considered at least a neurologic risk factor in surgery of any type.
   Many surgical procedures are performed in elderly patients, who suffer
   complications similar to those patients who have neurologic diseases.
   Exacerbations of neurologic signs and symptoms are common in the
   neurologic patient when there is a superimposed systemic illness or
   stress, as occurs in surgery. In reality, these are pseudo-exacerbations
   but often are mistaken for progression of the underlying neurologic
   disease. When the superimposed systemic problem or stress of surgery is
   alleviated, the neurologic patient slowly returns to his or her
   baseline. The important issue is to treat the superimposed problem and
   not change treatment for the underlying neurologic disorder and not
   order further neurologic testing. If there is an increase in signs and
   symptoms of the underlying neurologic disorder after surgery, the
   patient, family, and medical personnel need to be reassured that the
   patient will return to baseline after recovery from surgery.
   Postoperative delirium (acute confusional state) is a common and not
   unexpected problem in elderly patients in general and in neurologic
   patients specifically, particularly in patients who have dementia,
   Parkinson's disease or related disorders, previous stroke, multiple
   sclerosis, or previous head trauma or brain tumors. Sudden withdrawal of
   certain drugs, such as anticonvulsants or dopaminergics, can lead to
   problems, such as status epilepticus and the neuroleptic malignant
   syndrome. Headache might be difficult to manage in the postoperative
   migraineur. Neurologic patients who have weakness from their neurologic
   disease, and especially patients who have a neuropathy of any etiology,
   are prone to compressive neuropathies in the preoperative, operative,
   and postoperative periods. Patients in general who spend any time in
   ICUs are subject to critical illness neuropathy/myopathy; neuromuscular
   dysfunction acquired in the ICU frequently is reported in patients who
   have sepsis, multiple organ dysfunction, or both [1]. The epileptic
   patient might be prone to increased seizure frequency with the stress of
   surgery. The free level of phenytoin must be assessed in the critically
   ill epileptic patient who has been on phenytoin and is in need of blood
   level monitoring, because the total level may be falsely low. Phenytoin
   is highly protein bound and measurement of unbound phenytoin
   concentrations (free-level) may be more indicative of its pharmacologic
   effect. Total phenytoin concentrations and carbamazepine levels may vary
   up to 20% at steady state even in compliant patients [2,3]. The
   important concept is to treat the patient and not the blood level.
   Because many of the perioperative problems of the neurologic patient are
   predictable, they should be anticipated by the neurologist so that
   measures can be taken to prevent as many as possible and to recognize
   and manage those that cannot be prevented in a timely, efficient manner.
TC 2
ZB 0
Z8 0
ZS 0
Z9 2
SN 0733-8619
UT WOS:000220795800002
ER

PT J
AU Ambrosino, N
   Clini, E
TI Long-term mechanical ventilation and nutrition
SO RESPIRATORY MEDICINE
VL 98
IS 5
BP 413
EP 420
DI 10.1016/j.rmed.2003.11.008
PD MAY 2004
PY 2004
AB Mechanical ventilation (MV) in chronic situations is commonly used,
   either delivered invasively or by means of non-invasive interfaces, to
   control hypoventilation in patients with chest wall, neuromuscular or
   obstructive lung diseases (either in adulthood or childhood). The global
   prevalence of ventitator-assisted individuals (VAI) in Europe ranges
   from 2 to 30 per 100000 population according to different countries.
   Nutrition is a common problem to face with in patients with chronic
   respiratory diseases: nonetheless, it is a key component in the
   long-term management of underweight COPD patients whose muscular
   disfunction may rapidly turn to peripheral muscle waste. Since tong-term
   mechanical ventilation (LTMV) is usually prescribed in end-stage
   respiratory diseases with poor nutritional status, nutrition and dietary
   intake related problems need to be carefully assessed and corrected in
   these patients.
   This paper aims to review the most recent innovations in the field of
   nutritional status and food intake-related problems of VAI (both in
   adulthood and in childhood). (C) 2003 Elsevier Ltd. All rights reserved.
TC 11
ZB 2
Z8 5
ZS 0
Z9 16
SN 0954-6111
UT WOS:000221309400005
PM 15139570
ER

PT J
AU Odegard, KC
   Schure, A
   Saiki, Y
   Hansen, DD
   Jonas, RA
   Laussen, PC
TI Anesthetic considerations during caval inflow occlusion in children with
   congenital heart disease
SO JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA
VL 18
IS 2
BP 144
EP 147
DI 10.1053/jva.2004.01.017
PD APR 2004
PY 2004
AB Objective: Caval inflow occlusion (IO) was introduced to facilitate
   surgical pulmonary and aortic valvotomy without cardiopulmonary bypass
   (CPB). Although a technique that is used infrequently today, it remains
   useful in some patients with complex single-ventricle congenital cardiac
   defects who require an atrial septectomy. The potential for
   complications and anesthetic considerations have not been described
   previously.
   Design: Retrospective review.
   Setting: A tertiary care university teaching children's hospital.
   Participants: Eleven children, median age 3 months (range 3 days-3
   years) who underwent (IO) technique for atrial septectomy.
   Interventions: Atrial septectomy under 10 in patients with restrictive
   atrial septum.
   Measurements and Main Results: Eleven children, median age 3 months
   (range 3 days-3 years), underwent IO for atrial septectomy. Mean
   duration of IO was 87.7 +/- 25.5 seconds. There was 1 intraoperative
   death (9%). After release of the caval clamps, inotropic support was
   necessary in 7 of 11 patients, arrhythmias occurred in 4 of 11 patients
   (2 atrial and 2 ventricular fibrillation), and 10 of 11 patients
   required blood transfusion along with boluses of calcium gluconate and
   sodium bicarbonate to support the circulation immediately post-IO.
   Duration of postoperative mechanical ventilation was 2.2 +/- 1.6 days;
   10 of 11 patients (91%) survived to discharge with mean length of
   intensive care unit stay 3.7 +/- 2.2 days.
   Conclusion: IO is an effective technique for short intracardiac
   procedures without the need for CPB. Close collaboration between
   anesthesia and surgical staff is essential to keep the duration of 10 as
   short as possible and because of the potential for hemodynamic
   instability. (C) 2004 Elsevier Inc. All rights reserved
TC 3
ZB 3
Z8 0
ZS 2
Z9 4
SN 1053-0770
UT WOS:000220941500005
PM 15073701
ER

PT J
AU Vohr, BR
   Wright, LL
   Dusick, AM
   Perritt, R
   Poole, WK
   Tyson, JE
   Steichen, JJ
   Bauer, CR
   Wilson-Costello, DE
   Mayes, LC
CA Neonatal Res Network
TI Center differences and outcomes of extremely low birth weight infants
SO PEDIATRICS
VL 113
IS 4
BP 781
EP 789
DI 10.1542/peds.113.4.781
PD APR 1 2004
PY 2004
AB Objective. Previous multicenter studies have shown significant center
   differences in neonatal characteristics and morbidities. This study
   evaluated center differences in outcome at 18 to 22 months among
   extremely low birth weight (ELBW; 401- 1000 g) infants after adjusting
   for demographics and antenatal interventions, and it identified neonatal
   interventions associated with outcome differences.
   Methods. We assessed the outcome of 2478 liveborn infants who were
   admitted in 1993 and 1994 to the 12 centers of the Neonatal Research
   Network of the National Institute of Child Health and Human Development;
   1483 (60%) infants survived to 18 to 22 months, and 1151 (78%) had
   comprehensive evaluations. Logistic regression analyses were performed
   to identify center differences and the association of 4 neonatal
   interventions - active resuscitation, postnatal steroids, ventilator
   treatment for less than or equal to 27 days, and full enteral feedings
   less than or equal to 24 days - with adverse outcomes ( cerebral palsy,
   low Bayley scores, and neurodevelopmental impairment [NDI]), after
   adjusting for demographics and antenatal interventions.
   Results. Using bivariate analyses, significant center differences were
   identified for mortality, antenatal and postnatal interventions, social
   and environmental variables, neonatal morbidities, and
   neurodevelopmental outcomes for the 12 centers. After adjustment for
   maternal and infant demographics and antenatal interventions, the
   percentage of ELBW infants who had died or had NDI at 18 to 22 months
   ranged from 52% to 85%. Active resuscitation and postnatal steroids were
   associated with increases of NDI of 11.8% and 19.3%, whereas shorter
   ventilation support and shorter time to achieve full enteral feeds were
   associated with decreases in NDI of 20.7% and 17.3%, respectively.
   Conclusion. There are large and disturbing differences among centers in
   outcomes at 18 to 22 months after adjusting for demographic and
   antenatal interventions. Center differences in postnatal interventions
   associated with differences in outcome can provide hypotheses for
   testing in clinical trials to improve outcome.
TC 131
ZB 79
Z8 1
ZS 5
Z9 138
SN 0031-4005
UT WOS:000220585100014
PM 15060228
ER

PT J
AU Al-Jumah, MA
   Awada, AA
   Al-Ayafi, HA
   Kojan, SW
   Al-Shirawi, N
TI Neuromuscular paralysis in the intensive care unit
SO SAUDI MEDICAL JOURNAL
VL 25
IS 4
BP 474
EP 477
PD APR 2004
PY 2004
AB Objectives: To determine the features. causes, risk factors and outcome
   of acquired neuromuscular paralysis in critically ill patients.
   Methods: Retrospective review of all confirmed cases of acquired
   polyneuropathy and myopathy examined by our Neurology service in the
   Intensive Care Unit (ICU), at King Fahad National Guard Hospital,
   Riyadh, Kingdom Of Saudi Arabia over a period of 5 years. All patients
   had comprehensive electrophysiological Studies and one third had muscle
   and nerve biopsies.
   Results: Thirty cases were included, 8 cases of polyneuropathy, 15 cases
   of myopathy and 7 cases of mixed neuropathy and myopathy. Absent deep
   tendon reflexes and absent sensory potential oil nerve conduction
   Studies were significantly suggestive of neuropathy. The level of
   creatine phosphokinase was not of ureat diagnostic value. Most
   polyneuropathy and myopathy cases had passed through a stormy ICU Course
   with sepsis and multiorgan failure. The use of high doses of sterol as
   more associated with myopathy. Seven steroids patients died in ICU, the
   others were discharged to the wards after a mean ventilation period of
   40 days. One patient became chronic ventilator dependent.
   Conclusions: From this series and available literature, it seems that
   symptomatic myopathy is more frequent than polyneuropathy and some risk
   factors are common for both (sepsis and multiorgan failure) while the
   use of steroids is more associated with ICU myopathy. Treating sepsis
   and stopping corticosteroids results in the improvement of most of the
   cases.
TC 1
ZB 1
Z8 0
ZS 0
Z9 1
SN 0379-5284
UT WOS:000221254000012
PM 15083219
ER

PT J
AU Hansen, BM
   Hoff, B
   Uldall, P
   Greisen, G
CA Danish ETFOL Grp
TI Perinatal risk factors of adverse outcome in very preterm children: a
   role of initial treatment of respiratory insufficiency?
SO ACTA PAEDIATRICA
VL 93
IS 2
BP 185
EP 189
DI 10.1080/08035250310008230
PD FEB 2004
PY 2004
AB Aim: To investigate risk factors of adverse outcome in a cohort of very
   preterm children treated mainly with nasal continuous positive airway
   pressure (CPAP) during the neonatal course. Methods: In Denmark, preterm
   children are treated with nasal CPAP as a first approach to respiratory
   support. A national prospective study of all infants with a birthweight
   below 1000 g or a gestational age below 28 wk born in 1994-1995 was
   initiated to evaluate this approach. Of the 269 surviving children 164
   (61%) were not treated with mechanical ventilation in the neonatal
   period. A follow-up of the children at 5 y of age was conducted. Data
   from the neonatal period and the 5-y follow-up were analysed. Results:
   In multivariate analyses including 250 children, a severely abnormal
   neonatal brain ultrasound scan was predictive of cerebral palsy
   (OR=19.9, CI 95%: 6.1-64.8) and intellectual disability (OR=6.2, CI 95%:
   2.3-16.5). A high Clinical Risk Index for Babies (CRIB) score (OR=2.4,
   CI 95%: 1.1-5.5) and chronic lung disease (OR=2.8, CI 95%: 1.2-6.9) were
   predictive of intellectual disability. In univariate analyses mechanical
   ventilation was associated with cerebral palsy (OR=4.3, CI 95%:
   1.7-10.8) and intellectual disability (OR=2.2, CI 95%: 1.2-4.2), but the
   associations became insignificant in multivariate analyses including
   chronic lung disease and a severely abnormal ultrasound scan.
   Conclusion: The associations between neonatal risk factors and adverse
   outcome in our cohort were very similar to those found in other cohorts
   with another initial treatment of respiratory insufficiency. We found no
   significant adverse effects of mechanical ventilation beyond what Could
   be explained by associations with chronic lung disease and IVH 3-4/PVL.
TC 12
ZB 10
Z8 0
ZS 0
Z9 13
SN 0803-5253
UT WOS:000189304800012
PM 15046271
ER

PT J
AU Hansen, BM
   Hoff, B
   Greisen, G
   Mortensen, EL
CA Danish ETFOL Study Grp
TI Early nasal continuous positive airway pressure in a cohort of the
   smallest infants in Denmark: neurodevelopmental outcome at five years of
   age
SO ACTA PAEDIATRICA
VL 93
IS 2
BP 190
EP 195
DI 10.1080/08035250310008195
PD FEB 2004
PY 2004
AB Aim: To evaluate neurodevelopmental outcome at age 5 y of age in a
   cohort of preterm children treated mainly with nasal continuous positive
   airway pressure (CPAP) in the neonatal period. Methods: A national
   prospective observational study was conducted in Denmark which included
   all 269 surviving children with a birthweight below 1000 g or a
   gestational age below 28 wk born in Denmark in between 1994 and 1995. A
   total of 164 children (61%) had been treated with nasal CPAP only in the
   neonatal period. A reference group (n=76) of term children was studied
   in parallel. Results: Of the 269 surviving children, 252 (94%) were
   examined. Twenty-four children (10%) had cerebral palsy, and three
   children were blind. No case of hearing impairment was detected.
   Nineteen percent of the index children had an IQ score <-2 SD and 42%
   had an IQ score <-1 SD of the mean score of the reference group.
   Conclusions: The intellectual development of children in this cohort
   treated with early nasal CPAP did not suggest a higher proportion of
   adverse effects on the brain compared to the published follow-up Studies
   of preterm children treated with mechanical ventilation. In our
   population-based cohort, however, the Survival rate for infants below 25
   wk of gestation was relatively low and this may indicate a limit for the
   use of early nasal CPAP.
TC 18
ZB 15
Z8 0
ZS 0
Z9 18
SN 0803-5253
UT WOS:000189304800013
PM 15046272
ER

PT J
AU Yates, K
   Festa, M
   Gillis, J
   Waters, K
   North, K
TI Outcome of children with neuromuscular disease admitted to paediatric
   intensive care
SO ARCHIVES OF DISEASE IN CHILDHOOD
VL 89
IS 2
BP 170
EP 175
DI 10.1136/adc.2002.019562
PD FEB 1 2004
PY 2004
AB Aims: To determine the outcome of children with neuromuscular disease
   (NMD) following admission to a tertiary referral paediatric intensive
   care (PICU).
   Methods: All children with chronic NMD whose first PICU admission was
   between July 1986 and June 2001 were followed up from their first PICU
   admission to time of study. The outcomes recorded were death in or
   outside of PICU, duration of PICU admission, artificial ventilation
   during admission and following discharge from PICU, and readmission to
   PICU.
   Results: Over 15 years, 28 children were admitted on 69 occasions.
   Sixteen (57%) children had more than one admission. The median duration
   of PICU admission was 4 days ( range 0.5 - 42). Twenty three per cent of
   unplanned admissions resulted in the commencement of respiratory support
   that was continued after discharge from the PICU. Severity of functional
   impairment was not associated with longer duration of stay or higher
   PRISM scores. Ten children ( 36%) died, with four (14%) deaths in the
   PICU. A higher proportion of children with severe limitation of function
   were among children that died compared to survivors.
   Conclusion: Most children with NMD admitted to the PICU recover and are
   discharged without the need for prolonged invasive ventilation. However,
   in this group of children, the use of non-invasive home based
   ventilation is common and they are likely to require further PICU
   admission.
RI North, Kathryn/K-6476-2012
OI North, Kathryn/0000-0003-0841-8009
TC 18
ZB 5
Z8 0
ZS 0
Z9 18
SN 0003-9888
UT WOS:000188302500025
PM 14736637
ER

PT J
AU De Jonghe, Bernard
   Sharshar, Tarek
   Hopkinson, Nicholas
   Outin, Herve
TI Paresis following mechanical ventilation.
SO Current opinion in critical care
VL 10
IS 1
BP 47
EP 52
DI 10.1097/00075198-200402000-00008
PD 2004-Feb
PY 2004
AB PURPOSE OF REVIEW: To review the medical literature on neuromuscular
   abnormalities acquired in the intensive care unit (ICU), particularly
   after mechanical ventilation, focusing on the most recent advances in
   this field.
   RECENT FINDING: Using a simple bedside muscle strength score,
   significant clinical weakness is detected in one fourth of patients
   awakening in ICU after more than 1 week of mechanical ventilation.
   Weakness is associated with a longer time on mechanical ventilation,
   although the exact relationship between limb and respiratory
   neuromuscular involvement remains unclear. Muscle involvement is often
   combined with axonal involvement and can predominate or occur in
   isolation in some patients. Although prolonged severe weakness is
   unusual, milder abnormalities may persist for several months after
   discharge. In addition to severity and duration of initial organ
   failures, both neuromuscular inactivity and use of corticosteroids make
   an independent contribution of the neuromuscular abnormalities.
   Conversely, strict glycemic control may prevent neuromuscular
   abnormalities, although this needs to be confirmed in general ICU
   patients.
   SUMMARY: Avoiding complete neuromuscular inactivity, using
   corticosteroids with greater discernment, and closely monitoring blood
   glucose levels might be worthwhile avenues for research in prevention of
   neuromuscular abnormalities acquired in the most severely ill ICU
   patients. Investigations of the severity of the respiratory
   neuromuscular involvement are also warranted.
TC 17
ZB 8
Z8 0
ZS 3
Z9 20
SN 1070-5295
UT MEDLINE:15166849
PM 15166849
ER

PT J
AU Khilnani, G C
   Bansal, R
TI Neuromuscular weakness in critically ill.
SO The Journal of the Association of Physicians of India
VL 52
BP 131
EP 6
PD 2004-Feb
PY 2004
AB Neuromuscular weakness in critically ill has been increasingly reported
   in the recent years. Occasionally it may lead to difficulty in weaning
   the patients from mechanical ventilation, which is difficult to diagnose
   clinically. Though in well-planned studies the incidence has been
   reported to be high, the diagnosis is often missed due to the presence
   of various confounding factors in the form of drug effects, underlying
   disorder and coexisting abnormalities of the central nervous system. A
   high index of suspicion with detailed neurological and
   electrophysiological examination is required for an early and accurate
   diagnosis. A wide spectrum of disorders and drugs can be responsible for
   the critical illness neuromuscular abnormality. The most frequent and
   defined disorders include; critical illness polyneuropathy (CIP) which
   is characterized by a sensorimotor reversible polyneuropathy presenting
   as distal symmetrical weakness with loss of deep tendon reflexes. Acute
   myopathy is another important disorder in this group which usually
   presents with quadriplegia often related to steroid use. Persistent
   blockade of neuromuscular junction is also defined in critically ill
   patients. It is, therefore, important to understand these disorders and
   their implications in the management of these patients. Some of the
   conditions require prolonged neuro-rehabilitation. The various acquired
   disorders leading to neuromuscular abnormalities in critical care, and
   their diagnosis and management are discussed.
TC 1
ZB 1
Z8 0
ZS 0
Z9 1
SN 0004-5772
UT MEDLINE:15656048
PM 15656048
ER

PT J
AU Winkelman, Chris
TI Inactivity and inflammation: selected cytokines as biologic mediators in
   muscle dysfunction during critical illness.
SO AACN clinical issues
VL 15
IS 1
BP 74
EP 82
DI 10.1097/00044067-200401000-00006
PD 2004 Jan-Mar
PY 2004
AB Muscle dysfunction leads to activity intolerance, prolonged
   hospitalization, and additional days of mechanical ventilation. The
   etiology of muscle dysfunction in the critically ill patient is
   multifactoral. Inactivity and inflammation, common phenomena to patients
   in the intensive care unit, are associated with myopathy and muscle
   dysfunction. Cytokines are small biological active molecules that
   regulate inflammation and have a direct effect on muscle wasting. The
   purpose of this article is to describe selected cytokines (ie,
   interleukin-1, interleukin-6, interleukin-10, and tumor necrosis
   factor), explain their role in muscle dysfunction, and explore the role
   of therapeutic activity as a moderator of muscle dysfunction and
   cytokine-mediated muscle damage.
TC 26
ZB 14
Z8 0
ZS 1
Z9 28
SN 1079-0713
UT MEDLINE:14767366
PM 14767366
ER

PT J
AU Boudreaux, ED
   O'Hea, EL
TI Patient satisfaction in the Emergency Department: A review of the
   literature and implications for practice
SO JOURNAL OF EMERGENCY MEDICINE
VL 26
IS 1
BP 13
EP 26
DI 10.1016/j.jemermed.2003.04.003
PD JAN 2004
PY 2004
AB This article reviews the empirical literature on patient satisfaction in
   the Emergency Department (ED). It explores the implications for clinical
   practice, discusses limitations and weaknesses of the literature, and
   provides direction for future research. Articles resulting from a
   comprehensive electronic search were obtained, their references
   examined, and all other relevant articles not already discovered via the
   electronic search were acquired and reviewed. Articles were included if:
   1) the stated goal of the study was to investigate satisfaction with at
   least one aspect of ED care, 2) the study was conducted in the United
   States, 3) it provided enough information on the study methods, design,
   and statistical analyses to conduct a critical review, and 4) it used
   quantitative methods. Fifty studies met the above criteria. Based on the
   multivariate predictive studies, the most robust predictor of global
   satisfaction is the quality of interpersonal interactions with the ED
   provider. Perceived waiting times are more closely associated with
   satisfaction than actual waiting times. Several methods for improving
   satisfaction have shown promise, but none has garnered sufficient
   support to recommend unequivocally. Promising interventions include:
   providing information on how the ED functions through visual media,
   improving ED processes through performance improvement methodologies,
   and improving the interpersonal skills of providers. Interventions
   designed to reduce actual waiting times have not been sufficiently
   studied, but results from several well-designed studies suggest that
   such a strategy is unlikely to have as great an impact as those
   targeting perceived waiting times. To advance this area of research,
   investigators must use: 1) larger, more representative samples; 2)
   reliable and valid assessment instruments; 3) theory-driven hypothesis
   testing; and 4) randomized, controlled trials. (C) 2004 Elsevier Inc.
TC 77
ZB 4
Z8 0
ZS 1
Z9 78
SN 0736-4679
UT WOS:000188469100003
PM 14751474
ER

PT J
AU Richardson, WH
   Frei, SS
   Williams, SR
TI A case of type F botulism in southern California
SO JOURNAL OF TOXICOLOGY-CLINICAL TOXICOLOGY
VL 42
IS 4
BP 383
EP 387
DI 10.1081/CLT-120039544
PD 2004
PY 2004
AB Background. Botulism caused by type F botulinum toxin accounts for less
   than 0.1% of all human botulism cases and is rarely reported in the
   literature. Case Report. A 45-year-old woman presented to an emergency
   department complaining of bluffed vision, difficulty focusing, and
   dysphagia. The treating physician initially considered the possibility
   of paralytic shellfish poisoning due to a report of shellfish ingestion,
   which was later determined to be frozen shrimp and a can of tuna, but no
   gastroenteritis or paresthesias were present. During the emergency
   department observation, the patient developed respiratory distress with
   hypercapnea and required intubation and mechanical ventilation. Within
   hours, ptosis, mydriasis, and weakness in the arms and legs developed.
   Bivalent (A, B) botulinum antitoxin was administered approximately 24 h
   from the onset of initial symptoms, but over the next two days complete
   paralysis progressed to the upper and lower extremities. Shortly
   thereafter a stool toxin assay demonstrated the presence of type F
   botulinum toxin. The patient subsequently received an experimental
   heptavalent botulinum antitoxin on hospital day 7 but paralysis was
   already complete. Her three-week hospital course was complicated by
   nosocomial pneumonia and a urinary tract infection, but she gradually
   improved and was discharged to a rehabilitation facility. Anaerobic
   cultures and toxin assays have yet to elucidate the source of exposure.
   Conclusion. We report a rare case of type F botulism believed to be
   foodborne in etiology. Administration of bivalent botulinum antitoxin
   did not halt progression of paralysis.
TC 8
ZB 6
Z8 0
ZS 0
Z9 9
SN 0731-3810
UT WOS:000224104400007
PM 15461246
ER

PT J
AU Orlikowski, D
   Prigent, H
   Sharshar, T
   Lofaso, F
   Raphael, JC
TI Respiratory dysfunction in Guillain-Barre syndrome
SO NEUROCRITICAL CARE
VL 1
IS 4
BP 415
EP 422
DI 10.1385/NCC:1:4:415
PD 2004
PY 2004
AB Guillain-Barre Syndrome is the leading cause of nontraumatic acute
   paralysis in industrialized countries. About 30% of patients have
   respiratory failure requiring intensive care unit (ICU) admission and
   invasive mechanical ventilation. Progressive weakness of both the
   inspiratory and the expiratory muscles is the mechanism leading to
   respiratory failure. Aspiration pneumonia and atelectasis are common
   consequences of the bulbar muscle weakness and ineffective cough. The
   classical signs of respiratory distress occur too late to serve as
   guidelines for management, and measurements of vital capacity and static
   respiratory pressures are useful to determine the best times for
   starting and stopping mechanical ventilation. Several factors present at
   admission and during the ICU stay are known to predict a need for
   invasive mechanical ventilation. They include rapidly progressive motor
   weakness, involvement of both the peripheral limb and the axial muscles,
   ineffective cough, bulbar muscle weakness, and a rapid decrease in vital
   capacity. Specific treatments (plasma exchange and intravenous
   immunoglobulins) have decreased both the number of patients requiring
   ventilation and the duration of ventilation. The need for mechanical
   ventilation is associated with residual functional impairments, although
   all patients eventually recover normal respiratory muscle function.
TC 17
ZB 4
Z8 0
ZS 0
Z9 18
SN 1541-6933
UT WOS:000230489000002
PM 16174943
ER

PT J
AU Criswell, DS
   Shanely, RA
   Betters, JJ
   McKenzie, MJ
   Sellman, JE
   Van Gammeren, DL
   Powers, SK
TI Cumulative effects of aging and mechanical ventilation on in vitro
   diaphragm function
SO CHEST
VL 124
IS 6
BP 2302
EP 2308
DI 10.1378/chest.124.6.2302
PD DEC 2003
PY 2003
AB Study objective: Unloading the diaphragm, via mechanical ventilation
   (MV), results in significant diaphragmatic atrophy, contractile
   dysfunction, and oxidative stress in young adult animals. Since aging
   increases skeletal muscle susceptibility to atrophy and injury, we
   tested the hypothesis that MV-induced diaphragmatic contractile
   dysfunction would be exacerbated in aging rats.
   Methods: Fisher 344/Brown Norway hybrid rats (4 months old [young] and
   30 months old [old]) were assigned to either control or MV groups. MV
   rats were anesthetized, tracheostomized, and ventilated with 21% O-2 for
   12 h. Arterial BP, pH, and blood gas homeostasis were maintained in the
   MV animals throughout the experimental period. Animals in the control
   group were acutely anesthetized, and the diaphragms were immediately
   removed. Muscle strips from the mid-costal diaphragm were removed from
   each experimental animal, and contractile properties were studied in
   vitro.
   Results: Compared to young control animals, aging (old control animals)
   was associated with a 13% decrease in maximal isometric tension (24.5
   N/cm(2) vs: 21.3 N/cm(2)). Although, MV induced similar relative losses
   (24%) in diaphragmatic isometric tension in both young and old animals
   receiving MV, the combined effects of aging and MV resulted in a 34%
   decrement in diaphragmatic isometric tension compared to young control
   animals (24.5 N/cm(2) VS 16.1 N/cm(2)).
   Conclusions: These data do not support the hypothesis that aging
   exacerbates the relative MV-induced impairment in diaphragmatic
   isometric tension. Nonetheless, the additive effects of aging and MV
   have dramatic effects on diaphragmatic force reserve. This could
   exacerbate weaning difficulties in older individuals receiving MV.
TC 26
ZB 24
Z8 0
ZS 0
Z9 27
SN 0012-3692
UT WOS:000187364000042
PM 14665514
ER

PT J
AU Emanuelson, I
   Wendt, L V
   Hagberg, I
   Marchioni-Johansson, M
   Ekberg, G
   Olsson, U
   Larsson, J
   Egerlund, H
   Lindgren, K
   Pestat, C
TI Early community outreach intervention in children with acquired brain
   injury.
SO International journal of rehabilitation research. Internationale
   Zeitschrift fur Rehabilitationsforschung. Revue internationale de
   recherches de readaptation
VL 26
IS 4
BP 257
EP 64
DI 10.1097/00004356-200312000-00002
PD 2003-Dec
PY 2003
AB Ten patients with acquired brain injury were recruited over an 18 month
   period in the south-western health care region of Sweden in order to
   evaluate the costs and effectiveness of a multidisciplinary community
   outreach intervention programme. An experienced multidisciplinary
   project team was involved and patients underwent detailed functional,
   cognitive and motor assessments following initial contact within two
   weeks of injury, within six weeks of injury and at a 12-month follow-up.
   An individualized counselling programme was also offered. Of an expected
   recruitment number of 50 patients (based on epidemiological and
   population based figures) 10 children were reached, evaluated and
   followed; eight patients with traumatic brain injury (five severe, two
   moderate and one mild), and two patients with non-traumatic brain injury
   (both severe). At follow-up there was a significant improvement in motor
   function. No significant changes were seen in other areas of functional
   assessment or on neuropsychological measures although there were mild
   improvements in communication and behaviour functions. The financial
   costs per patient in the programme were deemed relatively modest
   compared with cost estimates of shorter-term in-patient rehabilitation.
   Time intensive interventions included supporting caregivers and school
   staff and the direct and indirect patient interventions were shown to
   enhance support and promote active involvement of local services.
TC 6
ZB 2
Z8 0
ZS 0
Z9 6
SN 0342-5282
UT MEDLINE:14634359
PM 14634359
ER

PT J
AU Kenny, DE
   Knightly, F
   Haas, B
   Hergott, L
   Kutinsky, I
   Eller, JL
TI Negative-pressure pulmonary edema complicated by acute respiratory
   distress syndrome in an orangutan (Pongo pygmaeus abelii)
SO JOURNAL OF ZOO AND WILDLIFE MEDICINE
VL 34
IS 4
BP 394
EP 399
DI 10.1638/02-023
PD DEC 2003
PY 2003
AB A 22-yr-old, 86-kg, morbidly obese female orangutan (Pongo pygmaeus
   abelii) was immobilized and transported to the Denver Zoological Gardens
   hospital for a routine physical examination. Immediately after arriving
   at the hospital, cyanosis and apparent inadequate ventilatory efforts
   were noted. Clinically significant hypoxia occurred despite attempts to
   ventilate the orangutan through face mask, and attempts to place an
   endotracheal tube began. A large volume of pink-tinged frothy fluid
   flowed from the trachea when the laryngoscope was inserted into the
   oropharynx. Severe pulmonary edema due to negative-pressure pulmonary
   edema, precipitating life-threatening hypoxia was suspected. The
   orangutan was maintained on a mechanical ventilator using the
   neuromuscular blocking agent cisatracurium besylate and sedation with
   periodic doses of isoflurane and midazolam for 48 hr. Positive
   end-expiratory pressure was used while the orangutan was ventilated
   mechanically to improve respiratory function. The edema and hypoxia
   improved, but respiratory arrest ensued 30 min after extubation, when
   the orangutan was removed from mechanical ventilation. Necropsy and
   histopathology demonstrated that serious lung injury had led to acute
   respiratory distress syndrome.
TC 7
ZB 5
Z8 0
ZS 0
Z9 8
SN 1042-7260
UT WOS:000220220400010
PM 15077717
ER

PT J
AU Domenech-Clar, R
   Nauffal-Manzur, D
   Perpina-Tordera, M
   Compte-Torrero, L
   Macian-Gisbert, V
TI Home mechanical ventilation for restrictive thoracic diseases: effects
   on patient quality-of-life and hospitalizations
SO RESPIRATORY MEDICINE
VL 97
IS 12
BP 1320
EP 1327
DI 10.1016/j.rmed.2003.08.002
PD DEC 2003
PY 2003
AB Forty-five patients with restrictive respiratory diseases, including
   thoracic wall diseases (TWD, n = 27) and neuromuscular diseases (NMD, n
   = 18), underwent 18 months of home mechanical ventilation (HMV)
   treatment. Treatment consisted of a two-level pressure system for 7h at
   night, with oxygen available if needed. Questionnaire-based assessments
   of health-related quality-of-life (HRQL) were evaluated before treatment
   and at 3, 6, 9, 12 and 18 months of follow-up. Hospitalization rates
   pre- and post-treatment were recorded, and the numbers need to treat
   (NNT) to avoid hospitalization and absolute risk reduction (ARR) rates
   were calculated. Several categories of HRQL, including physical function
   and vitality, improved significantly with treatment in both groups of
   patients; these improvements persisted over the entire 18 months. In
   contrast, other categories such as social function and mental health
   improved initially and declined subsequently. Hospitalizations decreased
   significantly with treatment. NNT calculations indicated that treatment
   would be needed for two TWD patients (ARR 63%) and one NMD patient (ARR
   78%) to prevent one hospitalization per year per disease group. We
   conclude that improved quality-of-life and decreased hospitalizations
   make home non-invasive mechanical ventilation an useful treatment for
   patients with restrictive respiratory disorders. (C) 2003 Published by
   Elsevier Ltd.
TC 17
ZB 1
Z8 0
ZS 0
Z9 17
SN 0954-6111
UT WOS:000187204800013
PM 14682414
ER

PT J
AU Roch, A
   Michelet, P
   Jullien, AC
   Thirion, X
   Bregeon, F
   Papazian, L
   Roche, P
   Pellet, W
   Auffray, JP
TI Long-term outcome in intensive care unit survivors after mechanical
   ventilation for intracerebral hemorrhage
SO CRITICAL CARE MEDICINE
VL 31
IS 11
BP 2651
EP 2656
DI 10.1097/01.CCM.0000094222.57803.B4
PD NOV 2003
PY 2003
AB Objective., To evaluate long-term survival and functional outcome in
   intensive care unit survivors after mechanical ventilation for
   intracerebral hemorrhage.
   Design: Retrospective chart review and prospective follow-up study.
   Setting. Outpatient follow-up.
   Patients: Between 1997 and 2000,120 patients were mechanically
   ventilated for an intracerebral hemorrhage at our intensive care unit.
   Sixty-two patients were discharged from hospital (in-hospital mortality
   = 48%). Sixty patients were evaluated for survival and functional
   outcome (two were lost to follow-up). Time between discharge and
   follow-up was greater than or equal to1 yr and was a mean of 27 +/- 14
   months (range, 12-56).
   Interventions. None.
   Measurements and Main Results. Patients' physicians were first asked
   about survival, and patients or proxies were interviewed by phone.
   Barthel Index and modified Rankin Scale scores were collected, and
   demographic information and general data were reviewed. The estimated
   life-table survival curve after discharge was 64.6% at 1 yr and 57% at 3
   yrs. In the 24 patients who died, the mean time between discharge and
   death was 5 +/- 6 months. Probability of death after discharge
   significantly increased if age at admission was >65 yrs (p < .01; odds
   ratio, 3.5; 95% confidence interval, 1.4-9.1) and if Glasgow Coma Scale
   score at discharge was <15 (p < .01; odds ratio, 3.9; 95% confidence
   interval, 1.6-9.5). In the 36 long-term survivors, Barthel Index was
   67.5 +/- 15 (median +/- median absolute dispersion) and modified Rankin
   Scale score was 2.6 +/- 0.5. Fifteen patients (42%) had a slight or no
   disability (Barthel Index 90 and modified Rankin Scale score less than
   or equal to2), whereas 21 patients (58%) had moderate or severe
   disability (Barthel Index :585 and modified Rankin Scale score >2).
   Conclusions. Probability of survival at 3 yrs after mechanical
   ventilation for an intracerebral hemorrhage was >50%. Age was an
   important determinant of long-term survival. Forty-two percent of
   long-term survivors were independent for activities of daily living.
   Only a few long-term survivors had a very high degree of disability.
TC 18
ZB 6
Z8 0
ZS 0
Z9 18
SN 0090-3493
UT WOS:000186626000014
PM 14605538
ER

PT J
AU Cree, Claire
TI Acquired brain injury: acute management.
SO Nursing standard (Royal College of Nursing (Great Britain) : 1987)
VL 18
IS 11
BP 45
EP 55
PD 2003 Nov 26-Dec 2
PY 2003
AB Acquired brain injury is a non-degenerative brain injury that may affect
   anyone at any time. Patients with acquired brain injury are often
   critically ill and this injury can have a devastating and long-lasting
   effect on the patient's quality of life. Although hospital treatment
   cannot change the initial injury, good nursing care will help to limit
   and prevent secondary damage thus reducing the probability of long-term
   disability.
TC 1
ZB 0
Z8 0
ZS 0
Z9 1
SN 0029-6570
UT MEDLINE:14689666
PM 14689666
ER

PT J
AU Calverley, P M A
TI Respiratory failure in chronic obstructive pulmonary disease.
SO The European respiratory journal. Supplement
VL 47
BP 26s
EP 30s
PD 2003-Nov
PY 2003
AB Respiratory failure is still an important complication of chronic
   obstructive pulmonary disease (COPD) and hospitalisation with an acute
   episode being a poor prognostic marker. However, other comorbid
   conditions, especially cardiovascular disease, are equally powerful
   predictors of mortality. The physiological basis of acute respiratory
   failure in COPD is now clear. Significant ventilation/perfusion
   mismatching with a relative increase in the physiological dead space
   leads to hypercapnia and hence acidosis. This is largely the result of a
   shift to a rapid shallow breathing pattern and a rise in the dead
   space/tidal volume ratio of each breath. This breathing pattern results
   from adaptive physiological responses which lessen the risk of
   respiratory muscle fatigue and minimise breathlessness. Treatment is
   directed at reducing the mechanical load applied to each breath,
   correcting specific precipitating factors, e.g. bacterial infection, and
   maintaining gas exchange. Both bronchodilators and oral corticosteroids
   can improve spirometric results in exacerbations of COPD and should be
   routinely offered to patients with respiratory failure. Controlled
   oxygen is still not always prescribed appropriately and high inspired
   oxygen concentrations can lead to severe acidosis by either worsening
   ventilation/perfusion mismatching and/or inducing a degree of
   hypoventilation. Ventilatory support using noninvasive ventilation has
   revolutionised the approach to these patients. Acute respiratory failure
   due to chronic obstructive pulmonary disease remains a common medical
   emergency that can be effectively managed. More attention should be
   focused on the prevention of these episodes and identifying the factors
   which cause early relapse.
TC 19
ZB 9
Z8 0
ZS 0
Z9 20
SN 0904-1850
UT MEDLINE:14621114
PM 14621114
ER

PT J
AU Deem, S
   Lee, CM
   Curtis, JR
TI Acquired neuromuscular disorders in the intensive care unit
SO AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE
VL 168
IS 7
BP 735
EP 739
DI 10.1164/rccm.200302-191UP
PD OCT 1 2003
PY 2003
TC 40
ZB 14
Z8 1
ZS 0
Z9 41
SN 1073-449X
UT WOS:000185611700004
PM 14522811
ER

PT J
AU Haslam, N
   Syndercombe, A
   Zimmer, CR
   Edmondson, L
   Duggan, JE
TI Intragastric pressure and its relevance to protective cricoid force
SO ANAESTHESIA
VL 58
IS 10
BP 1012
EP 1015
DI 10.1046/j.1365-2044.2003.03359.x
PD OCT 2003
PY 2003
AB Cricoid pressure is frequently used to protect the anaesthetised and
   paralysed patient from passive regurgitation. Although intragastric
   pressure (Pga) drives regurgitation, its relevance in the setting of
   protective cricoid force has been largely ignored. We sought to define
   the likely range of Pga encountered in the population at risk. We
   studied 100 consecutive patients presenting for surgery requiring
   mechanical ventilation. We measured respiratory swings in Pga during
   mechanical ventilation in the paralysed state following rapid sequence
   induction (n = 24) and routine induction of anaesthesia ( n = 76). Pga
   (mmHg) in the whole group recorded at end-inspiration (Pga-In) and
   end-expiration (Pga-Ex) was [ mean (SD)]: Pga-In 6.48 (2.60) mmHg and
   Pga-Ex 3.23 (2.24) mmHg. We found no correlation between Pga and body
   mass index ( r(2) = 0.018). These findings have implications for the
   level of cricoid force required to protect a patient during the
   induction of anaesthesia.
CT Meeting of the Anaesthetic-Research-Society
CY APR, 2002
CL SHEFFIELD, ENGLAND
SP Anaesthet Res Soc
TC 7
ZB 2
Z8 0
ZS 0
Z9 7
SN 0003-2409
UT WOS:000185252200011
PM 12969044
ER

PT J
AU Ceneviva, Gary D
   Thomas, Neal J
   Kees-Folts, Deborah
TI Magnesium sulfate for control of muscle rigidity and spasms and
   avoidance of mechanical ventilation in pediatric tetanus.
SO Pediatric critical care medicine : a journal of the Society of Critical
   Care Medicine and the World Federation of Pediatric Intensive and
   Critical Care Societies
VL 4
IS 4
BP 480
EP 4
DI 10.1097/01.PCC.0000090015.03962.8B
PD 2003-Oct
PY 2003
AB OBJECTIVE: To describe the use of intravenous magnesium sulfate for the
   control of muscle spasms and severe generalized rigidity in a child with
   moderate to severe tetanus without the need for prolonged deep sedation,
   mechanical ventilation, or neuromuscular blockade.
   DESIGN: Case report.
   SETTING: Pediatric intensive care unit in a tertiary care,
   university-based children's hospital.
   INTERVENTIONS: A continuous infusion of magnesium sulfate.
   MEASUREMENTS AND MAIN RESULTS: We describe a 12-yr-old child with
   moderate to severe tetanus who was treated with a continuous infusion of
   magnesium sulfate to control painful muscle spasms and severe
   generalized rigidity initially refractory to moderate sedation. Muscle
   spasms and severe generalized rigidity were improved with magnesium
   sulfate. No adverse effects associated with the use of magnesium sulfate
   were noted during the monitoring of cardiovascular and respiratory
   function, reflexes, and serum magnesium concentrations.
   CONCLUSIONS: An infusion of magnesium sulfate can be utilized to treat
   muscle spasms and severe generalized rigidity without the need for deep
   sedation, mechanical ventilation, or neuromuscular blockade. We
   recommend that magnesium sulfate be considered in the armamentarium of
   therapeutics utilized to treat muscle spasms and rigidity associated
   with tetanus, provided the patient's neurologic, cardiovascular, and
   respiratory status can be closely monitored in the pediatric intensive
   care unit.
TC 5
ZB 1
Z8 0
ZS 0
Z9 5
SN 1529-7535
UT MEDLINE:14525647
PM 14525647
ER

PT J
AU Wijkstra, PJ
   Avendano, MA
   Goldstein, RS
TI Inpatient chronic assisted ventilatory care: A 15-year experience
SO CHEST
VL 124
IS 3
BP 850
EP 856
DI 10.1378/chest.124.3.850
PD SEP 2003
PY 2003
AB Study objectives: Ventilator users who are unable to leave the acute
   care setting may be transferred to a unit for chronic assisted
   ventilatory care (CAVC) with the goal of optimizing their level of
   function. In this report, we summarize the outcomes of all patients
   admitted to a CAVC unit between 1986 and 2001.
   Patients and methods: Fifty patients (24 with neuromuscular disease
   [NMD], 10 with spinal cord injury [SCI], 7 with thoracic restriction
   [TR], 7 with COPD, and 2 with parenchymal restriction [PR]) were
   reviewed. Thirty-eight patients were transferred to the CAVC unit from
   intensive care, 5 patients were transferred from inpatient respiratory
   rehabilitation, 4 patients came from home, and 3 patients came from
   pediatric long-term care. At the time of CAVC unit admission, all
   patients were receiving mechanical ventilation via a tracheostomy tube.
   Results: Ventilator time increased gradually in patients with COPD from
   16 h (SD, 5.6) to 22.9 h (SD, 3.0) per day (p < 0.05), and in patients
   with TR from 18.9 h (SD, 6.1) to 22.9 h (SD, 4.5) [not significant].
   Five of the 10 patients with SCI were decannulated. Functional mobility,
   which decreased in patients with COPD and patients with TR, remained
   stable in NMD and PR and improved in SCI. Eighteen patients returned
   home or to an attendant care facility (COPD, n = 1; NMD, n = 10; SCI, n
   = 5; PR, n = 2); 11 patients died in the CAVC unit (COPD, n = 6; TR, n =
   3; NMD, n = 1; SCI, n = 1); and 7 patients were transferred to intensive
   care, where they died. The average direct cost per patient per them
   increased from $252 (Canadian) in 1988 to $335 in 2001.
   Conclusion: A CAVC unit can provide a safe environment for severely
   impaired, ventilator-dependent individuals, many of whom (36%) left for
   a more independent community-based environment. Better outcomes were
   seen among patients with SCI and NMD than in patients with COPD and TR.
TC 13
ZB 3
Z8 0
ZS 1
Z9 13
SN 0012-3692
UT WOS:000185344100016
PM 12970008
ER

PT J
AU Armada, M
   Love, S
   Barrett, E
   Monroe, J
   Peery, D
   Sobel, J
TI Foodborne botulism in a six-month-old infant caused by home-canned baby
   food
SO ANNALS OF EMERGENCY MEDICINE
VL 42
IS 2
BP 226
EP 229
DI 10.1067/mem.2003.259
PD AUG 2003
PY 2003
AB Previously reported cases of botulism in infants have been diagnosed as
   infant botulism; that is, botulism caused by intestinal colonization by
   Clostridium botulinum with intraluminal production and absorption of
   toxin. Foodborne botulism is caused by ingestion of preformed toxin. We
   describe an unusual case of foodborne botulism in a 6-month-old infant
   caused by the ingestion of improperly prepared home-canned baby food.
   This represents the youngest age of onset for foodborne botulism in the
   United States of which we are aware and illustrates the need to rule out
   foodborne botulism, which represents a public health emergency,
   regardless of the patient's age. The diagnosis could have been readily
   missed or delayed in this case because the weakness was rapidly
   progressive rather than insidious, as is typical of infant botulism.
TC 11
ZB 9
Z8 0
ZS 0
Z9 12
SN 0196-0644
UT WOS:000184423400008
PM 12883510
ER

PT J
AU Windisch, W
   Freidel, K
   Schucher, B
   Baumann, H
   Wiebel, M
   Matthys, H
   Petermann, F
TI The Severe Respiratory Insufficiency (SRI) Questionnaire - A specific
   measure of health-related quality of life in patients receiving home
   mechanical ventilation
SO JOURNAL OF CLINICAL EPIDEMIOLOGY
VL 56
IS 8
BP 752
EP 759
DI 10.1016/S0895-4356(03)00088-X
PD AUG 2003
PY 2003
AB Background and Objective: The objective of this study was to develop a
   specific instrument for measuring health-related quality of life (HRQL)
   in patients receiving home mechanical ventilation (HMV).
   Methods: The Severe Respiratory Insufficiency (SRI) Questionnaire was
   developed and tested for its psychometric properties following a
   multicentric clinical trial including 226 patients receiving HMV (mean
   age 57.3 +/- 14.0 years).
   Results: Forty-nine items passed the selection process and were
   allocated to seven subscales: Respiratory Complaints, Physical
   Functioning, Attendant Symptoms and Sleep, Social Relationships,
   Anxiety, Psychologic Well-Being, and Social Functioning. Cronbach's
   alpha was >0.7 in all subscales and >0.8 in four subscales indicating
   high internal consistency reliability. Construct validity was confirmed
   by factor analysis, indicating one summary scale that accounts for 59.8%
   of the variance. Concurrent validity was confirmed by correlating
   subscales of the SRI and the SF-36 (0.21 < r < 0.79). Item-scale
   correlations revealed a high item discriminant validity. In addition,
   different diagnostic groups could be discriminated by the SRI. Here, the
   overall best HRQL was measured in the following order: patients with
   kyphoscoliosis, miscellaneous disorders, neuromuscular diseases,
   post-tuberculosis, and chronic obstructive pulmonary disease (P <.05).
   Conclusion: The SRI is a new multidimensional instrument with high
   psychometric properties designed to measure specific HRQL in patients
   with SRI receiving HMV. (C) 2003 Elsevier Inc. All rights reserved.
TC 51
ZB 10
Z8 0
ZS 0
Z9 51
SN 0895-4356
UT WOS:000185298500008
PM 12954467
ER

PT J
AU Laghi, F
   Tobin, MJ
TI Disorders of the respiratory muscles
SO AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE
VL 168
IS 1
BP 10
EP 48
DI 10.1164/rccm.2206020
PD JUL 1 2003
PY 2003
AB The act of breathing depends on coordinated activity of the respiratory
   muscles to generate subatmospheric pressure. This action is compromised
   by disease states affecting anatomical sites ranging from the cerebral
   cortex to the alveolar sac. Weakness of the respiratory muscles can
   dominate the clinical manifestations in the later stages of several
   primary neurologic and neuromuscular disorders in a manner unique to
   each disease state. Structural abnormalities of the thoracic cage, such
   as scoliosis or flail chest, interfere with the action of the
   respiratory muscles-again in a manner unique to each disease state. The
   hyperinflation that accompanies diseases of the airways interferes with
   the ability of the respiratory muscles to generate subatmospheric
   pressure and it increases the load on the respiratory muscles. Impaired
   respiratory muscle function is the most severe consequence of several
   newly described syndromes affecting critically ill patients. Research on
   the respiratory muscles embraces techniques of molecular biology,
   integrative physiology, and controlled clinical trials. A detailed
   understanding of disease states affecting the respiratory muscles is
   necessary for every physician who practices pulmonary medicine or
   critical care medicine.
TC 194
ZB 78
Z8 1
ZS 20
Z9 208
SN 1073-449X
UT WOS:000183824700006
PM 12826594
ER

PT J
AU Kinirons, SA
   Shall, MS
   McClung, JR
   Goldberg, SJ
TI Effect of artificial rearing on the contractile properties and myosin
   heavy chain isoforms of developing rat tongue musculature
SO JOURNAL OF NEUROPHYSIOLOGY
VL 90
IS 1
BP 120
EP 127
DI 10.1152/jn.00809.2002
PD JUL 2003
PY 2003
AB This study's purpose was to examine the influence of an altered activity
   level, via artificial rearing, on the contractile properties, myosin
   heavy chain phenotypes (MHC), and muscle fiber sizes of the developing
   rat tongue retractor musculature. Artificially reared rat pups were fed
   through a gastric cannula, eliminating nutritive suckling from postnatal
   day 4 to postnatal day 14. Rat pups were observed immediately following
   artificial rearing (postnatal day 14) and after a 1-mo resumption of
   function (postnatal day 42). The contractile characteristics of the
   tongue retractor musculature were measured in response to stimulation of
   the hypoglossal nerve. At postnatal day 14, artificially reared rat pups
   demonstrated significantly longer twitch half-decay times, lower fusion
   frequencies, and a marked decrease in fatigue resistance. These
   contractile speed and fatigue characteristics were fully recovered
   following a 1-mo resumption of function. MHC phenotypes of the
   styloglossus muscle (a tongue retractor) were determined by gel
   electrophoresis. At postnatal day 14, artificial rearing had not altered
   the MHC phenotype or muscle fiber sizes of the styloglossus muscle.
   However, following a 1-mo resumption of function artificially reared rat
   pups demonstrated a small but significant increase in MHCIIa expression
   and decrease in MHCIIb expression compared with dam-reared rats. These
   results support artificial rearing as a useful model for altering the
   activity level of the tongue and suggest that normal suckling behavior
   is necessary for the normal postnatal development of the tongue
   retractor musculature. This may also be the case for premature infants
   necessarily fed artificially.
TC 12
ZB 10
Z8 0
ZS 0
Z9 12
SN 0022-3077
UT WOS:000183940600015
PM 12843305
ER

PT J
AU Ceriana, Piero
   Delmastro, Monica
   Rampulla, Ciro
   Nava, Stefano
TI Demographics and clinical outcomes of patients admitted to a respiratory
   intensive care unit located in a rehabilitation center.
SO Respiratory care
VL 48
IS 7
BP 670
EP 6
PD 2003-Jul
PY 2003
AB INTRODUCTION: A recent survey of respiratory intensive care units (RICU)
   in Italy showed that RICUs in Italy are mainly (85%) located in acute
   care hospitals. Forty-seven percent of the patients are admitted from
   emergency departments, and only 18% are admitted from intensive care
   units (ICU), so the percentage of patients admitted for difficulty in
   weaning is low (8%). Patient demographics and admission patterns in
   RICUs located outside acute care hospitals have not been previously
   described.
   METHODS: We analyzed admission patterns, demographics, treatment, and
   outcomes of patients during the first year of operation of a 7-bed RICU
   located in a rehabilitation center that does not have an emergency
   department.
   RESULTS: In the 1-year study period, 96 RICU patients were admitted for
   acute or chronic respiratory failure. The patients' mean Simplified
   Acute Physiology Score II was 28.9 +/- 3.6. Sixty-five percent of the
   patients were transferred from the ICU, 17% from medical wards of other
   hospitals, 7% and 5%, respectively, from the medical and surgical wards
   of our hospital, and 6% came directly from home for a periodic check.
   Difficulty in weaning from mechanical ventilation was the main reason
   for admission (42%), followed by simple monitoring (37%) and need for
   acute ventilatory invasive or noninvasive support (21%). Thirty-one
   patients had COPD, 23 had acute hypoxemic respiratory failure, 30 had
   post-surgical complications, and 12 had neuromuscular disease.
   Twenty-seven of 40 patients admitted for difficulty in weaning were
   liberated from ventilation. Intrahospital mortality was 13%. Fifty
   percent of patients were discharged directly to home; those patients'
   mean Dependence Nursing Scale score (which measures the degree of
   patient independence) improved during hospital stay (decreased from 23
   to 12 [p < 0.05]), whereas the remaining patients were transferred to
   long-term facilities or an acute care hospital.
   CONCLUSIONS: The admission pattern at our RICU in a rehabilitation
   center is quite different from that of an RICU in an acute care
   hospital. Most of our patients are admitted from ICU because of
   difficulty with weaning. This may be the consequence of the
   institutional philosophy of rehabilitation centers, which strive to
   achieve greater patient independence.
TC 11
ZB 1
Z8 0
ZS 0
Z9 11
SN 0020-1324
UT MEDLINE:12841857
PM 12841857
ER

PT J
AU Cicoira, M
   Kalra, PR
   Anker, SD
TI Growth hormone resistance in chronic heart failure and its therapeutic
   implications
SO JOURNAL OF CARDIAC FAILURE
VL 9
IS 3
BP 219
EP 226
DI 10.1054/jcaf.2003.23
PD JUN 2003
PY 2003
AB Background: In recent years the administration of recombinant human
   growth hormone (GH) has received great attention. This review compares
   the potential of this therapeutic intervention in heart failure with
   that in other diseases where wasting is commonly seen. The
   pathophysiologic importance of GH and insulin-like growth factor (IGF)-I
   in these conditions will be discussed.
   Methods and Results: Abnormalities of the GH-IGF-I axis play an
   important role in the development of cachexia in chronic illnesses. GH
   resistance is a major determinant of the wasting process, acting through
   several different mechanisms: increased catabolism, impaired anabolism,
   and enhanced apoptosis in peripheral tissues. GH therapy has been
   evaluated in chronic heart failure (CHF); acquired GH resistance may
   explain the general lack of therapeutic success in the majority of
   studies. The assessment of plasma levels of GH, IGF-I, and, in
   particular, GH binding protein may help to guide dosing of GH for CHF
   patients.
   Conclusions: GH resistance might be overcome by use of intermittent or
   higher doses of GH, or alternatively by combining GH with IGF-I.
   Randomized studies of GH therapy in catabolic states, with targeted
   dosing and longer duration of treatment are required to fully assess the
   safety and efficacy of this treatment approach.
RI Andrade, Hugo/M-6631-2013
OI Andrade, Hugo/0000-0001-6781-6125
TC 40
ZB 24
Z8 1
ZS 0
Z9 42
SN 1071-9164
UT WOS:000183617900010
PM 12815572
ER

PT J
AU Wolf, C
   Meiners, TH
TI Dysphagia in patients with acute cervical spinal cord injury
SO SPINAL CORD
VL 41
IS 6
BP 347
EP 353
DI 10.1038/sj.sc.3101440
PD JUN 2003
PY 2003
AB Study design: Longitudinal observational.
   Objectives: ( a) To establish a reliable and feasible method to indicate
   the presence and severity of dysphagia and (b) to establish a course of
   treatment in individuals presenting with cervical spinal cord
   injury(CSCI).
   Setting: Spinal Cord Injury Center, Werner Wicker Klinik, Bad Wildungen,
   Germany.
   Patients and methods: This is a cross-sectional study of 51 patients
   consecutively admitted to the Intensive Care Unit of the SCI in-patient
   service. They were subjected to neurological and fiberoptic endoscopic
   examination of swallowing ( FEES). Data concerning artificial
   respiration, presence of tracheostomy, oral or non-oral feeding were
   obtained from the medical charts. Statistics were carried out by a
   calculation of a nonparametric correlation ( Spearman).
   Results: Five levels of dysphagia could be distinguished. At levels 1
   and 2, patients presented with a severe impairment of swallowing, in
   level 3 aspiration was met by a powerful coughing re. ex, level 4
   comprised a laryngeal edema and/or a mild aspiration of fluids only and
   at level 5 laryngeal function was not compromised. On admission, 20
   patients with CSCI presented with mild ( level 4), eight with moderate (
   level 3) and 13 with severe dysphagia ( levels 1 and 2). In 10 no signs
   of dysphagia could be detected. After treatment, level 1 was no longer
   detected, one patient showed level 2, two patients showed level 3, all
   other patients showed only mild or no signs of dysphagia any longer.
   Conclusions: Dysphagia of various severities was present in the majority
   of these patients with CSCI together with respiratory insufficiency.
   FEES allows for the detection and classification of dysphagia as well as
   for an evaluation of the therapeutic management. Under interdisciplinary
   treatment the prognosis of dysphagia is good.
TC 23
ZB 10
Z8 0
ZS 0
Z9 23
SN 1362-4393
UT WOS:000183300900004
PM 12746741
ER

PT J
AU Murphy, GS
   Szokol, JW
   Marymont, JH
   Vender, JS
   Avram, MJ
   Rosengart, TK
   Alwawi, EA
TI Recovery of neuromuscular function after cardiac surgery: Pancuronium
   versus rocuronium
SO ANESTHESIA AND ANALGESIA
VL 96
IS 5
BP 1301
EP 1307
DI 10.1213/01.ANE.0000057602.27031.C8
PD MAY 2003
PY 2003
AB The use of pancuronium in fast-track cardiac surgical patients may be
   associated with delays in clinical recovery. Our objective in this study
   was to evaluate the incidence and severity of residual neuromuscular
   blockade after cardiac surgery in patients randomized to receive either
   pancuronium (0.08-0.1 mg/kg) or rocuronium (0.6-0.8 mg/kg). Eighty-two
   patients undergoing cardiopulmonary bypass were randomized to a
   pancuronium (n = 41) or rocuronium (n = 41) group. Intraoperative and
   postoperative management was standardized. In the intensive care unit,
   train-of-four (TOF) ratios were measured each hour until weaning off
   ventilatory support was initiated. Neuromuscular blockade was not
   reversed. After tracheal extubation, patients were examined for signs
   and symptoms of residual paresis. When weaning of ventilatory support
   was initiated, significant neuromuscular blockade was present in the
   pancuronium. subjects (TOF ratio: median, 0.14; range, 0.00-1.11)
   compared with the rocuronium subjects (TOF ratio: median, 0.99; range,
   0.87-1.21) (P < 0.05). Patients in the rocuronium group were more likely
   to be free of signs and symptoms of residual paresis than patients in
   the pancuronium group. Our findings suggest that the use of
   longer-acting muscle relaxants in cardiac surgical patients is
   associated not only with impaired neuromuscular recovery, but also with
   signs and symptoms of residual muscle weakness in the early
   postoperative period.
TC 24
ZB 12
Z8 0
ZS 1
Z9 25
SN 0003-2999
UT WOS:000182456900011
PM 12707123
ER

PT J
AU Behringer, W
   Safar, P
   Wu, XR
   Kentner, R
   Radovsky, A
   Kochanek, PM
   Dixon, CE
   Tisherman, SA
TI Survival without brain damage after clinical death of 60-120 mins in
   dogs using suspended animation by profound hypothermia
SO CRITICAL CARE MEDICINE
VL 31
IS 5
BP 1523
EP 1531
DI 10.1097/01.CCM.0000063450.73967.40
PD MAY 2003
PY 2003
AB Objectives: This study explored the limits of good outcome of brain and
   organism achievable after cardiac arrest (no blood flow)of 60-120 mins,
   with preservation (suspended animation) induced immediately after the
   start of exsanguination cardiac arrest.
   Design: Prospective experimental comparison of three arrest times,
   without randomization.
   Setting: University research laboratory.
   Subjects: Twenty-seven custom-bred hunting dogs (17-25 kg).
   Interventions: Dogs were exsanguinated over 5 mins to cardiac arrest
   no-flow of 60 mins, 90 mins, or 120 mins. At 2 mins of cardiac arrest,
   the dogs received, via a balloon-tipped catheter, an aortic flush of
   isotonic saline at 2degreesC (at a rate of 1 L/min), until tympanic
   temperature reached 20degreesC (for 60 mins of cardiac arrest),
   15degreesC (for 60 mins of cardiac arrest), or 10degreesC (for 60, 90,
   or 120 mins of cardiac arrest). Resuscitation was by closed-chest
   cardiopulmonary bypass, postcardiac arrest mild hypothermia (tympanic
   temperature 34degreesC) to 12 hrs, controlled ventilation to 20 hrs, and
   intensive care to 72 hrs.
   Measurements and Main Results: We assessed overall performance
   categories (OPC 1, normal; 2, moderate disability; 3, severe disability;
   4, coma; 5, death), neurologic deficit scores (NDS 0-10%, normal; 100%,
   brain death), regional and total brain histologic damage scores at 72
   hrs (total HDS >0-40, mild; 40-100, moderate; >100, severe damage), and
   morphologic damage of extracerebral organs. For 60 mins of cardiac
   arrest (n = 14), tympanic temperature 20degreesC (n = 6) was achieved
   after flush of 3 mins and resulted in two dogs with OPC 1 and four dogs
   with OPC 2: median NDS, 13% (range 0-27%); and median total HDS, 28
   (range, 4-36). Tympanic temperature of 15degreesC (n = 5) was achieved
   after flush of 7 mins and resulted in all five dogs with OPC 1, NDS 0%
   (0-3%), and HDS 8 (0-48). Tympanic temperature 10degreesC (n = 3) was
   achieved after flush of 11 mins and resulted in all three dogs with OPC
   1, NDS 0%, and HDS 16 (2-18). For 90 mins of cardiac arrest (n = 6),
   tympanic temperature 10degreesC was achieved after flush of 15 mins and
   resulted in all six dogs with OPC 1, NDS 0%, and HDS 8 (0-37). For 120
   mins of cardiac arrest (n = 7), three dogs had to be excluded. In the
   four dogs within protocol, tympanic temperature 10degreesC was achieved
   after flush of 15 mins. This resulted in one dog with OPC 1, NDS 0%, and
   total HDS 14; one with OPC 1, NDS 6%, and total HDS 20; one with OPC 2,
   NDS 13%, and total HDS 10; and one with OPC 3, NDS 39%, and total HDS
   22.
   Conclusions: In a systematic series of studies in dogs, the rapid
   induction of profound cerebral hypothermia (tympanic temperature
   10degreesC) by aortic flush of cold saline immediately after the start
   of exsanguination cardiac arrest-which rarely can be resuscitated
   effectively with current methods-can achieve survival without functional
   or histologic brain damage, after cardiac arrest no-flow of 60 or 90
   mins and possibly 120 mins. The use of additional preservation
   strategies should be pursued in the 120 min arrest model.
RI Kochanek, Patrick/D-2371-2015
OI Kochanek, Patrick/0000-0002-2627-913X
TC 61
ZB 24
Z8 0
ZS 0
Z9 63
SN 0090-3493
UT WOS:000182981300035
PM 12771628
ER

PT J
AU Gayan-Ramirez, G
   de Paepe, K
   Cadot, P
   Decramer, M
TI Detrimental effects of short-term mechanical ventilation on diaphragm
   function and IGF-I mRNA in rats
SO INTENSIVE CARE MEDICINE
VL 29
IS 5
BP 825
EP 833
DI 10.1007/s00134-003-1688-0
PD MAY 2003
PY 2003
AB Objectives: Because respiratory muscle weakness appears to play an
   important role in weaning from mechanical ventilation, we developed an
   animal model of mechanical ventilation with appropriate controls in
   order to determine whether 24 h of mechanical ventilation already
   affected diaphragmatic function. Design and interventions: Fifty-two
   male Wistar rats were randomized into three groups: a non-anesthetized
   control group (C, n=10), an anesthetized spontaneously breathing group
   (SB, n=9 out of 26), and an anesthetized and mechanically ventilated
   group (MV, n=12 out of 16). Results: After 24 h, in vitro diaphragmatic
   force was decreased in SB group but even more so in MV group (i.e., 80
   Hz: -15% in SB, P<0.005 vs C and -34% in MV group, P<0.005 vs C and SB).
   This was associated with a significant decrease in the diaphragm type I
   and type IIa dimensions in the SB group, which was more pronounced in
   the MV group. Interestingly, diaphragm IGF-I mRNA was decreased in the
   SB group (-14%, P<0.05 vs C), but more so in MV group (-29%, P<0.001 vs
   C and P<0.01 vs SB). Moreover, there was a significant correlation
   between diaphragm force and IGF-I mRNA (at 80 Hz r=0.51, P=0.0056).
   Conclusions: We conclude that 24 h of mechanical ventilation in rats,
   independently of anesthesia, already significantly reduced diaphragm
   force, fiber dimensions, and its IGF-I mRNA levels.
TC 50
ZB 32
Z8 1
ZS 2
Z9 53
SN 0342-4642
UT WOS:000183362600025
PM 12682716
ER

PT J
AU Ceriana, P
   Carlucci, A
   Navalesi, P
   Rampulla, C
   Delmastro, M
   Piaggi, G
   De Mattia, E
   Nava, S
TI Weaning from tracheotomy in long-term mechanically ventilated patients:
   feasibility of a decisional flowchart and clinical outcome
SO INTENSIVE CARE MEDICINE
VL 29
IS 5
BP 845
EP 848
DI 10.1007/s00134-003-1689-z
PD MAY 2003
PY 2003
AB Objective: To assess the feasibility of following a decisional flowchart
   to decide whether to remove tracheotomy in long-term mechanically
   ventilated patients. Design and setting: Prospective study in a
   respiratory intensive care unit, with beds dedicated to weaning from
   prolonged mechanical ventilation. Patients and participants: 108
   tracheotomized patients with respiratory failure of different causes
   (chronic obstructive pulmonary disease, postsurgical complications,
   recovery from hypoxemic respiratory failure, neuromuscular disorders),
   36 of whom died or could not be weaned from mechanical ventilation.
   Interventions: We applied a decisional flowchart based on some simple
   clinical and physiological parameters aimed at assessing the patient's
   ability to remove secretions, swallowing function, absence of
   psychiatric diseases, possibility of reaching spontaneous breathing, and
   amount of respiratory space. Measurements and results: Following our
   flowchart 56 of the remaining patients were successfully weaned from the
   tracheotomy cannula, with a reintubation rate at 3 months of 3%. The
   main reasons for not proceeding to decannulation were inability to
   remove secretions and severe glottic stenosis. No statistical
   differences were found between patients who received a surgical or
   percutaneous tracheotomy. Conclusions: Using a simple decisional
   flowchart we were able to remove tracheotomy cannula in almost 80% of
   the patients with spontaneous breathing autonomy without major clinical
   complications. Further larger prospective studies are needed to confirm
   this clinical approach in larger and different populations.
TC 30
ZB 3
Z8 0
ZS 4
Z9 34
SN 0342-4642
UT WOS:000183362600028
PM 12634987
ER

PT J
AU Gilgoff, RL
   Gilgoff, IS
TI Long-term follow-up of home mechanical ventilation in young children
   with spinal cord injury and neuromuscular conditions
SO JOURNAL OF PEDIATRICS
VL 142
IS 5
BP 476
EP 480
DI 10.1067/mpd.2003.47
PD MAY 2003
PY 2003
AB Objectives To provide outcomes of two decades of experience in home
   ventilation of children with spinal cord injury and neuromuscular
   conditions.
   Study design Data were collected through chart review and interviews on
   39 children who had become ventilator-dependent before their 6th
   birthday: 23 children had neuromuscular diseases and 16 had spinal cord
   injuries.
   Results Patients required an average of 0.7 rehospitalizations per year.
   There were 8 deaths. Survival rates were 97% at 1 year, 97% at 3 years,
   84% at 5 years, and 71% at 10 years. Thirty children attended school, 13
   were in regular school (1 at university level). 5 were home-schooled, 5
   were in special education schools, and 5 were in regular school with
   some special education classes. One graduated high school, and another
   graduated university and received a graduate degree. Three children had
   progressive weakness. Two gained significant muscle strength.
   Conclusions Our experience showed that these patients can be discharged
   to home with low morbidity and mortality rates and successful
   reintegration into the community.
TC 19
ZB 2
Z8 0
ZS 1
Z9 20
SN 0022-3476
UT WOS:000183068400006
PM 12756376
ER

PT J
AU Sritippayawan, S
   Kun, SS
   Keens, TG
   Ward, SLD
TI Initiation of home mechanical ventilation in children with neuromuscular
   diseases
SO JOURNAL OF PEDIATRICS
VL 142
IS 5
BP 481
EP 485
DI 10.1067/mpd.2003.157
PD MAY 2003
PY 2003
AB Objective To determine how often home mechanical ventilation (HMV) is
   instituted electively in children with respiratory failure from
   neuromuscular diseases and whether there were opportunities to discuss
   therapeutic options with patients/families before respiratory failure.
   Methods Patients with neuromuscular disease (n = 73) requiring HMV (age,
   2 months to 24 years) were studied. Whether HMV was initiated
   nonelectively because of acute respiratory failure or electively before
   acute respiratory failure, and opportunities for health care providers
   to discuss therapeutic options with patients/families before acute
   respiratory failure (hospitalization with pneumonia, clinic visits for
   preoperative evaluation, pulmonary function testing [PFT] and/or
   polysomnography [PSG]) were recorded.
   Results HMV was initiated electively in 21% of patients with
   neuromuscular disease; 69% of the nonelective HMV group had HAW
   initiated after respiratory failure caused by pneumonia. In the
   nonelective group, opportunities for discussion of therapeutic options
   with the patients and families could have occurred before respiratory
   failure during 111 hospitalizations for pneumonia,. 13 preoperative
   evaluations, 43 abnormal PFTs, and 24 abnormal PSGs.
   Conclusions Most patients with neuromuscular disease had HMV initiated
   nonelectively after acute respiratory failure caused by pneumonia.
   Opportunities for discussing the therapeutic options with patients and
   families before respiratory failure were missed or ineffective.
TC 22
ZB 5
Z8 0
ZS 0
Z9 22
SN 0022-3476
UT WOS:000183068400007
PM 12756377
ER

PT J
AU Price, Ann M
   Collins, Timothy J
   Gallagher, Alison
TI Nursing care of the acute head injury: a review of the evidence.
SO Nursing in critical care
VL 8
IS 3
BP 126
EP 33
DI 10.1046/j.1478-5153.2003.00019.x
PD 2003 May-Jun
PY 2003
AB This article aims to review the current evidence in relation to acute
   head injury care. Head injuries are a frequent cause of death and
   disability in western society with the first 72 h being an important
   period for prevention of further brain damage. The underlying physiology
   behind head injury and intracranial pressure will be discussed. The
   monitoring of intracranial pressure and implications for practice will
   be addressed. The specialized nursing care and drug therapy management
   that is necessary for acute head injury patients will be highlighted.
   Recommendations for practice will be given.
TC 3
ZB 1
Z8 0
ZS 0
Z9 3
SN 1362-1017
UT MEDLINE:12859083
PM 12859083
ER

PT J
AU Latronico, N
TI Paresis following mechanical ventilation
SO JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION
VL 289
IS 13
BP 1633
EP 1634
DI 10.1001/jama.289.13.1633-c
PD APR 2 2003
PY 2003
RI Latronico, Nicola/F-1557-2010
OI Latronico, Nicola/0000-0002-2521-5871
TC 1
ZB 0
Z8 1
ZS 0
Z9 2
SN 0098-7484
UT WOS:000181944500016
PM 12672724
ER

PT J
AU Ahmed, S
   Kupfer, Y
   Tessler, S
TI Paresis following mechanical ventilation
SO JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION
VL 289
IS 13
BP 1634
EP 1634
DI 10.1001/jama.289.13.1634-a
PD APR 2 2003
PY 2003
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 0098-7484
UT WOS:000181944500017
PM 12672727
ER

PT J
AU Weber-Carstens, S
   Bercker, S
   Busch, T
   Kaisers, U
TI Paresis following mechanical ventilation
SO JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION
VL 289
IS 13
BP 1634
EP 1634
DI 10.1001/jama.289.13.1634-b
PD APR 2 2003
PY 2003
RI bercker, sven/B-9278-2009
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 0098-7484
UT WOS:000181944500018
PM 12672726
ER

PT J
AU MacDuff, Andrew
   Grant, Ian S
TI Critical care management of neuromuscular disease, including long-term
   ventilation.
SO Current opinion in critical care
VL 9
IS 2
BP 106
EP 12
DI 10.1097/00075198-200304000-00005
PD 2003-Apr
PY 2003
AB PURPOSE OF REVIEW: This review highlights recent advances in the
   critical care management of neuromuscular disease, particularly in the
   long-term management of chronic respiratory failure occurring as a
   consequence of neuromuscular disease.
   RECENT FINDINGS: Although randomized clinical trial evidence of benefit
   is sparse, a large volume of nonrandomized clinical trial evidence has
   accumulated demonstrating that noninvasive positive pressure ventilation
   prolongs and improves quality of life in conditions such as Duchenne
   muscular dystrophy and motor neuron disease.
   SUMMARY: Immunomodulatory treatments favorably modify the course of
   neuromuscular diseases such as Guillain-Barre syndrome, whereas
   long-term noninvasive positive pressure ventilation has transformed the
   outlook in previously untreatable conditions such as motor neuron
   disease and muscular dystrophies. The availability of long-term
   noninvasive positive pressure ventilation raises major medical, social,
   economic, and ethical issues that are increasingly being investigated
   and discussed.
TC 9
ZB 3
Z8 0
ZS 0
Z9 9
SN 1070-5295
UT MEDLINE:12657972
PM 12657972
ER

PT J
AU Gonzalez, J
   Sharshar, T
   Hart, N
   Chadda, K
   Raphael, JC
   Lofaso, F
TI Air leaks during mechanical ventilation as a cause of persistent
   hypercapnia in neuromuscular disorders
SO INTENSIVE CARE MEDICINE
VL 29
IS 4
BP 596
EP 602
DI 10.1007/s00134-003-1659-5
PD APR 2003
PY 2003
AB Objective: This study investigated whether air leaks from the upper
   airway during assisted ventilatory support are associated with
   persistent hypercapnia (PaCO2 >45 mmHg) in patients with neuromuscular
   disorders. Setting: A rehabilitation hospital. Patients: The study was
   performed in 95 neuromuscular patients; 52 were tracheostomized with a
   cuffless tracheostomy tube (invasive ventilation), and 43 received
   noninvasive ventilation. Measurements and results: The volume of air
   leaked (VL) and arterial carbon dioxide (PaCO2) were routinely measured
   during mechanical ventilation; PaCO2 was also measured during
   spontaneous breathing. VL, expressed as a percentage of tidal volume,
   was higher in the hypercapnic group (32+/-14%, n=20) than the
   nonhypercapnic group (vs. 20+/-14%). PaCO2 during mechanical ventilation
   was correlated with both VL and the duration of ventilatory support per
   day; PaCO2 during spontaneous breathing was correlated only with the
   volume of air leaked. In stepwise multiple regression analysis, air
   leaks contributed to 8% of the variance in PaCO2 during mechanical
   ventilation, and daily duration of ventilatory support contributed 5%.
   In addition, reduction in VL with normalization of PaCO2 was achieved in
   five of the noninvasively ventilated patients with persistent
   hypercapnia by using a chin strap. Conclusions: Air leaks during
   wakefulness are an important cause of persistent hypercapnia in both
   invasively and noninvasively ventilated neuromuscular patients. However,
   simple practical measures to reduce the volume of air leaks improve the
   efficacy of ventilation in these patients.
TC 39
ZB 6
Z8 0
ZS 0
Z9 39
SN 0342-4642
UT WOS:000182759600016
PM 12589533
ER

PT J
AU Cavaliere, F
   Masieri, S
   Conti, G
   Antonelli, M
   Pennisi, MA
   Filipo, R
   Proietti, R
TI Effects of non-invasive ventilation on middle ear function in healthy
   volunteers
SO INTENSIVE CARE MEDICINE
VL 29
IS 4
BP 611
EP 614
DI 10.1007/s00134-003-1678-2
PD APR 2003
PY 2003
AB Objectives: To evaluate the effects of non-invasive ventilation (NIV)
   with facial mask or helmet on middle ear (ME). Design: Prospective,
   randomised study. Setting: University hospital. Participants: Ten
   healthy subjects randomly allocated in two groups of five subjects each.
   Interventions: NIV for I h, with helmet (group H) or facial mask (group
   M). Flow-triggered pressure support was 10 cmH(2)O, PEEP 5 cmH(2)O,
   FiO(2) 0.21. Measurements and results: Impedenzometry was performed
   before NIV and 5 min after NIV ended; it was repeated 60 min later. In
   group H the acoustic compliance increased after NIV from 2.0+/-.6 ml to
   2.3+/-.6 ml (P<.01), suggesting that the tympanic membrane became less
   stiff; I h later the compliance returned to basal values (2.0+/-.7 ml);
   in group M the compliance was unaffected (from 2.0+/-.5 ml to 2.0+/-.4
   ml; 1.9+/-.4 ml I h later). The acoustic reflex, i.e., the contraction
   of the stapedial muscle in response to an auditory stimulus, involving
   the acoustic and facial nerves, was also evaluated during impedenzometry
   at 250 Hz, 500 Hz, 1,000 Hz, and 4,000 Hz; no significant change of the
   threshold was observed. Conclusions: The tympanic membrane is tighten by
   the tensor tympani and a reversible loosening suggests muscle fatigue in
   response to the application of intermittent positive pressure applied to
   the external ear during NIV with helmet. The loss of tensor tympani
   protective action could theoretically predispose the middle and inner
   ear to mechanical damage during NIV with helmet, suggesting the use of
   protective devices (ear plugs) in selective cases requiring long-term,
   high-pressure treatment.
RI Cavaliere, Franco/G-1057-2010; Antonelli, Massimo/F-9848-2010
TC 9
ZB 0
Z8 0
ZS 1
Z9 9
SN 0342-4642
UT WOS:000182759600018
PM 12589536
ER

PT J
AU Ceriana, P
   Navalesi, P
   Rampulla, C
   Prinianakis, G
   Nava, S
TI Use of bronchodilators during non-invasive mechanical ventilation.
SO Monaldi archives for chest disease = Archivio Monaldi per le malattie
   del torace / Fondazione clinica del lavoro, IRCCS [and] Istituto di
   clinica tisiologica e malattie apparato respiratorio, Universita di
   Napoli, Secondo ateneo
VL 59
IS 2
BP 123
EP 7
PD 2003 Apr-Jun
PY 2003
AB Bronchodilators represent one of the most important therapeutic weapons
   for the treatment of airway obstructive diseases and the inhaled route
   of administration is very often employed due to the greater drug
   availability and reduced magnitude of side effects. During acute
   exhacerbations, it is not unfrequent that the elastic and resistive
   loads imposed on the ventilatory pump overcome the force sustainable by
   the respiratory muscles and the patient requires ventilatory assistance,
   in order to relieve fatigue and to optimize alveolar gas exchange.
   During these episodes, inhaled bronchodilators, far from being
   discontinued, sometime must be administered during mechanical
   ventilation, that, in hypercapnic ventilatory failure can be frequently
   applied noninvasively with a good rate of success. While in the current
   literature there are a lot of data about inhaled drug administration
   during invasive mechanical ventilation, very few data are available on
   the topic of aerosol therapy during noninvasive mechanical ventilation.
   With the present paper we want to analyze the rationale, the feasibility
   and the current data dealing with the administration of inhaled drugs
   during noninvasive mechanical ventilation.
TC 5
ZB 3
Z8 0
ZS 0
Z9 5
SN 1122-0643
UT MEDLINE:14635500
PM 14635500
ER

PT J
AU Tekgul, H
   Serdaroglu, G
   Tutuncuoglu, S
TI Outcome of axonal and demyelinating forms of Guillain-Barre syndrome in
   children
SO PEDIATRIC NEUROLOGY
VL 28
IS 4
BP 295
EP 299
DI 10.1016/S0887-8994(02)00626-4
PD APR 2003
PY 2003
AB Previous reports have suggested that outcome is worse in the axonal
   compared with the demyelinating form of Guillain-Barre syndrome (GBS).
   We performed a retrospective study of 23 children with
   electrophysiologically confirmed cases of predominant subtypes of GBS to
   investigate this issue. The patients were classified based on the
   electrodiagnostic features: Ten (44%) had acute inflammatory
   demyelinating polyradiculoneuropathy, eight (35%) had acute motor axonal
   neuropathy, and five (21%) had acute motor-sensory axonal neuropathy.
   All patients received a standard intravenous immunoglobulin therapy (0.4
   g /kg /day for 5 consecutive days). In the acute phase of the disease,
   patients with the axonal forms of GBS were more disabled than were those
   with the demyelinating GBS, as measured by GBS scores. Mechanical
   ventilation was required in five (38%) patients in the axonal group
   compared with one (10%) patient in the demyelinating group. There was no
   significant difference at 6 months in GBS scores between demyelinating
   and axonal forms of GBS. All 20 survivors recovered completely by 12
   months. After standard intravenous immunoglobulin therapy, children with
   axonal forms of GBS recover more slowly than those with the
   demyelinating form, but outcome at 12 months appears to be equally
   favorable in two groups. (C) 2003 by Elsevier Inc. All rights reserved.
TC 20
ZB 6
Z8 2
ZS 0
Z9 22
SN 0887-8994
UT WOS:000184143600008
PM 12849884
ER

PT J
AU Stone, AC
   Nolan, S
   Abu-Hijelhia, M
   McCool, D
   Hill, NS
TI A novel form of manually assisted ventilation
SO CHEST
VL 123
IS 3
BP 949
EP 952
DI 10.1378/chest.123.3.949
PD MAR 2003
PY 2003
AB We report an individual with limb-girdle muscular dystrophy who has
   devised a way to assist her respiration by using her hands braced
   against the tray of her wheelchair. Utilizing this method, she was able
   to increase her tidal volume (VT) and lower her respiratory rate
   compared to unassisted spontaneous breathing, thereby maintaining a
   stable minute volume. The manually assisted VT measurements were
   comparable to those achieved using an intermittent abdominal pressure
   respirator (pneumatic belt). We believe that others with neuromuscular
   syndromes could use this technique, possibly decreasing their dependence
   on mechanical ventilatory assist devices.
TC 1
ZB 0
Z8 0
ZS 0
Z9 1
SN 0012-3692
UT WOS:000181536500049
PM 12628900
ER

PT J
AU Herridge, MS
   Cheung, AM
   Tansey, CM
   Matte-Martyn, A
   Diaz-Granados, N
   Al-Saidi, F
   Cooper, AB
   Guest, CB
   Mazer, CD
   Mehta, S
   Stewart, TE
   Barr, A
   Cook, D
   Slutsky, AS
CA Canadian Critical Care Trials Grp
TI One-year outcomes in survivors of the acute respiratory distress
   syndrome
SO NEW ENGLAND JOURNAL OF MEDICINE
VL 348
IS 8
BP 683
EP 693
DI 10.1056/NEJMoa022450
PD FEB 20 2003
PY 2003
AB BACKGROUND:
   As more patients survive the acute respiratory distress syndrome, an
   understanding of the long-term outcomes of this condition is needed.
   METHODS:
   We evaluated 109 survivors of the acute respiratory distress syndrome 3,
   6, and 12 months after discharge from the intensive care unit. At each
   visit, patients were interviewed and underwent a physical examination,
   pulmonary-function testing, a six-minute-walk test, and a
   quality-of-life evaluation.
   RESULTS:
   Patients who survived the acute respiratory distress syndrome were young
   (median age, 45 years) and severely ill (median Acute Physiology, Age,
   and Chronic Health Evaluation score, 23) and had a long stay in the
   intensive care unit (median, 25 days). Patients had lost 18 percent of
   their base-line body weight by the time they were discharged from the
   intensive care unit and stated that muscle weakness and fatigue were the
   reasons for their functional limitation. Lung volume and spirometric
   measurements were normal by 6 months, but carbon monoxide diffusion
   capacity remained low throughout the 12-month follow-up. No patients
   required supplemental oxygen at 12 months, but 6 percent of patients had
   arterial oxygen saturation values below 88 percent during exercise. The
   median score for the physical role domain of the Medical Outcomes Study
   36-item Short-Form General Health Survey (a health-related
   quality-of-life measure) increased from 0 at 3 months to 25 at 12 months
   (score in the normal population, 84). The distance walked in six minutes
   increased from a median of 281 m at 3 months to 422 m at 12 months; all
   values were lower than predicted. The absence of systemic corticosteroid
   treatment, the absence of illness acquired during the intensive care
   unit stay, and rapid resolution of lung injury and multiorgan
   dysfunction were associated with better functional status during the
   one-year follow-up.
   CONCLUSIONS:
   Survivors of the acute respiratory distress syndrome have persistent
   functional disability one year after discharge from the intensive care
   unit. Most patients have extrapulmonary conditions, with muscle wasting
   and weakness being most prominent.
RI Slutsky, Arthur/A-6013-2008
OI Slutsky, Arthur/0000-0002-6063-3876
TC 737
ZB 231
Z8 3
ZS 12
Z9 756
SN 0028-4793
UT WOS:000181014400003
PM 12594312
ER

PT J
AU Fauroux, B
   Boffa, C
   Desguerre, I
   Estournet, B
   Trang, H
TI Long-term noninvasive mechanical ventilation for children at home: A
   national survey
SO PEDIATRIC PULMONOLOGY
VL 35
IS 2
BP 119
EP 125
DI 10.1002/ppul.10237
PD FEB 2003
PY 2003
AB Experience with domiciliary noninvasive mechanical ventilation (NIMV) in
   children is limited. The aim of this study was to determine the number
   of patients and categorize the use of domiciliary NIMV in children in
   France.
   An anonymous cross-sectional national study was performed, using a
   postal questionnaire sent to all specialist centers utilizing
   domiciliary NIMV for chronic respiratory failure. Patients aged <18
   years and receiving home NIMV were included in the study.
   Detailed information was obtained from 102 patients from 15 centers:
   4/15 centers cared for 84% of patients; 7% of patients were under 3
   years old; 35% were between 4-11 years old; and 58% were older than 12
   years. Underlying diagnoses included neuromuscular disease (34%),
   obstructive sleep apnea (OSA) and/or cranio-facial abnormalities (30%),
   cystic fibrosis (17%), congenital hypoventilation (9%), scoliosis (8%),
   and other disorders (2%), NIMV was started because of nocturnal
   hypoventilation (67%), acute exacerbation (28%), and/or failure to
   thrive (21%). Volume-targeted ventilation was preferred in restrictive
   disorders (56%) and central hypoventilation (56%), while pressure
   support ventilation (PSV) was preferred in cystic fibrosis (71%).
   Patients with OSA and/or cranio-facial abnormalities were ventilated
   with continuous positive airway pressure (45%) or bilevel PSV (52%).
   In conclusion, NIMV is currently used in France for the domiciliary
   management of children with a variety of conditions causing chronic
   respiratory failure. However, NIMV in children is still performed on a
   small scale, and combined with the heterogeneity of the patient
   population, its application would best be served by centers specializing
   in the initiation and long-term follow-up of these patients. (C) 2003
   Wiley-Liss, Inc.
TC 46
ZB 10
Z8 3
ZS 5
Z9 52
SN 8755-6863
UT WOS:000180771500008
PM 12526073
ER

PT J
AU Laghi, F
   Cattapan, SE
   Jubran, A
   Parthasarathy, S
   Warshawsky, P
   Choi, YSA
   Tobin, MJ
TI Is weaning failure caused by low-frequency fatigue of the diaphragm?
SO AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE
VL 167
IS 2
BP 120
EP 127
DI 10.1164/rccm.200210-1246OC
PD JAN 15 2003
PY 2003
AB Because patients who fail a trial of weaning from mechanical ventilation
   experience a marked increase in respiratory load, we hypothesized that
   these patients develop diaphragmatic fatigue. Accordingly, we measured
   twitch transdiaphragmatic pressure using phrenic nerve stimulation in 11
   weaning failure and 8 weaning success patients. Measurements were made
   before and 30 minutes after spontaneous breathing trials that lasted up
   to 60 minutes. Twitch transdiaphragmatic pressure was 8.9 +/- 2.2 cm H2O
   before the trials and 9.4 +/- 2.4 cm H2O after their completion in the
   weaning failure patients (p = 0.17); the corresponding values in the
   weaning success patients were 10.3 +/- 1.5 and 11.2 +/- 1.8 cm H2O (P =
   0.18). Despite greater load (p = 0.04) and diaphragmatic effort (p =
   0.01), the weaning failure patients did not develop low-frequency
   fatigue probably because of greater recruitment of rib cage and
   expiratory muscles (p = 0.004) and because clinical signs of distress
   mandating the reinstitution of mechanical ventilation arose before the
   development of fatigue. Twitch pressure revealed considerable
   diaphragmatic weakness in many weaning failure patients. In conclusion,
   in contrast to our hypothesis, weaning failure was not accompanied by
   low-frequency fatigue of the diaphragm, although many weaning failure
   patients displayed diaphragmatic weakness.
RI Parthasarathy, Sairam/L-1612-2013
TC 133
ZB 60
Z8 3
ZS 3
Z9 140
SN 1073-449X
UT WOS:000180410400011
PM 12411288
ER

PT J
AU Lahrmann, H
   Wild, M
   Zdrahal, F
   Grisold, W
TI Expiratory muscle weakness and assisted cough in ALS
SO AMYOTROPHIC LATERAL SCLEROSIS AND OTHER MOTOR NEURON DISORDERS
VL 4
IS 1
BP 49
EP 51
DI 10.1080/14660820310006733
PD 2003
PY 2003
AB Elimination of airway secretion is a major issue in the care of patients
   with ALS. Sufficient cough flows have to be generated by expiratory
   muscles to allow airway clearance. Bulbar and expiratory muscle weakness
   are often reasons for failure of non-invasive ventilation (NIV) and may
   lead to tracheostomy. Expiratory aids may help to overcome these
   problems, at least for some time. We report a patient with advanced ALS,
   receiving nocturnal NIV, who gained much benefit from regular use of a
   mechanical in-exsufflation device.
TC 5
ZB 1
Z8 0
ZS 0
Z9 6
SN 1466-0822
UT WOS:000182593500011
PM 12745619
ER

PT J
AU Shanely, RA
   Coombes, JS
   Zergeroglu, AM
   Webb, AI
   Powers, SK
TI Short-duration mechanical ventilation enhances diaphragmatic resistance
   but impairs fatigue force production
SO CHEST
VL 123
IS 1
BP 195
EP 201
DI 10.1378/chest.123.1.195
PD JAN 2003
PY 2003
AB Study objectives: Mechanical ventilation (MV) is a life-support measure
   for patients who cannot maintain adequate alveolar ventilation.
   Following prolonged MV, difficulty in weaning patients from the
   ventilator can occur, and it has been postulated that difficult weaning
   is linked to respiratory muscle dysfunction. We tested the hypothesis
   that IS h of controlled MV will diminish diaphragmatic maximal tetanic
   specific tension (force per cross-sectional area of muscle) without
   impairing diaphragmatic fatigue resistance.
   Design: To test this postulate, adult Sprague-Dawley rats were randomly
   classified into one of two experimental groups: (1) control group (n =
   8), and (2) 18-h MV group (n = 6). MV-treated animals were anesthetized,
   tracheostomized, and received room air ventilation. Animals in the
   control group were acutely anesthetized but did not receive MV. Muscle
   strips from the mid-costal diaphragm were removed from both experimental
   groups, and contractile propel-ties were studied in vitro to determine
   the effects of MV on diaphragmatic endurance and maximal force
   production. Diaphragmatic endurance was investigated by measuring
   tension development during repeated contractions throughout a 30-min
   fatigue protocol.
   Results: MV resulted in a reduction (p < 0.05) in diaphragmatic maximal
   specific tension (control group, 26.8 +/- 0.2 Newtons/cm(2) VS MV group,
   21.3 +/- 0.6 Newtons/cm(2)). Compared to the control group, diaphragms
   from MV-treated animals maintained higher (p < 0.05) percentages of the
   initial force production throughout the fatigue protocol. The observed
   improvement in fatigue resistance was associated with an increase in
   diaphragmatic oxidative and antioxidant capacity as evidenced by
   increases (p < 0.05) in both citrate synthase and superoxide dismutase
   activities. However, by comparison to the control group, diaphragms from
   MV-treated animals generated less (p < 0.05) absolute specific force
   throughout the fatigue protocol.
   Conclusions: These data indicate that IS h of MV enhances diaphragmatic
   fatigue resistance but impairs diaphragmatic specific tension.
RI Coombes, Jeff/F-1764-2010
TC 30
ZB 21
Z8 0
ZS 3
Z9 34
SN 0012-3692
UT WOS:000180491100034
PM 12527622
ER

PT J
AU Durand, MC
   Lofaso, F
   Lefaucheur, JP
   Chevret, S
   Gajdos, P
   Raphael, JC
   Sharshar, T
TI Electrophysiology to predict mechanical ventilation in Guillain-Barre
   syndrome
SO EUROPEAN JOURNAL OF NEUROLOGY
VL 10
IS 1
BP 39
EP 44
DI 10.1046/j.1468-1331.2003.00505.x
PD JAN 2003
PY 2003
AB To determine whether electrophysiological features predict endotracheal
   mechanical ventilation (ETMV) in Guillain-Barre syndrome (GBS).
   Non-ventilated GBS patients admitted to an ICU underwent standard
   electrophysiological testing. Endotracheal mechanical ventilation was
   decided by physicians who were unaware of electrophysiological results.
   Sixty consecutive patients underwent electrophysiological testing within
   17 days of GBS onset; based on Hadden's criteria, 37 (62%) had primary
   demyelinating, 18 (30%) equivocal and five (8%) axonal disease. Time at
   electrophysiological testing and proportions of patients treated by
   plasma exchange and intravenous immunoglobulins were similar in the
   three groups, whereas primary demyelinating patients had worse results
   for disability grade and arm grade. The ETMV was required within 20 days
   of electrophysiological testing in 20 patients, 17 (46%) in the primary
   demyelinating group, three (17%) in equivocal group and none in the
   axonal group (P = 0.02). This prospective study suggests that
   electrophysiological demyelination may predict a need for ETMV in GBS.
TC 20
ZB 10
Z8 1
ZS 0
Z9 21
SN 1351-5101
UT WOS:000180394700006
PM 12534991
ER

PT J
AU Capdevila, X
   Lopez, S
   Bernard, N
   Rabischong, E
   Ramonatxo, M
   Martinazzo, G
   Prefaut, C
TI Effects of controlled mechanical ventilation on respiratory muscle
   contractile properties in rabbits
SO INTENSIVE CARE MEDICINE
VL 29
IS 1
BP 103
EP 110
DI 10.1007/s00134-002-1548-3
PD JAN 2003
PY 2003
AB Objective: We examined in rabbits the effects of more than 48 h of
   mechanical ventilation on the contractile properties and fiber type
   adaptations of the respiratory muscles. Design and setting: Experimental
   prospective study in a university laboratory. Animals and interventions:
   Nineteen rabbits were randomly allocated to two groups: control (n=10)
   or mechanically ventilated (MV; n=9) for 51 +/- 3 h. Measurements and
   results: Respiratory muscles contractile properties were analyzed before
   and after a fatigue protocol using in vivo isometric 1-s tetanic
   contraction characteristics in both muscles: peak tetanic force,
   contraction time, relaxation time, and total contraction time. Both
   muscle fiber type proportions, diameter, and cross-sectional areas were
   measured using ATPase staining. The MV rabbits showed significant weight
   loss in both muscles, accompanied by a reduced peak tetanic force (9.96
   +/- 3.2 vs. 7.44 +/- 2.2 N for diaphragm of control and MV animals
   respectively), fatigue resistance index, and increased relaxation time
   (57.5 +/- 8.7 vs. 85.8 +/- 9.4 ms for diaphragm of control and MV
   animals) and contraction time. These impairments in the MV group
   worsened after the fatigue runs. Both muscle showed a significant
   atrophy of type IIa and IIb fibers but a stability in type I fibers
   cross-sectional area. Conclusions: Mechanical ventilation in rabbits
   produces alterations in contractile properties of the diaphragm and 5th
   external intercostal muscle, increases both muscles fatigue, and
   promotes atrophy of type II fibers.
TC 44
ZB 25
Z8 0
ZS 2
Z9 45
SN 0342-4642
UT WOS:000180865800018
PM 12528030
ER

PT J
AU Symington, A
   Pinelli, J
TI Developmental care for promoting development and preventing morbidity in
   preterm infants.
SO The Cochrane database of systematic reviews
IS 4
BP CD001814
EP CD001814
PD 2003
PY 2003
AB BACKGROUND: Preterm infants experience a range of morbidity related to
   the immaturity of their organ systems and to concurrent disease states.
   An unfavourable environment in the neonatal intensive care unit (NICU)
   may compound this morbidity. Modification of the environment could
   minimize the iatrogenic effects. Developmental care is a broad category
   of interventions designed to minimize the stress of the NICU
   environment. These interventions may include one or more elements such
   as control of external stimuli (vestibular, auditory, visual, tactile),
   clustering of nursery care activities, and positioning or swaddling of
   the preterm infant. Individual strategies have also been combined to
   form programs, such as the 'Neonatal Individualized Developmental Care
   and Assessment Program' (NIDCAP) (Als 1986).
   OBJECTIVES: In preterm infants, do developmental care interventions
   reduce neurodevelopmental delay, poor weight gain, length of hospital
   stay, length of mechanical ventilation, physiological stress and other
   clinically relevant adverse outcomes?
   SEARCH STRATEGY: The Neonatal Review Group search strategy was utilized.
   Searches were made of MEDLINE from 1966 to July, 2003, and of CINAHL,
   The Cochrane Central Register of Controlled Trials (CENTRAL, The
   Cochrane Library, Issue 2, 2003), and conference and symposia
   proceedings in the English language from 1990 to July, 2003. A list of
   all relevant articles was sent to two experts in the field to identify
   any omissions or additional unpublished studies.
   SELECTION CRITERIA: Randomized trials in which elements of developmental
   care are compared to routine nursery care for infants < 37 weeks
   gestation and that measured clinically relevant outcomes. Reports were
   in English or a language for which a translator was available.
   Computerized searches were conducted and all potentially relevant titles
   and abstracts were extracted. Retrieved articles were assessed for
   relevance independently by two reviewers, based on predetermined
   criteria. Articles that met all criteria for relevance were assessed for
   methodological quality based on predetermined criteria. Articles judged
   to have the appropriate quality by both reviewers were included in the
   analysis.
   DATA COLLECTION AND ANALYSIS: Data were extracted independently by the
   two authors. Meta-analyses were conducted for each intervention where
   the same outcome measures and/or instruments were used within comparable
   time points.
   MAIN RESULTS: This review detected 32 eligible randomized controlled
   trials involving four major groups of developmental care interventions,
   19 sub-groups and multiple clinical outcomes. The results of the review
   indicate that developmental care interventions demonstrate some benefit
   to preterm infants with respect to: improved short-term growth and
   feeding outcomes, decreased respiratory support, decreased length and
   cost of hospital stay, and improved neurodevelopmental outcomes to 24
   months corrected age. These findings were based on two or three small
   trials for each outcome, and did not involve meta-analyses of more than
   two trials for any one outcome. Although a number of other benefits were
   demonstrated, those results were from single studies with small sample
   sizes. The lack of blinding of the assessors was a significant
   methodological flaw in half of the studies. The cost of the
   interventions and personnel was not considered in any of the studies.
   REVIEWER'S CONCLUSIONS: Because of the inclusion of multiple
   interventions in most studies, the determination of the effect of any
   single intervention is difficult. Although there is evidence of some
   benefit of developmental care interventions overall, and no major
   harmful effects reported, there were a large number of outcomes for
   which no or conflicting effects were demonstrated. The single trials
   that did show a significant effect of an intervention on a major
   clinical outcome were based on small sample sizes, and the findings were
   often not supported in other small trials. Before a clear direction for
   practice can be supported, evidence demonstrating more consistent
   effects of developmental care interventions on important short- and
   long-term clinical outcomes is needed. The economic impact of the
   implementation and maintenance of developmental care practices should be
   considered by individual institutions.
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
UT MEDLINE:14583939
PM 14583939
ER

PT J
AU Lindemann, Kate
TI The ethics of receiving.
SO Theoretical medicine and bioethics
VL 24
IS 6
BP 501
EP 9
DI 10.1023/B:META.0000006927.95755.a8
PD 2003
PY 2003
AB As a teacher and philosopher, Dr. Kate Lindemann has spent much of her
   professional life thinking about morality in human relationships.
   Critical analyses abound about the obligations and particular
   responsibilities of health care providers to patients, teachers to
   students, etc. Such analyses often emphasize the inherent inequality,
   and thus vulnerability, of those who are the recipients of care or
   knowledge. Though familiar with the ethics of care as a moral framework,
   Dr. Lindemann's perspectives on such relationships were profoundly
   affected and forever altered after acquiring a brain injury in 1998. The
   current manuscript describes how her views on caring acts as not only
   dynamic but reciprocal have been shaped by her experiences during
   rehabilitation and as a person now living with disability.
TC 3
ZB 0
Z8 0
ZS 0
Z9 3
SN 1386-7415
UT MEDLINE:14750546
PM 14750546
ER

PT J
AU Phipps, P
   Garrard, CS
TI The pulmonary physician in critical care .12: Acute severe asthma in the
   intensive care unit
SO THORAX
VL 58
IS 1
BP 81
EP 88
DI 10.1136/thorax.58.1.81
PD JAN 2003
PY 2003
AB Most deaths from acute asthma occur outside hospital, but the at-risk
   patient may be recognised on the basis of prior ICU admission and asthma
   medication history. Patients who fail to improve significantly in the
   emergency department should be admitted to an HDU or ICU for
   observation, monitoring, and treatment. Hypoxia, dehydration, acidosis,
   and hypokalaemia render the severe acute asthmatic patient vulnerable to
   cardiac dysrrhythmia and cardiorespiratory arrest. Mechanical
   ventilation may be required for a small proportion of patients for whom
   it may be life saving. Aggressive bronchodilator (continuous nebulised
   beta agonist) and anti-inflammatory therapy must continue throughout the
   period of mechanical ventilation. Recognised complications of mechanical
   ventilation include hypotension, barotrauma, and nosocomial pneumonia.
   Low ventilator respiratory rates, long expiratory times, and small tidal
   volumes help to prevent hyperinflation. Volatile anaesthetic agents may
   produce bronchodilation in patients resistant to beta agonists.
   Fatalities in acute asthmatics admitted to HDU/ICU are rare.
TC 26
ZB 8
Z8 4
ZS 1
Z9 30
SN 0040-6376
UT WOS:000180487700015
PM 12511728
ER

PT J
AU De Jonghe, B
   Sharshar, T
   Lefaucheur, JP
   Authier, FJ
   Durand-Zaleski, I
   Boussarsar, M
   Cerf, C
   Renaud, E
   Mesrati, F
   Carlet, J
   Raphael, JC
   Outin, H
   Bastuji-Garin, S
CA Grp Reflexion d'Etude Neuromyopath
TI Paresis acquired in the intensive care unit - A prospective multicenter
   study
SO JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION
VL 288
IS 22
BP 2859
EP 2867
DI 10.1001/jama.288.22.2859
PD DEC 11 2002
PY 2002
AB Context Although electrophysiologic and histologic neuromuscular
   abnormalities are common in intensive care unit (ICU) patients, the
   clinical incidence of ICU-acquired neuromuscular disorders in patients
   recovering from severe illness remains unknown.
   Objectives To assess the clinical incidence, risk factors, and outcomes
   of ICU-acquired paresis (ICUAP) during recovery from critical illness in
   the ICU and to determine the electrophysiologic and histologic patterns
   in patients with ICUAP.
   Design Prospective cohort study conducted from March 1999 to June 2000.
   Setting Three medical and 2 surgical ICUs in 4 hospitals in France.
   Participants All consecutive ICU patients without preexisting
   neuromuscular disease who underwent mechanical ventilation for 7 or more
   days were screened daily for awakening. The first day a patient was
   considered awake was day 1. Patients with severe muscle weakness on day
   7 were considered to have ICUAP.
   Main Outcome Measures Incidence and duration of ICUAP, risk factors for
   ICUAP, and comparative duration of mechanical ventilation between ICUAP
   and control patients.
   Results Among the 95 patients who achieved satisfactory awakening, the
   incidence of ICUAP was 25.3% (95% confidence interval [CI],
   16.9%-35.2%). All ICUAP patients had a sensorimotor axonopathy, and all
   patients who underwent a muscle biopsy had specific muscle involvement
   not related to nerve involvement. The median duration of ICUAP after day
   1 was 21 days. Mean (SD) duration of mechanical ventilation after day 1
   was significantly longer in patients with ICUAP compared with those
   without (18.2 [36.3] vs 7.6 [19.2] days; P=.03). Independent predictors
   of ICUAP were female sex (odds ratio [OR], 4.66; 95% CI, 1.19-18.30),
   the number of days with dysfunction of 2 or more organs (OR, 1.28; 95%
   CI, 1.11-1.49), duration of mechanical ventilation (OR, 1.10; 95% CI
   1.00-1.22), and administration of corticosteroids (OR, 14.90; 95% CI,
   3.20-69.80) before day 1.
   Conclusions identified using simple bedside clinical criteria, ICUAP was
   frequent during, recovery from critical illness and was associated with
   a prolonged duration of mechanical ventilation. Our findings,suggest an
   important role of corticosteroids in the development of ICUAP.
TC 404
ZB 113
Z8 1
ZS 7
Z9 410
SN 0098-7484
UT WOS:000179732600031
PM 12472328
ER

PT J
AU Varelas, PN
   Chua, HC
   Natterman, J
   Barmadia, L
   Zimmerman, P
   Yahia, A
   Ulatowski, J
   Bhardwaj, A
   Williams, MA
   Hanley, DF
TI Ventilatory care in myasthenia gravis crisis: Assessing the baseline
   adverse event rate
SO CRITICAL CARE MEDICINE
VL 30
IS 12
BP 2663
EP 2668
DI 10.1097/01.CCM.0000038088.73995.33
PD DEC 2002
PY 2002
AB Objective: Myasthenic patients who require mechanical ventilation often
   develop pneumonia or atelectasis. Although there are differences in the
   prevalence of these complications among various institutions, there is
   no evidence that aggressive treatment shortens the course of the
   myasthenic crisis. We have quantified the severity of lung injury and
   aggressiveness of respiratory intervention in myasthenic patients
   admitted to the neuro-critical care unit.
   Design: We retrospectively identified all mechanically ventilated
   myasthenic patients admitted in our unit between 1990 and 1998.
   Setting: Neuro-critical care unit of a tertiary care center in an urban
   area with a large, established, regional neuromuscular disease program.
   Patients: Eighteen myasthenia gravis patients with 24 episodes of
   respiratory failure requiring mechanical ventilation.
   Interventions: A novel respiratory intervention index, comprising the
   use of suction, intermittent positive-pressure breathing or
   bronchodilator treatments, sighs, and chest physiotherapy represented
   the aggressiveness of the respiratory treatment. The respiratory
   intervention index was correlated with the lung injury score, used as a
   measure of lung involvement and other respiratory variables.
   Measurements and Main Results: Our patients had less atelectasis and
   pneumonia than previously published series (46% vs. 91%), leading to
   shorter mechanical support and neuro-critical care unit stay. The mean
   respiratory intervention index correlated with lung injury score and
   inversely with forced vital capacity.
   Conclusions: This study presents an estimate for both severity of
   pulmonary complications and intensity of respiratory therapy in the
   severe myasthenic patient with mechanical ventilatory compromise. Our
   results suggest that aggressive respiratory treatment should be used in
   myasthenic patients in crisis to diminish the risk for prolonged
   respiratory complications. These observations should be validated in a
   prospective study.
TC 25
ZB 11
Z8 2
ZS 1
Z9 29
SN 0090-3493
UT WOS:000180257300009
PM 12483056
ER

PT J
AU Gayan-Ramirez, G
   Decramer, M
TI Effects of mechanical ventilation on diaphragm function and biology
SO EUROPEAN RESPIRATORY JOURNAL
VL 20
IS 6
BP 1579
EP 1586
DI 10.1183/09031936.02.00063102
PD DEC 2002
PY 2002
AB The pathophysiological mechanisms of weaning from mechanical ventilation
   are not fully known, but there is accumulating evidence that mechanical
   ventilation induces inspiratory muscle dysfunction.
   Recently, several animal models have provided potential mechanisms for
   mechanical ventilation-induced effects on muscle function. In patients,
   weaning difficulties are associated with inspiratory muscle weakness and
   reduced endurance capacity. Animal studies demonstrated that diaphragm
   force was already decreased after 12 h of controlled mechanical
   ventilation and this worsened with time spent on the ventilator.
   Diaphragmatic myofibril damage observed after 3-days controlled
   mechanical ventilation was inversely correlated with maximal
   diaphragmatic force. Downregulation of the diaphragm insulin-like growth
   factor-I and MyoD/myogenin messenger ribonucleic acid occurred after 24
   h and diaphragmatic oxidative stress and increased protease activity
   after 18 h. In keeping with these findings, diaphragm fibre atrophy was
   shown after 12 h and reduced diaphragm mass was reported after 48 h of
   controlled mechanical ventilation. These animal studies show that early
   alterations in diaphragm function develop after short-term mechanical
   ventilation.
   These alterations may contribute to the difficulties in weaning from
   mechanical ventilation seen in patients. Strategies to preserve
   respiratory muscle mass and function during mechanical ventilation
   should be developed. These may include: adaptation of medication,
   training of the diaphragm, stabilisation of the catabolic state and
   pharmacotherapy.
TC 40
ZB 19
Z8 1
ZS 4
Z9 45
SN 0903-1936
UT WOS:000180064000034
PM 12503720
ER

PT J
AU Corrado, Antonio
   Gorini, Massimo
TI Long-term negative pressure ventilation.
SO Respiratory care clinics of North America
VL 8
IS 4
BP 545
EP 57, v-vi
DI 10.1016/S1078-5337(02)00026-6
PD 2002-Dec
PY 2002
AB Noninvasive mechanical ventilatory techniques include the use of
   negative and positive pressure ventilators. Negative pressure
   ventilators support ventilation by exposing the surface of the chest
   wall to subatmospheric pressure during inspiration, whereas expiration
   occurs when the pressure around the chest wall increases and becomes
   equal to or greater than atmospheric pressure. In this article, a
   description of negative pressure ventilators and the physiologic effects
   of negative pressure ventilation (NPV) is given, and the application of
   this technique in the long-term treatment of chronic respiratory failure
   is summarized. Many studies, although uncontrolled, have shown that
   long-term treatment with NPV can improve respiratory muscle function,
   arterial blood gases, and survival in patients with neuromuscular and
   chest wall disorders. NPV devices, however, are more cumbersome and
   difficult to use than home positive pressure ventilators (PPVs) and tend
   to predispose to obstructive apnoeas during sleep. In the last several
   decades, NPV has been supplanted by mask PPV. In experienced hands, NPV
   remains a second viable option in patients with neuromuscular and chest
   wall disorders who, for technical or other reasons, cannot be offered
   mask PPV. There is no evidence, however, that long-term treatment with
   NPV can improve respiratory muscle function, exercise endurance, quality
   of life, and survival in patients with severe chronic obstructive
   pulmonary disease.
TC 3
ZB 2
Z8 0
ZS 0
Z9 4
SN 1078-5337
UT MEDLINE:12602414
PM 12602414
ER

PT J
AU Krachman, Samuel L
   Criner, Gerard J
TI Sleep and long-term ventilation.
SO Respiratory care clinics of North America
VL 8
IS 4
BP 611
EP 29
DI 10.1016/S1078-5337(02)00032-1
PD 2002-Dec
PY 2002
AB The development of sleep-disordered breathing is common in patients with
   chronic respiratory insufficiency due to neuromuscular and restrictive
   disorders, as well as in those with COPD. Nocturnal hypoventilation and
   obstructive and central apneas result in daytime symptoms of
   hypersomnolence and fatigue, and contribute to abnormalities in awake
   gas exchange. Long-term mechanical ventilation, delivered invasively by
   tracheostomy or more recently by NPPV, has been shown to eliminate
   sleep-disordered breathing and correct abnormalities in nocturnal gas
   exchange, resulting in an improvement in sleep quality. Improved daytime
   symptoms and gas exchange, with the suggestion of a decrease in
   morbidity and mortality, support the use of long-term mechanical
   ventilation during sleep in selected patients with these disorders.
TC 4
ZB 1
Z8 0
ZS 0
Z9 4
SN 1078-5337
UT MEDLINE:12602418
PM 12602418
ER

PT J
AU Markstrom, A
   Sundell, K
   Lysdahl, M
   Andersson, G
   Schedin, U
   Klang, B
TI Quality-of-life evaluation of patients with neuromuscular and skeletal
   diseases treated with noninvasive and invasive home mechanical
   ventilation
SO CHEST
VL 122
IS 5
BP 1695
EP 1700
DI 10.1378/chest.122.5.1695
PD NOV 2002
PY 2002
AB Background: Home mechanical ventilation (HMV) is known to be a
   successful therapy for chronic respiratory insufficiency, with regard to
   long-term survival. However, the quality of life (QoL) of patients
   receiving HMV has not previously been systematically investigated. The
   purpose of this study was to assess the QoL of patients with
   neuromuscular disorders and skeletal deformities (ie, restrictive lung
   disease) receiving HMV.
   Methods: Patients receiving HMV treated by tracheostomy or noninvasive
   ventilation (NIV). Three different, standardized, and validated
   questionnaires were used: the Sickness Impact Profile (SIP), the Health
   Index (HI), and the Sense of Coherence (SOC) scale. Underlying diseases
   were postpolio dysfunction (37%), neuromuscular disorder (20%),
   scoliosis (15%), and other diseases (28%).
   Results: The group treated with tracheostomy had higher HI scores than
   the group treated with NIV. For the three main diagnosis groups treated
   with tracheostomy or NIV, the patients with postpoho dysfunction treated
   with tracheostomy had lower SIP scores than the patients with postpolio
   dysfunction treated with NIV. This was in contrast to the patients with
   neuromuscular disorders treated with tracheostomy, who had higher scores
   in the SIP, compared with patients with postpolio dysfunction treated
   with tracheostomy and patients with neuromuscular disorders treated with
   NIV. A SIP score > 10% indicates a functional disability of clinical
   importance, and a high score on the HI and SOC scale indicates good
   perceived health. For the three main diagnosis groups treated with NIV,
   the patients with scoliosis had no dysfunction of clinical importance
   (4.6 +/- 3.7) on the SIP score compared with patients with postpolio
   dysfunction (15.5 +/- 7.6) and patients with neuromuscular disorders
   (13.2 +/- 5.2) [mean +/- SD]. The men showed more dysfunction in the SIP
   score than the women.
   Conclusion: Patients receiving HMV reported a good perceived health,
   despite severe physical limitations. The patients with postpolio
   dysfunction and the patients with scoliosis treated with tracheostomy
   perceived the best health, compared with NIV for this diagnosis.
TC 40
ZB 10
Z8 1
ZS 0
Z9 41
SN 0012-3692
UT WOS:000179376600035
PM 12426273
ER

PT J
AU Bird, Shawn J
   Rich, Mark M
TI Critical illness myopathy and polyneuropathy.
SO Current neurology and neuroscience reports
VL 2
IS 6
BP 527
EP 33
DI 10.1007/s11910-002-0041-2
PD 2002-Nov
PY 2002
AB Neuromuscular weakness commonly develops in the setting of critical
   illness. This weakness delays recovery and often causes prolonged
   ventilator dependence. An axonal sensory-motor polyneuropathy, critical
   illness polyneuropathy (CIP), is seen in up to one third of critically
   ill patients with the systemic inflammatory response syndrome (usually
   due to sepsis). An acute myopathy, critical illness myopathy (CIM),
   frequently develops in a similar setting, often in association with the
   use of corticosteroids and/or nondepolarizing neuromuscular blocking
   agents. These patients are often difficult to evaluate due to the
   limitations imposed by the critical care setting and may be further
   complicated by the presence of both CIP and CIM in varying degrees. This
   paper reviews the clinical and electrophysiologic features of these
   disorders, as well as the putative pathophysiology. In the case of CIM,
   an animal model has provided evidence that weakness in this disorder is
   caused by muscle membrane inexcitability due to altered membrane sodium
   currents and loss of myosin thick filaments.
TC 23
ZB 14
Z8 0
ZS 0
Z9 23
SN 1528-4042
UT MEDLINE:12359108
PM 12359108
ER

PT J
AU Koc, M
   Ozalp, N
   Zulfikaroglu, B
TI Major surgery with Guillain-Barre syndrome: A case report
SO JOURNAL OF INTERNATIONAL MEDICAL RESEARCH
VL 30
IS 6
BP 601
EP 604
PD NOV-DEC 2002
PY 2002
AB Guillain-Barre syndrome (GBS) is an acute demyelinating polyneuropathy
   characterized by progressive muscle weakness and areflexia. The
   pathogenesis of GBS is unknown, but it is generally believed to result
   from aberrant humoral and cellular immune responses against components
   of the peripheral nervous system. The overall prognosis of GBS is quite
   good with approximately 85% of survivors making a good functional
   recovery. When a diagnosis of GBS has been made, appropriate treatment
   should be started as early as possible. This may include supportive care
   in intensive care units, ventilatory assistance, monitoring of blood
   pressure, fluid status, cardiac rhythm, nutritional supports and medical
   therapy. Our patient reached maximum deficiency 3 weeks after the onset
   of GBS. Full recovery took 8 months. The occurrence of GBS after major
   surgery is rare. We believe that major surgical stress may be the
   potential triggering factor for the occurrence of GBS in this case
   report.
TC 4
ZB 1
Z8 0
ZS 0
Z9 4
SN 0300-0605
UT WOS:000180056400009
PM 12526288
ER

PT J
AU Honore, PM
   Matson, JR
TI Hemofiltration, adsorption, sieving and the challenge of sepsis therapy
   design
SO CRITICAL CARE
VL 6
IS 5
BP 394
EP 396
PD OCT 2002
PY 2002
TC 27
ZB 15
Z8 0
ZS 0
Z9 30
SN 1466-609X
UT WOS:000178368500006
PM 12398774
ER

PT J
AU Marinelli, WA
   Leatherman, JW
TI Neuromuscular disorders in the intensive care unit
SO CRITICAL CARE CLINICS
VL 18
IS 4
BP 915
EP +
AR PII S0749-0704(02)00020-9
DI 10.1016/S0749-0704(02)00020-9
PD OCT 2002
PY 2002
AB Neuromuscular disorders encountered in the ICU can be categorized as
   muscular diseases that lead to ICU admission and those that are acquired
   in the ICU. This article discusses three neuromuscular disorders can
   lead to ICU admission and have a putative immune-mediated pathogenesis:
   the Guillian-Barre syndrome, myasthenia gravis, and
   dermatomyositis/polymyositis. It also reviews critical care
   polyneuropathy and ICU acquired myopathy, two disorders that, alone or
   in combination, are responsible for nearly all cases of severe ICU
   acquired muscle weakness.
TC 17
ZB 5
Z8 0
ZS 0
Z9 17
SN 0749-0704
UT WOS:000179092600012
PM 12418447
ER

PT J
AU Robertson, Charlene M T
   Joffe, Ari R
   Moore, Alison J
   Watt, Joe M
TI Neurodevelopmental outcome of young pediatric intensive care survivors
   of serious brain injury.
SO Pediatric critical care medicine : a journal of the Society of Critical
   Care Medicine and the World Federation of Pediatric Intensive and
   Critical Care Societies
VL 3
IS 4
BP 345
EP 50
DI 10.1097/00130478-200210000-00003
PD 2002-Oct
PY 2002
AB OBJECTIVES: To determine the number of children with severe brain injury
   due to closed head injury or hypoxic-ischemic encephalopathy as a
   proportion of all admissions of children <3 yrs of age in the regional
   pediatric intensive care unit; to determine the outcome of these
   children at >6 mos postinjury; and to explore the relationship of
   outcome measures to predictors of outcome obtained within the first 24
   hrs after brain injury.
   DESIGN: Prospective, descriptive outcome study of an inception cohort.
   RESULTS: Neonatal and Infant Follow-up Clinic, Glenrose Rehabilitation
   Hospital, Edmonton, Canada.
   PATIENTS: Of a cohort of 53 children of <3 yrs of age (4% of pediatric
   intensive care unit admissions, 1995-1998) admitted for severe acquired
   brain injury (Glasgow Coma Score, <or=8), 12 (23%) died, three (6%) were
   lost to follow-up, and 38 (71%) survived and received multidisciplinary
   outcome assessments.
   MEASUREMENTS AND MAIN RESULTS: Of 50 children with known outcome, 23
   (46%) had a good recovery on the Glasgow Outcome Scale; however, only
   eight (16%) of these had average or above scores on both the mental and
   motor developmental indices of the Bayley Scales of Infant
   Development-II at 18-36 mos of age. Acute injury predictors of adverse
   outcome were apnea at scene, bolus epinephrine given for resuscitation,
   pupils nonreactive, arterial pH <or=7.2, and Glasgow Coma Score of 3.
   For 38 survivors, sensitivity and specificity from predictors for the
   Glasgow Outcome Scale were 73% and 83% respectively; for mental scores,
   86% and 93%; for motor scores, 75% and 89%.
   CONCLUSIONS: Of children of <3 yrs of age identified by a Glasgow Coma
   Score of <or=8 after acute brain injury, >80% have adverse outcome of
   death, disability, or mental or motor developmental scores below
   average. A Glasgow Outcome Scale of 5 overestimates good recovery.
   Universal registry and follow-up of these children are needed.
TC 11
ZB 6
Z8 0
ZS 0
Z9 11
SN 1529-7535
UT MEDLINE:12780952
PM 12780952
ER

PT J
AU Watt, JWH
TI Pressure support ventilation and the critically ill patient with muscle
   weakness
SO BRITISH JOURNAL OF ANAESTHESIA
VL 89
IS 3
BP 373
EP 375
PD SEP 2002
PY 2002
TC 1
ZB 0
Z8 1
ZS 0
Z9 2
SN 0007-0912
UT WOS:000177771100002
PM 12402713
ER

PT J
AU Marik, PE
   Varon, J
   Trask, T
TI Management of head trauma
SO CHEST
VL 122
IS 2
BP 699
EP 711
DI 10.1378/chest.122.2.699
PD AUG 2002
PY 2002
AB Traumatic brain injury (TBI) is a major cause of disability and death in
   most Western nations and consumes an estimated $100 billion annually in
   the United States alone. In the last 2 decades, the management of TBI
   has evolved dramatically, as a result of a more thorough understanding
   of the physiologic events leading to secondary neuronal injury as well
   as advances in the care of critically ill patients. However, it is
   likely that many patients with TBI are not treated according to current
   treatment principles. This article presents an overview of the current
   management of patients with TBI.
TC 59
ZB 19
Z8 0
ZS 5
Z9 63
SN 0012-3692
UT WOS:000177449400052
PM 12171853
ER

PT J
AU Lettinga, KD
   Verbon, A
   Nieuwkerk, PT
   Jonkers, RE
   Gersons, BPR
   Prins, JM
   Speelman, P
TI Health-related quality of life and posttraumatic stress disorder among
   survivors of an outbreak of legionnaires disease
SO CLINICAL INFECTIOUS DISEASES
VL 35
IS 1
BP 11
EP 17
DI 10.1086/340738
PD JUL 1 2002
PY 2002
AB A follow-up study of 122 survivors of an outbreak of legionnaires
   disease (LD) in The Netherlands was conducted to determine persistence
   of symptoms, health-related quality of life (HRQL), and presence of
   posttraumatic stress disorder (PTSD). Seventeen months after diagnosis
   of LD, survivors completed a questionnaire assessing symptoms and HRQL
   and a questionnaire assessing PTSD. The most prevalent new symptoms were
   fatigue (in 75% of patients), neurologic symptoms (in 66%), and
   neuromuscular symptoms (in 63%). HRQL was impaired in 7 of the 8
   dimensions assessed by the HRQL questionnaire, and 15% of patients
   experienced PTSD. Symptoms and impaired HRQL persisted for >1.5 years.
   As a result of the design of this study, it could not be inferred
   whether Legionella pneumophila infection, severe pneumonia in general,
   or the outbreak situation was responsible for impaired well-being.
   However, awareness of this problem by health care providers may improve
   the aftercare of patients.
TC 25
ZB 14
Z8 0
ZS 0
Z9 26
SN 1058-4838
UT WOS:000176183900002
PM 12060869
ER

PT J
AU Kalb, TH
   Lorin, S
TI Infection in the chronically critically ill: unique risk profile in a
   newly defined population
SO CRITICAL CARE CLINICS
VL 18
IS 3
BP 529
EP +
AR PII S0749-0704(02)00009-X
DI 10.1016/S0749-0704(02)00009-X
PD JUL 2002
PY 2002
AB Although chronic critical illness (CCI) is defined as prolonged
   ventilatory failure with tracheotomy stemming from preceding critical
   illness, the contention that multisystem debilities impact on most CCI
   patients' care and recovery is a central thesis of this volume. Perhaps
   reflecting the combined debilities inherent in CCI, infectious
   complications take their toll in morbidity, mortality and persistent
   ventilatory insufficiency. Enhanced susceptibility to infection results
   from a potent admixture of barrier breakdown, exposure to virulent and
   resistant nosocomial pathogens, and postulated "immune exhaustion" that
   stems from the combined impact of comorbidities and the sequellae of
   critical illness. Strategies to improve outcome in CCI-related infection
   include standard measures of support especially nutrition, reducing
   environmental inoculum through pulmonary hygiene measures, skin care and
   limiting barrier breaches, and appropriate antimicrobials directed at
   likely pathogens. Future stratification of patient risk on the basis of
   immune phenotype or genotype and potential immunomodulatory prophylaxis
   may be around the corner, as new prospects in the pharmaceutical
   armamentarium are presently undergoing testing.
TC 22
ZB 5
Z8 0
ZS 2
Z9 24
SN 0749-0704
UT WOS:000176783000006
PM 12140912
ER

PT J
AU Lorin, S
   Nierman, DM
TI Critical illness neuromuscular abnormalities
SO CRITICAL CARE CLINICS
VL 18
IS 3
BP 553
EP +
AR PII S0749-0704(02)00003-9
DI 10.1016/S0749-0704(02)00003-9
PD JUL 2002
PY 2002
AB The chronically critically ill (CCI) are a group of intensive care unit
   (ICU) patients who require long-term mechanical ventilation. Many
   acutely critically ill patients develop new neuromuscular disorders
   following ICU admission secondary to their critical illness. These
   acquired disorders have been labeled Critical Illness Neuromuscular
   Abnormalities (CINMAs). Critical Illness Polyneuropathy (CIP) has been
   the most widely studied CINMA. CINMAs can lead to ventilator dependency
   and contribute to the development of chronic critical illness. This
   chapter will review the epidemiology, etiology, treatment, and prognosis
   of patients with CINMAs.
TC 21
ZB 5
Z8 0
ZS 1
Z9 22
SN 0749-0704
UT WOS:000176783000007
PM 12140913
ER

PT J
AU Nelson, JE
TI Palliative care of the chronically critically ill patient
SO CRITICAL CARE CLINICS
VL 18
IS 3
BP 659
EP +
AR PII S0749-0704(02)00004-0
DI 10.1016/S0749-0704(02)00004-0
PD JUL 2002
PY 2002
AB Evidence is accumulating that distressing physical and emotional
   symptoms are prevalent among patients with critical illness, including
   those requiring prolonged mechanical ventilation, and that suffering is
   underestimated and undertreated by caregivers. Although patients and
   their families rank communication as a preeminent concern, it remains
   deficient in process and content, even when the illness requires weeks
   of critical care. Strategies are available to improve symptom management
   and communication about appropriate goals of care. For the chronically
   critically ill, whose risks of death, disability, and suffering are so
   high, it is essential that excellent palliative care be provided along
   with restorative treatment in an integrated way.
TC 13
ZB 3
Z8 0
ZS 0
Z9 13
SN 0749-0704
UT WOS:000176783000012
PM 12140918
ER

PT J
AU Cano, NJM
   Roth, H
   Court-Fortune, I
   Cynober, L
   Gerard-Boncompain, M
   Cuvelier, A
   Laaban, JP
   Melchior, JC
   Pichard, C
   Raphael, JC
   Pison, CM
CA Societe Francophone Nutr Enterale
TI Nutritional depletion in patients on long-term oxygen therapy and/or
   home mechanical ventilation
SO EUROPEAN RESPIRATORY JOURNAL
VL 20
IS 1
BP 30
EP 37
DI 10.1183/09031936.02.01812001
PD JUL 2002
PY 2002
AB The purpose of this study was to estimate the prevalence of malnutrition
   in outpatients on long-term oxygen therapy or home mechanical
   ventilation to, determine the relationships between malnutrition and
   impairment/disability and smoking and also to identify relevant tools
   for routine nutritional assessment.
   In 744 patients (M:F 1.68, aged 65+/-15 yrs) with chronic obstructive
   pulmonary disease (COPD, 40%), restrictive disorders (27%), mixed
   respiratory failure (15%) neuromuscular diseases (13%) and
   bronchiectasis (5%), body mass index (BMI). fat-free mass (FFM), serum
   albumin, transthyretin, 6-min walking test, forced vital capacity (FVC),
   forced expiratory volume in one second (FEV1) and blood gases were
   recorded.
   FFM was the most sensitive parameter for detecting malnutrition, being
   abnormal in 53.6% of patients, while BMI was <20 in 23.2% serum albumin
   <35 g(.)L(-1) m 20.7%, and serum transthyretin <200 mg(.)L(-1) in 20%.
   FFM depletion predominated in neuromuscular, bronchiectasis and
   restrictive disorders. BMI and FFM were correlated with FEV1, FVC and
   6-min walking test. In multivariate analysis a BMI <20 was related to
   FEV1 and smoking habits, and a low FFM to smoking, FEV1 and female sex.
   Malnutrition is highly prevalent in home-assisted respiratory patients
   and is related to causal disease, forced expiratory volume in one
   second, smoking and disability. Fat-free mass appeared to be the most
   sensitive and relevant nutritional parameter according to impairment and
   disability.
TC 45
ZB 12
Z8 1
ZS 1
Z9 46
SN 0903-1936
UT WOS:000177188600006
PM 12166577
ER

PT J
AU Sassoon, CSH
   Caiozzo, VJ
   Manka, A
   Sieck, GC
TI Altered diaphragm contractile properties with controlled mechanical
   ventilation
SO JOURNAL OF APPLIED PHYSIOLOGY
VL 92
IS 6
BP 2585
EP 2595
DI 10.1152/japplphysiol.01213.2001
PD JUN 2002
PY 2002
AB This study shows that, over time, diaphragm inactivity with controlled
   mechanical ventilation (CMV) decreases diaphragm force and produces
   myofibril damage contributing to the reduced force. We measured in vivo
   and in vitro diaphragm contractile and morphological properties in 30
   sedated rabbits grouped (n = 6) as follows: 1 or 3 days of CMV, 1 or 3
   days of 0 cmH(2)O continuous positive airway pressure, and control. The
   CMV rate was set sufficient to suppress diaphragm electrical activity.
   Compared with the control group, phrenic-stimulated maximum
   transdiaphragmatic pressure did not decrease with continuous positive
   airway pressure but decreased to 63% after 1 day of CMV and to 49% after
   3 days of CMV. The in vitro tetanic force decreased to 86% after 1 day
   of CMV and to 44% after 3 days of CMV. After 3 days of CMV, significant
   myofibril damage occurred in the diaphragm but not in the soleus. The
   decrease in tetanic force correlated with the volume density of abnormal
   myofibrils. We conclude that CMV had a detrimental effect on diaphragm
   contractile properties.
TC 115
ZB 58
Z8 6
ZS 3
Z9 123
SN 8750-7587
UT WOS:000175739200047
PM 12015377
ER

PT J
AU Hickling, Keith G
TI Permissive hypercapnia.
SO Respiratory care clinics of North America
VL 8
IS 2
BP 155
EP v
DI 10.1016/S1078-5337(02)00006-0
PD 2002-Jun
PY 2002
AB There has been increasing recognition that mechanical ventilation can
   cause acute parenchymal lung injury (ventilator-induced lung injury, or
   VILI) in addition to the more widely recognized forms of barotrauma.
   Furthermore, in patients with acute lung injury, this type of injury may
   cause considerable morbidity and mortality. Subsequently, the goals of
   mechanical ventilation have been altered to avoid this outcome. In
   patients with relatively normal lungs who are receiving mechanical
   ventilation because of neuromuscular dysfunction or impaired conscious
   level or for short-term postoperative support, maintaining normal
   blood-gas tensions without risk of VILI is usually easy. In patients
   with acute asthma, chronic obstructive pulmonary disease, or acute lung
   injury, however, accepting abnormal blood-gas tensions, particularly an
   elevated PaCO2 (permissive hypercapnia), to improve survival and reduce
   complications is frequently necessary. Extensive experience has shown
   that ventilated patients usually tolerate moderate hypercapnia and
   frequently some degree of hypoxemia in the absence of shock, anemia,
   severe cardiac disease, or other contraindications.
TC 18
ZB 4
Z8 4
ZS 3
Z9 24
SN 1078-5337
UT MEDLINE:12481813
PM 12481813
ER

PT J
AU Meadow, W
   Frain, L
   Ren, YY
   Lee, G
   Soneji, S
   Lantos, J
TI Serial assessment of mortality in the neonatal intensive care unit by
   algorithm and intuition: Certainty, uncertainty, and informed consent
SO PEDIATRICS
VL 109
IS 5
BP 878
EP 886
DI 10.1542/peds.109.5.878
PD MAY 2002
PY 2002
AB Objectives. Does predictive power for outcomes of neonatal intensive
   care unit (NICU) patients get better with time? Or does it get worse? We
   determined the predictive power of Score for Neonatal Acute Physiology
   (SNAP) scores and clinical intuitions as a function of day of life (DOL)
   for newborn infants admitted to our NICU.
   Methods. We identified 369 infants admitted to our NICU during 1996-1997
   who required mechanical ventilation. We calculated SNAP scores on DOL 1,
   3, 4, 5, 7, 10, 14, 21, 28, and weekly thereafter until either death or
   extubation. We also asked nurses, residents, fellows, and attendings on
   each day of mechanical ventilation: "Do you think this child is going to
   live to go home to their family, or die before hospital discharge?"
   Results. Two thousand twenty-eight SNAP scores were calculated for 285
   infants. On DOL 1, SNAP for nonsurvivors (24 +/- 8.7 [standard
   deviation]) was significantly higher than SNAP for survivors (13 +/-
   6.1). However, this difference diminished steadily and by DOL 10 was no
   longer statistically significant (12.7 +/- 4.9 vs 10.0 +/- 4.8). On each
   NICU day, at all ranges of SNAP scores, there were at least as many
   infants who would ultimately survive as would die. Consequently, the
   positive predictive value of any SNAP value for subsequent mortality was
   <0.5 on all NICU days. Prediction profiles were obtained for 230
   ventilated infants reflecting over 11 000 intuitions obtained on 2867
   patient days. One hundred fifty-seven (81%) of 192 survivor profiles
   displayed consistent accurate prediction profiles-at least 90% of their
   NICU ventilation days were characterized by 100% prediction of survival.
   Twenty-five (13%) of 192 surviving infants survived somewhat
   unexpectedly; that is, after at least 1 day characterized by at least 1
   estimate of "death." Thirty-three (60%) of the 55 nonsurvivors died
   before DOL 10. Eighty-two percent of the prediction profiles for these
   early dying infants were homogeneous, dismal, and accurate. Twenty-two
   (40%) of the 55 nonsurvivors died after DOL 10. Seventeen (78%) of these
   22 late-dying infants were predicted to live by many observers on many
   hospital days. Sixty-one (30%) of 230 profiled patients had at least 1
   NICU day characterized by at least 1 prediction of death; 26/61 (43%) of
   these patients were incorrectly predicted; that is, they survived.
   Seventeen infants who were predicted to die during but survived
   nonetheless were assessed neurologically at 1 year. Fourteen (82%) of
   these 17 were not neurologically normal-8 were clearly abnormal, 1
   suspicious, and 5 had died.
   Conclusions. If absolute certainty about mortality is the only criterion
   that can justify a decision to withhold or withdraw life-sustaining
   treatment in the NICU, these data would make such decisions difficult on
   the first day of life, and increasingly problematic thereafter. However,
   if we acknowledge that medicine is inevitably an inexact science and
   that clinical predictions can never be perfect, we can ask the more
   interesting question of whether good but less-than-perfect predictions
   of imprecise but ethically relevant clinical outcomes can still be
   useful. We think that they can-and that they must.
TC 41
ZB 27
Z8 0
ZS 0
Z9 41
SN 0031-4005
UT WOS:000175321200039
PM 11986450
ER

PT J
AU Feudtner, C
   Christakis, DA
   Zimmerman, FJ
   Muldoon, JH
   Neff, JM
   Koepsell, TD
TI Characteristics of deaths occurring in children's hospitals:
   Implications for supportive care services
SO PEDIATRICS
VL 109
IS 5
BP 887
EP 893
DI 10.1542/peds.109.5.887
PD MAY 2002
PY 2002
AB Context. End-of-life care is an important yet underdeveloped component
   of pediatric hospital services.
   Objectives. We sought 1) to describe the demographics of children who
   die in children's hospitals, 2) to describe the prevalence of complex
   chronic conditions (CCCs) among these cases, and 3) to test the
   hypotheses that cases with a greater number of CCC diagnoses experience
   longer periods both of mechanical ventilation and of hospitalization
   before death.
   Design and Methods. We identified all deaths of patients 0 to 24 years
   old that occurred in the 60 hospitals contributing discharge data to the
   National Association of Children's Hospitals and Related Institutions
   data consortium for the years 1991, 1994, and 1997. We classified
   discharge diagnoses into 9 major categories of CCCs (cardiovascular,
   neuromuscular, malignancy, respiratory, renal, metabolic,
   gastrointestinal, hematologic/ immunologic, and other
   congenital/genetic).
   Results. Of the 13 761 deaths identified, 42% had been admitted between
   0 and 28 days of life, 18% between 1 and 12 months, 25% between 1 and 9
   years, and 15% between 10 and 24 years. Fifty-three percent were white,
   20% were black, and 9% were Hispanic. The principal payer was listed as
   a governmental source for 42% and a private insurance company for 35%.
   Based on all the discharge diagnoses recorded for each case, 40% had no
   CCC diagnosis, 44% had diagnoses representing 1 major CCC category, 13%
   had diagnoses representing 2 CCC categories, and 4% had diagnoses
   representing 3 or more CCC categories. Among cases that had no CCC
   diagnoses, the principal diagnoses were related to prematurity and
   newborn disorders for 32% of these cases, injuries and poisoning for
   26%, and an assortment of acute and infectious processes for the
   remaining 42%. Mechanical ventilation was provided to 66% of neonates,
   40% of infants, 36% of children, and 36% of adolescents. Cases with CCCs
   were more likely than non-CCC cases to have been mechanically ventilated
   (52% vs 46%), and to have been ventilated longer (mean: 11.7 days for
   CCC cases vs 4.8 days for non-CCC cases). The median duration of
   hospitalization was 4 days, while the mean was 16.4 days. After
   adjustment for age, sex, year, and principal payer, compared with
   patients with no CCC diagnoses, those with 1 major CCC category had a
   significantly lower hazard of dying soon after admission (hazard ratio
   [HR]: 0.60; 95% confidence interval [CI]: 0.57-0.62), those with 2 CCC
   categories even lower (HR: 0.53; 95% CI: 0.50-0.57), and those with 3 or
   more CCC categories the lowest hazard of rapid death (HR: 0.51; 95% CI:
   0.46-0.57). This trend of diminishing hazard of rapid death was
   significant across the 3 groups of children with 1 or more CCCs.
   Conclusions. Children's hospitals care for a substantial number of dying
   patients, who differ widely by age and medical conditions. Children who
   die in the hospital with CCCs are more likely to experience longer
   periods of mechanical ventilation and hospitalization before death.
RI Zimmerman, Frederick/C-7259-2008
TC 75
ZB 35
Z8 0
ZS 1
Z9 76
SN 0031-4005
UT WOS:000175321200040
PM 11986451
ER

PT J
AU Lechtzin, N
   Rothstein, J
   Clawson, L
   Diette, GB
   Wiener, CM
TI Amyotrophic lateral sclerosis: evaluation and treatment of respiratory
   impairment
SO AMYOTROPHIC LATERAL SCLEROSIS AND OTHER MOTOR NEURON DISORDERS
VL 3
IS 1
BP 5
EP 13
DI 10.1080/146608202317576480
PD MAR 1 2002
PY 2002
AB Patients with amyotrophic lateral sclerosis (ALS) invariably develop
   respiratory muscle weakness and most die from pulmonary complications.
   There are numerous tests available to evaluate respiratory status in ALS
   and it is important to understand their various advantages and
   limitations. Forced vital capacity (FVC) is commonly used but can remain
   normal despite substantial inspiratory muscle weakness. Maximal
   pressures measured at the mouth are useful for excluding weakness if
   they are normal but are difficult to interpret if abnormal. Invasive
   testing, such as measurement of transdiaphragmatic pressure, provides an
   accurate measure of inspiratory strength but is not readily available
   and is not practical for serial measures. There are supportive
   respiratory techniques that have been shown to benefit patients with
   ALS. Clinicians should be familiar with these interventions, including
   mechanically assisted coughing, non-invasive ventilation and
   tracheostomy with mechanical ventilation. Observational studies have
   demonstrated improved survival and quality of life with noninvasive
   ventilation. Tracheostomy with long-term mechanical ventilation is not
   frequently used but can be an important component of care for ALS. This
   review describes an approach to respiratory evaluation and care of
   patients with ALS.
RI rothstein, jeffrey/C-9470-2013
TC 28
ZB 20
Z8 0
ZS 1
Z9 29
SN 1466-0822
UT WOS:000176301500003
PM 12061943
ER

PT J
AU Radell, PJ
   Remahl, S
   Nichols, DG
   Eriksson, LI
TI Effects of prolonged mechanical ventilation and inactivity on piglet
   diaphragm function
SO INTENSIVE CARE MEDICINE
VL 28
IS 3
BP 358
EP 364
DI 10.1007/s00134-002-1207-8
PD MAR 2002
PY 2002
AB Objectives: Muscle weakness is associated with immobilization, prolonged
   mechanical ventilation, critical illness and various critical care
   therapies. This study used an animal model simulating the critical care
   environment to investigate the effects of 5 days' mechanical ventilation
   and inactivity on diaphragm contractility and neurophysiologic function.
   Design: Prospective laboratory study. Setting: Animal research
   laboratory. Subjects: Seven 2-3 month old piglets weighing 20-25 kg.
   Interventions: The animals received constant-flow, volume-controlled
   mechanical ventilation (Tv 12-15 ml/kg, PEEP 3-5 cmH(2)O, I:E 1:2) and
   sedation without paralysis, and spontaneous breathing efforts were
   prevented. Evoked diaphragm contractions were achieved by transvenous
   phrenic nerve pacing. Measurements and main findings: Transdiaphragmatic
   pressure (Pdi) measurements were used to assess force frequency
   relationships. Evoked electrophysiologic measures included lowest
   stimulus threshold and latency, compound muscle action potential (CMAP)
   amplitude and duration, and amplitude during repetitive nerve
   stimulation at 3 Hz. Lung function measures included airway pressures,
   tidal and minute volumes, and dynamic compliance and resistance. There
   were no clinically significant changes in hemodynamics, oxygenation or
   ventilation. Indirect measures of lung volume remained stable. Pdi
   decreased by 20% at all frequencies tested and was accompanied by a 30%
   decrease in evoked CMAP amplitude, (6.7 +/- 4.7 mV to 4.5 +/- 3.9 mV,
   p=0.01) while CMAP threshold, latency and duration were unchanged and no
   significant decrement in amplitude was seen during repetitive
   stimulation at 3 Hz. Conclusion: In this in-vivo model of prolonged
   mechanical ventilation in an intensive caring setting, 5 days of
   mechanical ventilation with sedation and complete diaphragm inactivity
   resulted in disturbed diaphragm contractility and activation, while
   nerve conduction and neuromuscular transmission were not affected. Based
   on these findings, it is likely that the changes seen occur at the level
   of peripheral muscle.
TC 58
ZB 33
Z8 4
ZS 2
Z9 64
SN 0342-4642
UT WOS:000175136600021
PM 11904668
ER

PT J
AU Kane, SL
   Dasta, JF
TI Clinical outcomes of critical illness polyneuropathy
SO PHARMACOTHERAPY
VL 22
IS 3
BP 373
EP 379
DI 10.1592/phco.22.5.373.33199
PD MAR 2002
PY 2002
AB it is often difficult to isolate the origin of acute weakness in the
   critically ill population because of multiple etiologies.
   Aminoglycosides, corticosteroids, and neuromuscular blockers frequently
   are implicated as the source of acute weakness. Recently, critical
   illness polyneuropathy (CIP), a syndrome of unknown etiology, was added
   to the differential diagnosis. The frequency of CIE is approximately 70%
   in patients with sepsis. Early studies of CIE which were mostly
   retrospective, underestimated its frequency due to the complexity of the
   diagnosis and unfamiliarity with the syndrome. Prospective studies have
   explored the causality and clinical outcomes of CIE Clinical outcomes of
   patients with CIP include difficulty weaning from mechanical
   ventilation, increased length of stay, prolonged recovery, and an
   overall mortality rate of 26-71%. The association of CIP with sepsis,
   multiorgan failure, and drugs is still unclear.
TC 8
ZB 4
Z8 1
ZS 0
Z9 9
SN 0277-0008
UT WOS:000174242500008
PM 11898892
ER

PT J
AU Hurford, William E
TI Sedation and paralysis during mechanical ventilation.
SO Respiratory care
VL 47
IS 3
BP 334
EP 46; discussion 346-7
PD 2002-Mar
PY 2002
AB Treatment of anxiety and delirium, provision of adequate analgesia, and,
   when necessary, amnesia in critically ill patients is humane and may
   reduce the incidence of post-traumatic stress disorders. Injudicious use
   of sedatives and paralytics to produce a passive and motionless patient,
   however, may prolong weaning and length of stay in the intensive care
   unit. This report reviews indications and choices for pharmacologic
   treatment of anxiety, delirium, agitation, and provision of anesthesia
   in critically ill patients. The choice of pharmacologic agents is made
   difficult by complex or poorly understood pharmacokinetics, drug
   actions, and adverse effects in critically ill patients. Advantages,
   adverse effects, and limitations of drug treatment, including use of
   neuromuscular blocking drugs and use of sedatives and analgesia during
   the withdrawal of life-sustaining measures are reviewed.
RI Hurford, William/G-6386-2013
OI Hurford, William/0000-0003-1201-0313
TC 3
ZB 1
Z8 1
ZS 0
Z9 4
SN 0020-1324
UT MEDLINE:11874611
PM 11874611
ER

PT J
AU Papiris, S
   Kotanidou, A
   Malagari, K
   Roussos, C
TI Clinical review: Severe asthma
SO CRITICAL CARE
VL 6
IS 1
BP 30
EP 44
PD FEB 2002
PY 2002
AB Severe asthma, although difficult to define, includes all cases of
   difficult/therapy-resistant disease of all age groups and bears the
   largest part of morbidity and mortality from asthma. Acute, severe
   asthma, status asthmaticus, is the more or less rapid but severe
   asthmatic exacerbation that may not respond to the usual medical
   treatment. The narrowing of airways causes ventilation perfusion
   imbalance, lung hyperinflation, and increased work of breathing that may
   lead to ventilatory muscle fatigue and life-threatening respiratory
   failure.
   Treatment for acute, severe asthma includes the administration of
   oxygen, beta(2)-agonists (by continuous or repetitive nebulisation), and
   systemic corticosteroids. Subcutaneous administration of epinephrine or
   terbutaline should be considered in patients not responding adequately
   to continuous nebulisation, in those unable to cooperate, and in
   intubated patients not responding to inhaled therapy. The exact time to
   intubate a patient in status asthmaticus is based mainly on clinical
   judgment, but intubation should not be delayed once it is deemed
   necessary. Mechanical ventilation in status asthmaticus supports
   gas-exchange and unloads ventilatory muscles until aggressive medical
   treatment improves the functional status of the patient. Patients
   intubated and mechanically ventilated should be appropriately sedated,
   but paralytic agents should be avoided, Permissive hypercapnia, increase
   in expiratory time, and promotion of patient-ventilator synchronism are
   the mainstay in mechanical ventilation of status asthmaticus. Close
   monitoring of the patient's condition is necessary to obviate
   complications and to identify the appropriate time for weaning. Finally,
   after successful treatment and prior to discharge, a careful strategy
   for prevention of subsequent asthma attacks is imperative.
TC 60
ZB 24
Z8 5
ZS 0
Z9 67
SN 1466-609X
UT WOS:000174363900011
PM 11940264
ER

PT J
AU Shapiro, Janet M
TI Management of respiratory failure in status asthmaticus.
SO American journal of respiratory medicine : drugs, devices, and other
   interventions
VL 1
IS 6
BP 409
EP 16
PD 2002
PY 2002
AB Status asthmaticus is a life-threatening episode of asthma that is
   refractory to usual therapy. Recent studies report an increase in the
   severity and mortality associated with asthma. In the airways,
   inflammatory cell infiltration and activation and cytokine generation
   produce airway injury and edema, bronchoconstriction and mucus plugging.
   The key pathophysiological consequence of severe airflow obstruction is
   dynamic hyperinflation. The resulting hypoxemia, tachypnea together with
   increased metabolic demands on the muscles of respiration may lead to
   respiratory muscle failure. The management of status asthmaticus
   involves intensive pharmacological therapy particularly with
   beta-adrenoceptor agonists (beta-agonists) and corticosteroids.
   Albuterol (salbutamol) is the most commonly used beta2-selective inhaled
   bronchodilator in the US. Epinephrine (adrenaline) or terbutaline,
   administered subcutaneously, have not been shown to provide greater
   bronchodilatation compared with inhaled beta-agonists. Corticosteroids
   such as methylprednisolone should be administered early. Aerosolized
   corticosteroids are not recommended for patients with status
   asthmaticus. Inhaled anticholinergic agents may be useful in patients
   refractory to inhaled beta-agonists and corticosteroids. In patients
   requiring mechanical ventilation, the strategy aims to avoid dynamic
   hyperinflation by enhancing expiratory time to allow complete
   exhalation. Complications of dynamic inflation are hypotension and
   barotrauma. Sedation with opioids, benzodiazepines or propofol is
   required to facilitate ventilator synchrony but neuromuscular blockade
   should be avoided as myopathy has been a reported complication. Overall,
   in the management of patients with status asthmaticus, the challenge to
   the pulmonary/critical care clinician is to provide optimal
   pharmacological and ventilatory support and avoid the adverse
   consequences of dynamic hyperinflation.
TC 9
ZB 2
Z8 0
ZS 4
Z9 13
SN 1175-6365
UT MEDLINE:14720028
PM 14720028
ER

PT J
AU Fox, BC
   Imrey, PB
   Voights, MB
   Norwood, S
TI Infectious disease consultation and microbiologic surveillance for
   intensive care unit trauma patients: A pilot study
SO CLINICAL INFECTIOUS DISEASES
VL 33
IS 12
BP 1981
EP 1989
DI 10.1086/324083
PD DEC 15 2001
PY 2001
AB Infection remains a major cause of posttrauma morbidity. We
   retrospectively reviewed 2 cohorts of trauma patients admitted to a
   regional trauma center before and after a policy change integrating
   prospective microbiologic surveillance and infectious disease (ID)
   consultation into management of trauma admissions. Primary interests
   were effects of this policy change on antimicrobial use and diagnostic
   precision (particularly differentiation of infection from colonization).
   Associated costs, microflora, survival, and disability were also
   compared. Patients were stratified for risk of infection. ID
   consultation was associated with a 49% increased odds that an infection
   diagnosis was microbiologically based (P = .006) and 57% reduction of
   antibiotics costs per hospitalized day (P = .0008). Costs of
   consultation and an 86% increase (P < 10(-6)) in total cultures combined
   to minimally exceed that financial saving. The observed improvements in
   diagnostic precision and antimicrobial usage, however, suggest
   consideration of prospective microbiologic surveillance and
   multidisciplinary physician teams including ID physicians for high-risk
   trauma patients.
TC 28
ZB 17
Z8 0
ZS 1
Z9 28
SN 1058-4838
UT WOS:000172297500004
PM 11712090
ER

PT J
AU Pittock, SJ
   Rodriguez, M
   Wijdicks, EFM
TI Rapid weaning from mechanical ventilator in acute cervical cord multiple
   sclerosis lesion after steroids
SO ANESTHESIA AND ANALGESIA
VL 93
IS 6
BP 1550
EP 1551
DI 10.1097/00000539-200112000-00045
PD DEC 2001
PY 2001
TC 2
ZB 1
Z8 0
ZS 0
Z9 2
SN 0003-2999
UT WOS:000172364000035
PM 11726441
ER

PT J
AU Sasaki, M
   Sugai, K
   Fukumizu, M
   Hanaoka, S
   Kaga, M
TI Mechanical ventilation care in severe childhood neurological disorders
SO BRAIN & DEVELOPMENT
VL 23
IS 8
BP 796
EP 800
DI 10.1016/S0387-7604(01)00317-5
PD DEC 2001
PY 2001
AB Forty-five patients underwent long-term life-sustaining mechanical
   ventilation care in the Child Neurology Ward, National Center Hospital
   for Mental. Nervous and Muscular Disorders from 1990 to 2000. Twenty
   patients had chronic respiratory insufficiency due to neuromuscular
   disorders. nine of whom underwent home mechanical ventilation care.
   Nineteen of the 45 patients had chronic respiratory insufficiency due to
   progressive central nervous system disorders, three of whom underwent
   home mechanical ventilation care. Six patients with chronic respiratory
   insufficiency due to the sequelae of transient events were on
   ventilation, two of whom underwent home mechanical ventilation care. In
   some patients, especially ones with neuromuscular disorders, mechanical
   ventilation care is very useful for improving their daily activity and
   quality of life. In other patients, however, mechanical ventilation care
   is merely a means of prolonging life without visible improvement of
   their quality of life. As medical resources are limited, home mechanical
   ventilation cares a recommended method for patients who need
   life-sustaining mechanical ventilation care. Considering an individual
   or social consensus, the indication of long-term life-sustaining
   mechanical ventilation care for chronic respiratory insufficiency due to
   severe childhood neurological disorders should be further discussed. (C)
   2001 Elsevier Science B.V. All rights reserved.
TC 6
ZB 1
Z8 0
ZS 0
Z9 6
SN 0387-7604
UT WOS:000173055300004
PM 11720796
ER

PT J
AU de Letter, MACJ
   Schmitz, PIM
   Visser, LH
   Verheul, FAM
   Schellens, RLLA
   de Coul, DAWO
   van der Meche, FGM
TI Risk factors for the development of polyneuropathy and myopathy in
   critically ill patients
SO CRITICAL CARE MEDICINE
VL 29
IS 12
BP 2281
EP 2286
DI 10.1097/00003246-200112000-00008
PD DEC 2001
PY 2001
AB Background. Previously, mainly retrospective and a few important
   prospective studies postulated the role of sepsis or systemic
   inflammatory response syndrome (SIRS), multiple organ failure, and the
   use of medication as causative factors for the development of critical
   illness polyneuropathy and myopathy (CIPNM). This study aimed to
   identify the risk factors in the development of CIPNM.
   Methods. Prospectively, we studied 98 patients who were on artificial
   respirators for the development of CIPNM. The Acute Physiology and
   Chronic Health Evaluation (APACHE) III score, presence of SIRS, and
   sepsis severity score at entry; the dosage of midazolam, vecuronium, and
   steroids at entry and day 7 of artificial respiration; and the use of
   aminoglycosides at entry were related with time to CIPNM or time of last
   follow-up. The Kaplan-Meier method and log-rank test were used.
   Results. Thirty-two patients (33%) developed CIPNM. After multivariate
   analysis, it was found that the APACHE III score and the presence of
   SIRS were significantly related with risk for the development of CIPNM.
   No significant relation was found for the use of midazolam, vecuronium,
   or steroids. Based on a risk index from a Cox regression model with
   APACHE III score and presence of SIRS as outcomes, three groups could be
   constructed with low-, medium-, and high-risk patients for the
   development of CIPNM.
   Conclusions. The APACHE III score, a quantitative index of disease
   severity based on clinical and laboratory physiologic data, is a
   valuable predictor for the development of CIPNM in patients in the
   intensive care unit. Together with the presence of SIRS, it can be used
   to estimate the risk of developing CIPNM for patients on artificial
   respirators.
TC 150
ZB 54
Z8 1
ZS 0
Z9 150
SN 0090-3493
UT WOS:000172907500008
PM 11801825
ER

PT J
AU Lorenz, JM
   Paneth, N
   Jetton, JR
   den Ouden, L
   Tyson, JE
TI Comparison of management strategies for extreme prematurity in New
   Jersey and the Netherlands: Outcomes and resource expenditure
SO PEDIATRICS
VL 108
IS 6
BP 1269
EP 1274
DI 10.1542/peds.108.6.1269
PD DEC 2001
PY 2001
AB Objective. To quantify differences in resource expenditure in the
   perinatal period and long-term outcome of extremely premature infants
   who received systematically different approaches to neonatal intensive
   care.
   Methods. Perinatal management, mortality, prevalence of disabling
   cerebral palsy (DCP), and resource expenditure of 2 population-based
   inception cohorts of extremely premature infants born in the mid-1980s
   were compared. Electronic fetal monitoring, tocolysis, cesarean section
   delivery, and assisted ventilation were used to characterize management
   approaches. Participants included all live births at 23 to 26 weeks'
   gestation in a 3-county area of central New Jersey (NJ) from 1984 to
   1987 (N = 146) and throughout the Netherlands (NETH) in 1983 (N = 142).
   Mortality and the prevalence of DCP were the primary outcomes. Numbers
   of hospital days with and without assisted ventilation were the measures
   of resource expenditure.
   Results. Electronic fetal monitoring (100% vs 38%), cesarean section
   (28% vs 6%), and assisted ventilation (95% vs 64%) were all more
   commonly used in NJ than in NETH. Ten percent of NJ deaths occurred
   without assisted ventilation, compared with 45% of Dutch deaths. A total
   of 1820 ventilator days were expended per 100 live births in NJ,
   compared with 448 in NETH. The increase in the number of nonventilator
   days (3174 vs 2265 days per 100 live births) did not reach statistical
   significance. Survival to age 2 (46 vs 22%) and the prevalence of DCP
   among survivors (17.2 vs 3.4%) were significantly greater in NJ at age 2
   than in NETH at age 5.
   Conclusions. Near universal initiation of intensive care in NJ, compared
   with selective initiation of intensive care in NETH, was associated with
   24.1 additional survivors per 100 live births, 7.2 additional cases of
   DCP per 100 live births, and a cost of 1372 additional ventilator days
   per 100 live births.
TC 77
ZB 43
Z8 0
ZS 0
Z9 77
SN 0031-4005
UT WOS:000172498000024
PM 11731647
ER

PT J
AU Dunford, M
   Donoghue, J
   Power, G
   Mitten-Lewis, S
TI Managing ventilatory insufficiency and failure in a patient with
   kyphoscoliosis: a case study.
SO Australian critical care : official journal of the Confederation of
   Australian Critical Care Nurses
VL 14
IS 4
BP 165
EP 9
DI 10.1016/S1036-7314(05)80060-8
PD 2001-Nov
PY 2001
AB This article reports a case study of 'Sue', a 37 year old female who was
   transferred to a metropolitan hospital's intensive care unit in acute
   respiratory failure secondary to severe kyphoscoliosis (KS). KS is
   defined as a deformity of the spine involving both lateral displacement
   (scoliosis) and anteroposterior angulation (kyphosis). Over time, this
   anatomical distortion results in ventilatory insufficiency due to muscle
   weakness. Sue displayed a restrictive lung pattern, evidenced by a
   decreased vital capacity and tidal volume with severe nocturnal
   dyspnoea, resulting in raised carbon dioxide levels in arterial blood
   and decreased oxygenation. This paper reviews Sue's progress throughout
   her hospitalisation and examines the key issues involved in her care.
   Particular attention is given to specific problems encountered on the
   acute care ward related to oxygen delivery, tracheostomy care,
   non-invasive ventilation and rehabilitation. The paper highlights the
   increased acuity of respiratory ward patients who require the use of
   substantial technological support to optimise their management. Nurses
   working in these wards need specialised knowledge, excellent patient
   communication ability and well-developed technical skills. The trend is
   to treat patients with respiratory failure, either chronic or acute, on
   wards rather than in critical care units' which has promoted the
   development of a specialised role in respiratory nursing.
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 1036-7314
UT MEDLINE:11806515
PM 11806515
ER

PT J
AU Adnet, F
   Dhissi, G
   Borron, SW
   Galinski, M
   Rayeh, F
   Cupa, M
   Pourriat, JL
   Lapostolle, F
TI Complication profiles of adult asthmatics requiring paralysis during
   mechanical ventilation
SO INTENSIVE CARE MEDICINE
VL 27
IS 11
BP 1729
EP 1736
DI 10.1007/s00134-001-1112-6
PD NOV 2001
PY 2001
AB Objective: To assess the characteristics and the incidence of morbidity
   of intubated asthmatic patients who received long-term paralysis.
   Design: Retrospective cohort study. Setting: Five intensive care units
   (ICUs) in Paris and the surrounding suburbs.
   Patients and participants: The NMB group consisted of patients who
   received neuromuscular blocking agents for more than 12 h (NMB group)
   versus sedation alone (SED).
   Interventions: None.
   Measurements and results: The incidence of post-extubation muscle
   weakness and/or myopathy was 18 % in the NMB group compared to 2 % in
   the SED group (p = 0.01). The occurrence of ventilator-associated
   pneumonia was higher in the NMB group (42 % versus 4 % : p < 0.0001).
   The duration of ICU stay and of mechanical ventilation were
   significantly greater in the NMB group. Multiple logistic regression
   analysis showed that inclusion in the NMB group was the only independent
   predictor of the presence of the overall morbidity, [odds ratio 6.4
   (2.09: 9.64)].
   Conclusion: While greater initial severity of respiratory compromise in
   the NMB group may explain part of the difference, use of NMB agents
   appears to be strongly related to the presence of significant
   complications among mechanically-ventilated asthmatic patients.
TC 24
ZB 6
Z8 1
ZS 0
Z9 25
SN 0342-4642
UT WOS:000172738800007
PM 11810115
ER

PT J
AU Piradov, MA
   Pirogov, VN
   Popova, LM
   Avdunina, IA
TI Diphtheritic polyneuropathy - Clinical analysis of severe forms
SO ARCHIVES OF NEUROLOGY
VL 58
IS 9
BP 1438
EP 1442
DI 10.1001/archneur.58.9.1438
PD SEP 2001
PY 2001
AB Background: Diphtheritic polyneuropathy (DP) is a dangerous complication
   of diphtheria, especially its severe forms with bulbar, respiratory
   tract, and circulatory disturbances. However, the clinical picture of
   severe forms of DP is practically unknown.
   Objective: To investigate the clinical features and peculiarities of the
   course of severe forms of DP.
   Patients: Thirty-two patients with severe forms of DP
   Results: The first symptoms of DP developed in most patients 3 to 5
   weeks after the onset of diphtheria. The cranial nerves were involved in
   all patients, most frequently nerves IX and X (32 patients); VII (28
   patients); III, IV, and VI (27 patients); and XI (27 patients). One
   third of the patients had quadriplegia. The remaining patients had
   quadripareses. Of the 32 patients, 24 underwent artificial ventilation.
   All patients had sensory signs, proprioceptive more often than
   superficial. Autonomic disturbances were observed also in all patients.
   Only 2 of the 32 patients died.
   Conclusions: A direct indication for tracheotomy and artificial
   ventilation in patients with DP is a decrease of the vital capacity of
   the lungs below the traditional 16 mL/kg body weight or the development
   of the paralytic closure of the larynx against the background of the
   increasing weakness of the respiratory muscles. Characteristic of severe
   forms of DP is the phenomenon of the oppositely directed change in the
   neurological symptoms in the second month of the disease: the
   restoration of the function of the cranial nerves against the background
   of the further increase of the motor disturbances in the extremities and
   trunk. Special attention and care should be taken of patients during the
   period of the appearance of the episodes of vascular collapses-between
   the fourth and seventh weeks of DP.
RI Pirogov, Viktor/B-4409-2012; Piradov, Mikhail/B-4407-2012
OI Piradov, Mikhail/0000-0002-6055-8335
TC 15
ZB 6
Z8 0
ZS 0
Z9 15
SN 0003-9942
UT WOS:000170942800013
PM 11559316
ER

PT J
AU Garnacho-Montero, J
   Madrazo-Osuna, J
   Garcia-Garmendia, JL
   Ortiz-Leyba, C
   Jimenez-Jimenez, FJ
   Barrero-Almodovar, A
   Garnacho-Montero, MC
   Moyano-Del-Estad, MR
TI Critical illness polyneuropathy: risk factors and clinical consequences.
   A cohort study in septic patients
SO INTENSIVE CARE MEDICINE
VL 27
IS 8
BP 1288
EP 1296
PD AUG 2001
PY 2001
AB Objective: To determine risk factors and clinical consequences of
   critical illness polyneuropathy (CIP) evaluated by the impact on
   duration of mechanical ventilation, length of stay and mortality.
   Design: Inception cohort study.
   Setting: Intensive care unit of a tertiary hospital.
   Patients: Septic patients with multiple organ dysfunction syndrome
   requiring mechanical ventilation and without previous history of
   polyneuropathy
   Interventions: Patients under-went two scheduled electrophysiologic
   studies (EPS): on the 10th and 21st days after the onset of mechanical
   ventilation.
   Results: Eighty-two patients were enrolled, although nine of them were
   not analyzed. Forty-six of the 73 patients presented CIP on the first
   EPS and 4 other subjects were diagnosed with CIP on the second
   evaluation. The APACHE II scores of patients with and without CIP were
   similar on admission and on the day of the first EPS. However. days of
   mechanical ventilation [32.3 (21.1) versus 18.5 (5.8); p = 0.002],
   length of ICU and hospital stay in patients discharged alive from the
   ICU as well as in-hospital mortality were greater in patients with CIP
   (42/50, 84 % versus 13/23, 56.5 %; p = 0.01). After multivariate
   analysis, independent risk factors were hyperosmolality [odds ratio (OR)
   4.8; 95 % confidence intervals (95 % CI) 1.05-24.38: p = 0.046],
   parenteral nutrition (OR 5.11; 95 % CI 1.14-22.88; p = 0.02), use of
   neuromuscular blocking agents (OR 16.32; 95 % Cl 1.34-199; p = 0.0008)
   and neurologic failure (GCS below 10) (OR 24.02; 95 % Cl 3.68-156.7; p <
   0.001). while patients with renal replacement therapy had a lower risk
   for CIP development (OR 0.02; 95 % CI 0.05-0.15; p < 0.001). By
   multivariate analysis, CIP (OR 7.11; 95 % CI 1.54-32.75; p < 0.007), age
   over 60 years (OR 9.07; 95 % CI 2.02-40.68; p < 0.002) and the worst
   renal SOFA (OR 2.18; 95 % CI 1.27-3.74; p < 0.002) were independent
   predictors of in-hospital mortality.
   Conclusions: CIP is associated with increased duration of mechanical
   ventilation and in-hospital mortality. Hyperosmolality, parenteral
   nutrition. non-depolarizing neuromuscular blockers and neurologic
   failure can favor CIP development.
TC 160
ZB 47
Z8 2
ZS 2
Z9 162
SN 0342-4642
UT WOS:000170824100009
PM 11511941
ER

PT J
AU Putensen, C
   Zech, S
   Wrigge, H
   Zinserling, J
   Stuber, F
   Von Spiegel, T
   Mutz, N
TI Long-term effects of spontaneous breathing during ventilatory support in
   patients with acute lung injury
SO AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE
VL 164
IS 1
BP 43
EP 49
PD JUL 2001
PY 2001
AB Improved gas exchange has been observed during spontaneous breathing
   with airway pressure release ventilation (APRV) as compared with
   controlled mechanical ventilation. This study was designed to determine
   whether use of APRV with spontaneous breathing as a primary ventilatory
   support modality better prevents deterioration of cardiopulmonary
   function than does initial controlled mechanical ventilation in patients
   at risk for acute respiratory distress syndrome (ARDS). Thirty patients
   with multiple trauma were randomly assigned to either breathe
   spontaneously with APRV (APRV Group) (n = 15) or to receive
   pressure-controlled, time-cycled mechanical ventilation (PCV) for 72 h
   followed by weaning with APRV (PCV Group) (n = 15). Patients maintained
   spontaneous breathing during APRV with continuous infusion of sufentanil
   and midazolam (Ramsay sedation score [RSS] of 3). Absence of spontaneous
   breathing (PCV Group) was induced with sufentanil and midazolam (RSS of
   5) and neuromuscular blockade. Primary use of APRV was associated with
   increases (p < 0.85) in respiratory system compliance (C(RS)), arterial
   oxygen tension (Pa(O2)), cardiac index (CI), and oxygen delivery
   (Do(2)), and with reductions (p < 0.05) in venous admixture ((Q) over
   dot VA/(Q) over dot T), and oxygen extraction. In contrast, patients who
   received 72 h of PCV had lower C(RS), Pa(O2) CI, Do(2), and (Q) over dot
   A/(Q) over dot T values (p < 0.05) and required higher doses of
   sufentanil (p < 0.05), midazolam (p < 0.05), noradrenalin (p = 0.05),
   and dobutamine (p < 0.05). C(RS), Pa(O2), CI and Do(2) were lowest (p <
   0.05) and (Q) over dot VA/(Q) over dot T was highest (p < 0.05) during
   PCV. Primary use of APRV was consistently associated with a shorter
   duration of ventilatory support (APRV Group: 15 +/- 2 d [mean +/- SEM];
   PCV Group: 21 +/- 2 d) (p < 0.05) and length of intensive care unit
   (ICU) stay (APRV Group: 23 +/- 2 d; PCV Group: 30 +/- 2 d) (p < 0.05).
   These findings indicate that maintaining spontaneous breathing during
   APRV requires less sedation and improves cardiopulmonary function,
   presumably by recruiting nonventilated lung units, requiring a shorter
   duration of ventilatory support and ICU stay.
TC 212
ZB 79
Z8 6
ZS 0
Z9 226
SN 1073-449X
UT WOS:000169880700010
PM 11435237
ER

PT J
AU Watson, AC
   Hughes, PD
   Harris, ML
   Hart, N
   Ware, RJ
   Wendon, J
   Green, M
   Moxham, J
TI Measurement of twitch transdiaphragmatic, esophageal, and endotracheal
   tube pressure with bilateral anterolateral magnetic phrenic nerve
   stimulation in patients in the intensive care unit
SO CRITICAL CARE MEDICINE
VL 29
IS 7
BP 1325
EP 1331
DI 10.1097/00003246-200107000-00005
PD JUL 2001
PY 2001
AB Objective: In the critically ill, respiratory muscle strength usually
   has been assessed by measuring maximum inspiratory pressure. The
   maneuver is volitional, and results can be unreliable. The nonvolitional
   technique of bilateral anterolateral magnetic stimulation of the phrenic
   nerves, producing twitch transdiaphragmatic pressure, has been
   successful in normal subjects and ambulatory patients. In this study we
   used the technique in the intensive care unit and explored the
   measurement of twitch endotracheal tube pressure as a less invasive
   technique to assess diaphragmatic contractility.
   Design: Clinical study to quantify diaphragm strength in the intensive
   care unit.
   Setting: patients from three London teaching hospital intensive care
   units and high-dependency units.
   Patients: Forty-one intensive care patients were recruited. Of these, 33
   (20 men, 13 women) were studied.
   Interventions: Esophageal and gastric balloon catheters were passed
   through the anaesthetized nose, and an endotracheal tube occlusion
   device was placed in the Ventilation circuit, next to the endotracheal
   tube. Two 43-mm magnetic coils were placed anteriorly on the patient's
   neck, and the phrenic nerves were stimulated magnetically. Measurements
   and Main Results: On phrenic nerve stimulation, twitch gastric pressure,
   twitch esophageal pressure, twitch transdiaphragmatic pressure, and
   twitch endotracheal tube pressure were measured. Forty-one consecutive
   patients consented to take part in the study, and twitch pressure data
   were obtained in 33 of these. Mean transdiaphragmatic pressure was 10.7
   cm H(2)O, mean twitch esophageal pressure was 6.7 cm H(2)O, and mean
   twitch endotracheal tube pressure was 6.7 cm H(2)O. The mean difference
   between twitch esophageal pressure and twitch endotracheal tube pressure
   was 0.02 cm H(2)O. Correlation of the means of twitch endotracheal tube
   pressure to twitch esophageal pressure was 0.93, and that for twitch
   endotracheal tube pressure to transdiaphragmatic pressure was 0.78.
   Conclusions: Transdiaphragmatic pressure can be measured in the
   critically ill to give a nonvolitional assessment of diaphragm
   contractility, but not all patients can be studied. At present, the
   relationship of twitch endotracheal tube pressure to transdiaphragmatic
   pressure is too variable to reliably represent a less invasive measure
   of diaphragm strength.
TC 69
ZB 37
Z8 5
ZS 1
Z9 76
SN 0090-3493
UT WOS:000169944400005
PM 11445679
ER

PT J
AU Santoli, F
   De Jonghe, B
   Hayon, J
   Tran, B
   Piperaud, M
   Merrer, J
   Outin, H
TI Mechanical ventilation in patients with acute ischemic stroke: survival
   and outcome at one year
SO INTENSIVE CARE MEDICINE
VL 27
IS 7
BP 1141
EP 1146
DI 10.1007/s001340100998
PD JUL 2001
PY 2001
AB Objective: To assess the pro gnosis of patients with acute ischemic
   stroke who require mechanical ventilation and to determine early factors
   influencing mortality.
   Design: Prospective observational study.
   Setting: Medical intensive care unit with a cerebrovascular emergency
   unit in a university-affiliated hospital.
   Patients: Fifty-eight consecutive patients (mean age 65 +/- 13 years)
   requiring mechanical ventilation in the early course of an acute
   ischemic stroke.
   Measurements and results: Clinical data were recorded before intubation
   according to a standardized procedure. Mortality and functional outcome
   were assessed after a 1-year follow-up. Mechanical ventilation was
   started within 48 h after admission in 53 patients (91.4%). The mean
   duration of ventilation was similar in survivors (9.7 +/- 9.0 days) and
   non-survivors (8.6 +/- 8.7 days). Mortality was 72.4% at 1 year. Among
   the 16 survivors, none were in a persistent vegetative state and 11 had
   a Barthel index of 60, reflecting good functional status. Bilateral
   absence of corneal reflex and bilateral absence of pupillary light
   reflex had a positive predictive value of death of 1 (95% CI 0.78-1.00
   and 0.74-1.00, respectively). After Cox regression analysis, presence of
   stupor or coma (OR 2.6, 95% CI 1.5-5.0), bilateral absence of corneal
   reflex before intubation (OR 3.4, 95% CI 1.4-8.7) and presence of
   ischemic cardiopathy (OR 2.8, 95% CI 1.4-5.5) were independent
   predictors of mortality.
   Conclusions: Systematic withholding of endotracheal intubation in
   patients with AIS is not recommended. Careful and rigorous neurologic
   examination, including assessment of brain stem reflexes, might help to
   identify patients with a very high probability of death despite
   mechanical ventilation.
TC 32
ZB 9
Z8 0
ZS 1
Z9 32
SN 0342-4642
UT WOS:000170379400007
PM 11534561
ER

PT J
AU Lua, AC
   Shi, KC
   Chua, LP
TI Proportional assist ventilation system based on proportional solenoid
   valve control
SO MEDICAL ENGINEERING & PHYSICS
VL 23
IS 6
BP 381
EP 389
DI 10.1016/S1350-4533(01)00058-3
PD JUL 2001
PY 2001
AB A new proportional assist ventilation (PAV) method using a proportional
   solenoid valve (PSV) to control air supply to patients suffering from
   respiratory disabilities, was studied. The outlet flow and pressure from
   the proportional solenoid valve at various air supply pressures were
   tested and proven to be suitable for pressure and flow control in a PAV
   system. In vitro tests using a breathing simulator, which has been
   proven to possess the general characteristics of human respiratory
   system in spontaneous breathing tests, were conducted and the results
   demonstrated the viability of this PAV system in normalizing the
   breathing patterns of patients with abnormally high resistances and
   elastances as well as neuromuscular weaknesses. With a back-up safety
   mechanism incorporated in the control program, pressure 'run-away' can
   be effectively prevented and safe operation of the system can be
   guaranteed. (C) 2001 IPEM. Published by Elsevier Science Ltd. All rights
   reserved.
RI Lua , Aik Chong/F-8904-2010; Chua, Leok/A-3833-2011
OI Chua, Leok/0000-0002-7149-5093
TC 4
ZB 1
Z8 0
ZS 0
Z9 4
SN 1350-4533
UT WOS:000171323400003
PM 11551814
ER

PT J
AU Lawn, ND
   Fletcher, DD
   Henderson, RD
   Wolter, TD
   Wijdicks, EFM
TI Anticipating mechanical ventilation in Guillain-Barre syndrome
SO ARCHIVES OF NEUROLOGY
VL 58
IS 6
BP 893
EP 898
DI 10.1001/archneur.58.6.893
PD JUN 2001
PY 2001
AB Context: The combination of multiple clinical factors culminates in
   neuromuscular respiratory failure in up to 30% of the patients with
   Guillain-Barre syndrome (GBS). Although guidelines exist as to when to
   proceed with intubation, early indicators of subsequent progression to
   respiratory failure have not been established.
   Objectives: To identify clinical and respiratory features associated
   with progression to respiratory failure and to examine patterns of
   respiratory decline in patients with severe GBS.
   Design: Retrospective survey.
   Setting: Tertiary care hospital.
   Patients: One hundred fourteen consecutive patients with severe GBS
   admitted to the intensive care unit between January 1, 1976, and
   December 31, 1996.
   Main Outome Measures: Early markers of impending respiratory failure,
   requirement for mechanical ventilation, and patterns of respiratory
   decline.
   Methods: The clinical and electrophysiologic features of 60 patients
   receiving mechanical ventilation were compared with 54 patients with
   severe GBS who did not receive mechanical ventilation. Daily
   preventilation maximal inspiratory and maximal expiratory respiratory
   pressures and vital capacity were analyzed. Multivariate predictors of
   the necessity for mechanical ventilation were assessed using logistic
   regression analysis.
   Results: Progression to mechanical ventilation was highly likely to
   occur in those patients with rapid disease progression, bulbar
   dysfunction, bilateral facial weakness, or dysautonomia. Factors
   associated with progression to respiratory failure included vital
   capacity of less than 20 mL/kg, maximal inspiratory pressure less than
   30 cm H2O, maximal expiratory pressure less than 40 cm H2O or a
   reduction of more than 30% in vital capacity, maximal inspiratory
   pressure, or maximal expiratory pressure. No clinical features predicted
   the pattern of respiratory decline; however, serial measurements of
   pulmonary function tests allowed detection of those at risk for
   respiratory failure.
   Conclusions: While inherently unpredictable, the course of patients with
   severe GBS can, to some extent, be predicted on the basis of clinical
   information and simple bedside tests of respiratory function. These data
   may be used in the decisions regarding admission to the intensive care
   unit and preparation for elective intubation.
CT 51st Annual Meeting of the American-Academy-of-Neurology
CY APR 17-24, 1999
CL TORONTO, CANADA
SP Amer Acad Neurol
TC 85
ZB 25
Z8 3
ZS 2
Z9 90
SN 0003-9942
UT WOS:000169237500005
PM 11405803
ER

PT J
AU Kamm, M
   Burger, R
   Rimensberger, P
   Knoblauch, A
   Hammer, J
TI Survey of children supported by long-term mechanical ventilation in
   Switzerland
SO SWISS MEDICAL WEEKLY
VL 131
IS 19-20
BP 261
EP 266
PD MAY 19 2001
PY 2001
AB Objective: The aim of the present study was to identify the number of
   children, from birth to 16 years of age, on long-term mechanical
   ventilation in Switzerland, and to establish their current location,
   underlying diagnoses and ventilatory needs.
   Methods: Postal questionnaires were sent to all chest physicians
   (pulmonologists), intensive care specialists, neurologists, national
   health care organisations, rehabilitation services and ventilator
   suppliers known or thought to be involved in paediatric long-term
   ventilation in Switzerland.
   Results: Detailed information was obtained on 32 children from 7
   centers. Underlying disorders included congenital central
   hypoventilation syndrome (CCHS, 41%), neuromuscular disorders (41%),
   spinal cord injury (6%), craniofacial anomalies (6%) and others (6%). 10
   children received positive pressure ventilation by tracheostomy and 19
   children by nasal mask. Two children were ventilated by phrenic nerve
   pacing and one child with the help of a pneumatic belt. Children with
   CCHS were almost equally divided into nasal mask and tracheostomy users.
   Ventilation for 16-24 hours a day was necessary in 5 children,
   exclusively during sleep in 24 children and only episodically in 3
   children. All but 2 children were cared for at home. The majority of
   families received home care support. The most common reasons for
   readmission into hospital a ere regular follow-up examinations and
   respiratory tract infections. The children were mainly admitted to
   paediatric intensive care units.
   Conclusions: There are few ventilator-supported children in Switzerland
   and most of them are cared for at home. Nevertheless, there is a need to
   establish a system for continuing data collection in this particular
   patient population to assess outcome and quality of home care support
   and to follow incidence trends.
TC 30
ZB 7
Z8 0
ZS 0
Z9 30
SN 1424-7860
UT WOS:000169765700002
PM 11452864
ER

PT J
AU Gaillard, EA
   Cooke, RWI
   Shaw, NJ
TI Improved survival and neurodevelopmental outcome after prolonged
   ventilation in preterm neonates who have received antenatal steroids and
   surfactant
SO ARCHIVES OF DISEASE IN CHILDHOOD
VL 84
IS 3
SI SI
BP F194
EP F196
DI 10.1136/fn.84.3.F194
PD MAY 2001
PY 2001
AB Aims-To assess survival and neurodevelopmental outcome following
   prolonged ventilation beyond 27 or 49 days of postnatal life in neonates
   treated with antenatal steroids and surfactant.
   Methods-The medical records of 84 babies born in 1994-1996 requiring
   ventilation after 27 postnatal days at Liverpool Women's Hospital were
   reviewed to determine the duration of mechanical ventilation, survival,
   and neurodevelopmental outcome at 3 years of age.
   Results-Fifty six babies were mechanically ventilated after 27 postnatal
   days but for less than 50 days; 48 (86%) survived to 3 years. Twenty six
   (54%) of the survivors had normal neurodevelopment at 3 years and seven
   (15%) had only mild disability. Twenty eight babies were ventilated
   after 49 postnatal days; 14 survived to 3 years. Five of these survivors
   were neurodevelopmentally normal at 3 years and two had mild disability.
   Conclusions-Survival decreases with more prolonged ventilation. When
   antenatal steroids and postnatal surfactant are used, there appears to
   be improved survival and neurodevelopmental outcome in preterm babies
   who require prolonged ventilation.
TC 9
ZB 5
Z8 0
ZS 0
Z9 10
SN 0003-9888
UT WOS:000168475800013
PM 11320047
ER

PT J
AU Karakurt, S
   Fanfulla, F
   Nava, S
TI Is it safe for patients with chronic hypercapnic respiratory failure
   undergoing home noninvasive ventilation to discontinue ventilation
   briefly?
SO CHEST
VL 119
IS 5
BP 1379
EP 1386
DI 10.1378/chest.119.5.1379
PD MAY 2001
PY 2001
AB Study objectives: A brief discontinuation (< 1 week) of long-term
   ventilation may be necessary in patients who are not totally
   ventilator-dependent in cases of technical problems, intolerable nasal
   irritation, upper airway congestion, or travel. We examined the
   incidence, timing, and causes of possible clinical deterioration after a
   brief withdrawal of ventilation in patients with chronic respiratory
   failure (CRF) who were well-established on long-term noninvasive
   mechanical ventilation (NIMV).
   Study design: Prospective clinical study.
   Patients: Eleven inpatients in clinically stable condition (COPD, 6
   patients; and restrictive thoracic disease [RTD], 5 patients) who had
   severe CRF (Paco(2), > 50 mm Hg) and had been receiving NIMV for (mean
   +/- SD) 19.3 +/- 5.3 months were enrolled.
   Interventions and measurements: Arterial blood gas (ABG) levels, maximal
   inspiratory pressure (PImax), breathing pattern, dyspnea rating, and
   life symptoms (measured by a questionnaire) were recorded daily after
   NIMV withdrawal for 6 days or until the patients showed clinical and/or
   ABG level deterioration, Pulmonary function tests were pet-formed and
   neuromuscular drive was measured at the beginning and the end of the
   study.
   Results: Five of the 11 patients (45.4%) [COPD, 3 patients; and RTD, 2
   patients] were reconnected to a ventilator before the scheduled time
   because of ABG level deterioration. Despite these changes, none of the
   patients reported severe worsening of symptoms or other medical
   complications. The patients whose ABG levels worsened had statistically
   significant decreases in tidal volume and PImax, suggesting that the
   development of alveolar hypoventilation was related to respiratory
   muscle weakness.
   Conclusions: A brief discontinuation of NIMV in patients who were
   affected by chronic hypercapnic respiratory failure and were
   well-established on NIMV is associated with a relatively high incidence
   of ABG level worsening due to the development of alveolar
   hypoventilation. If NIMV must be briefly interrupted for clinical
   reasons, the patient should be monitored closely for abrupt worsening,
   and prompt technical intervention should be provided if a ventilator
   fails.
TC 13
ZB 4
Z8 2
ZS 0
Z9 15
SN 0012-3692
UT WOS:000168711400015
PM 11348942
ER

PT J
AU Druschky, A
   Herkert, M
   Radespiel-Troger, M
   Druschky, K
   Hund, E
   Becker, CM
   Hilz, MJ
   Erbguth, F
   Neundorfer, B
TI Critical illness polyneuropathy: clinical findings and cell culture
   assay of neurotoxicity assessed by it prospective study
SO INTENSIVE CARE MEDICINE
VL 27
IS 4
BP 686
EP 693
DI 10.1007/s001340100890
PD APR 2001
PY 2001
AB Objective: First, to evaluate the role of typical intensive care-related
   conditions like sepsis, prolonged ventilation, drug effects and
   metabolic disorders in the pathogenesis of critical illness
   polyneuropathy (CIP); second, to investigate the possible significance
   of patient serum neurotoxicity assessed by an in vitro cytotoxicity
   assay with respect to CIP development.
   Design: Prospective study.
   Setting: Neurological intensive care unit.
   Patients and participants: Twenty-eight patients who were on mechanical
   respiratory support for at least 4 days during a 21-month study period.
   Results: Diagnosis of CIP was established by clinical and
   electrophysiological examination in 16 (57%) of 28 patients. Patients
   were investigated on days 4, 8 and 14 of mechanical ventilation. Two of
   16 CIP patients had clinical signs of polyneuropathy at initial
   examination. Factors that correlated significantly with the development
   of CIP were: the multiple organ failure score on day S of ventilation,
   the total duration of respiratory support, the presence of weaning
   problems and the manifestation of complicating sepsis and/or lung
   failure. The in vitro toxicity assay showed serum neurotoxicity in 12 of
   16 CIP patients. Electrophysiological investigations yielded false
   positive results of the toxicity assay in sis patients (not developing
   CIP) and false negative results in four patients (developing clinical
   and electrophysiological signs of CIP). Statistical analysis did not
   reveal a significant correlation between the diagnosis of CIP and the
   finding serum neurotoxicity.
   Conclusion: The results support the hypothesis of a multi-factorial
   aetiopathogenesis of CIP. We observed serum neurotoxicity in the
   majority of CIP patients, indicating the possible involvement of a so
   far unknown, low-molecular-weight neurotoxic agent ill CIP pathogenesis.
TC 51
ZB 23
Z8 2
ZS 1
Z9 53
SN 0342-4642
UT WOS:000168400300012
PM 11398694
ER

PT J
AU Luce, JM
   Luce, JA
TI Management of dyspnea in patients with far-advanced lung disease - "Once
   I lose it, it's kind of hard to catch it..."
SO JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION
VL 285
IS 10
BP 1331
EP 1337
DI 10.1001/jama.285.10.1331
PD MAR 14 2001
PY 2001
AB Dyspnea is a common problem among patients with interstitial fibrosis,
   lung cancer, cystic fibrosis, and chronic obstructive pulmonary disease.
   The slow but steady progression of such diseases, often punctuated by
   acute exacerbations or secondary illnesses, can lead to decisionmaking
   dilemmas among patients and their caregivers, such as when to accept
   mechanical ventilation, when to forgo aggressive therapies, and when to
   make formal end-of-life care plans. Two cases, a 74-year-old woman with
   dyspnea secondary to emphysema and a 65-year-old woman with recurrent
   lung cancer and severe exertional fatigue and dyspnea, illustrate how
   dyspneic patients approaching the end of life can be evaluated and
   treated. Four management strategies for dyspnea are discussed: reducing
   ventilatory impedance, reducing ventilatory demand, improving
   respiratory muscle function, and altering central perception. Physicians
   should encourage endstage lung disease patients and their families to
   discuss issues such as hospitalization and mechanical ventilation, to
   prepare advance directives, and to participate in a plan to manage their
   dyspnea.
TC 34
ZB 15
Z8 0
ZS 1
Z9 35
SN 0098-7484
UT WOS:000167339000026
PM 11255389
ER

PT J
AU Sheridan, R
   Stoddard, F
   Querzoli, E
TI Management of background pain and anxiety in critically burned children
   requiring protracted mechanical ventilation
SO JOURNAL OF BURN CARE & REHABILITATION
VL 22
IS 2
BP 150
EP 153
DI 10.1097/00004630-200103000-00012
PD MAR-APR 2001
PY 2001
AB Optimal control of pain and anxiety is an elusive but important goal in
   children with protracted critical illness. This review represents an
   effort to document the doses of background medication required to
   achieve this goal in a group of children managed under a pain and
   anxiety protocol that adjusts background infusions to comfort. The
   course of children with wounds involving at least 10% of the body
   surface and coincident respiratory failure requiring mechanical
   ventilation for more than 7 days managed 1 Jan 97 to 31 Dec 98 was
   reviewed. A pain and anxiety protocol was used, including background
   infusions of morphine and midazolam. adjusted to comfort. These 28
   children had a mean (+/- standard deviation) age of 5.3 +/- 4.6 years,
   wound size of 48.3 +/- 28.4%, and were intubated for 25.0 +/- 23.9 days.
   Neuromuscular blocking drugs were administered for 65 of 447 (14.5%)
   ventilator days. To maintain comfort, drugs were required at doses
   substantially above standard dosing schemes. The highest daily
   background infusion of morphine sulfate averaged 0.40 mg/kg/hr +/- 0.24
   mg/kg/hr (usual starting dose was 0.05 to 0.1 mg/kg/hr) and was reached
   14.1 +/- 12.8 days after admission. The highest daily background
   infusion of midazolam averaged 0.15 +/- 0.07 mg/kg/hr (usual starting
   dose was 0.04 mg/kg/hr) and was reached 14.0 +/- 3.8 days after
   admission. Morphine infusions at extubation averaged 0.22 +/- 0.17
   mg/kg/hr and midazolam infusions 0.10 +/- 0.12 mg/kg/hr. All children
   survived to discharge and there was no perceived morbidity related to
   these high doses of medication. Children with serious burns and
   respiratory failure will require high doses of background opiates and
   benzodiazepines to remain comfortable, because they develop drug
   tolerance during protracted critical illness. Infusions can be continued
   at a reduced dose through extubation, do not result in addiction or
   other apparent morbidity if adjusted to desired level of comfort, and
   may contribute to a reduced incidence of treatment-related stress
   disorders.
TC 18
ZB 9
Z8 0
ZS 0
Z9 18
SN 0273-8481
UT WOS:000178749500010
PM 11302604
ER

PT J
AU Agrawal, PN
   Aggarwal, AN
   Gupta, D
   Behera, D
   Prabhakar, S
   Jindal, SK
TI Management of respiratory failure in severe neuroparalytic snake
   envenomation
SO NEUROLOGY INDIA
VL 49
IS 1
BP 25
EP 28
PD MAR 2001
PY 2001
AB Fourteen patients with severe neuroparalytic snake envenomation,
   resulting in acute type II respiratory failure, admitted to respiratory
   critical care unit for mechanical ventilation during one year period,
   were studied. Ventilatory requirements, amount of anti snake venom (ASV)
   infused, period of neurological recovery and hospital survival were
   evaluated. All patients had severe manifestations such as ptosis,
   extraocular muscle paresis and limb weakness along with dyspnoea. Seven
   patients (50%) had additional complaints of dysphagia and dysphonia, ASV
   nias administered to all, with a median requirement of 900 mi.
   Mechanical ventilation was required for a median duration of 17 hours
   and all except one patient, who had suffered irreversible hypoxic
   cerebral injury prior to resuscitation, survived with complete
   neurological recovery. We conclude, that the timely institution of
   ventilatory support and anti-venom therapy in such patients, is
   associated with an excellent outcome.
RI GUPTA, DHEERAJ/B-5124-2011
TC 15
ZB 9
Z8 0
ZS 2
Z9 15
SN 0028-3886
UT WOS:000168286000005
PM 11303237
ER

PT J
AU Stuart, M
   Weinrich, M
TI Protecting the most vulnerable: Home mechanical ventilation as a case
   study in disability and medical care: Report from an NIH conference
SO NEUROREHABILITATION AND NEURAL REPAIR
VL 15
IS 3
BP 159
EP 166
DI 10.1177/154596830101500302
PD 2001
PY 2001
AB Patients requiring chronic mechanical ventilation represent a
   particularly vulnerable segment of the expanding Population of
   individuals with chronic disabilities. Many of these individuals can
   live successfully at home, but face significant obstacles. Current
   policies in health care coverage, durable medical equipment coverage,
   eligibility for assisted living, and licensing of caregivers all
   restrict the abilities of these individuals to live in the community.
   Prolonged home mechanical ventilation was pioneered in France, where a
   current international "best practice" provides a model for developing
   comprehensive, cost-effective care for these individuals.
TC 10
ZB 1
Z8 0
ZS 0
Z9 10
SN 0888-4390
UT WOS:000174509100002
PM 11944736
ER

PT J
AU Symington, A
   Pinelli, J
TI Developmental care for promoting development and preventing morbidity in
   preterm infants.
SO The Cochrane database of systematic reviews
IS 4
BP CD001814
EP CD001814
PD 2001
PY 2001
AB BACKGROUND: Preterm infants experience a range of morbidity related to
   the immaturity of their organ systems and to concurrent disease states.
   An unfavourable environment in the neonatal intensive care unit (NICU)
   may compound this morbidity. Modification of the environment could
   minimize the iatrogenic effects. Developmental care is a broad category
   of interventions designed to minimize the stress of the NICU
   environment. These interventions may include one or more elements such
   as control of external stimuli (vestibular, auditory, visual, tactile),
   clustering of nursery care activities, and positioning or swaddling of
   the preterm infant. Individual strategies have also been combined to
   form programs, such as the 'Neonatal Individualized Developmental Care
   and Assessment Program' (NIDCAP) (Als 1986).
   OBJECTIVES: In preterm infants, do developmental care interventions
   reduce neurodevelopmental delay, poor weight gain, length of hospital
   stay, length of mechanical ventilation, physiological stress and other
   clinically relevant adverse outcomes?
   SEARCH STRATEGY: The Neonatal Review Group search strategy was utilized.
   Searches were made of Medline from 1966 to July, 2000, and of CINAHL,
   The Cochrane Library, and conference and symposia proceedings in the
   English language from 1990 to July, 2000. A list of all relevant
   articles was sent to two experts in the field to identify any omissions
   or additional unpublished studies.
   SELECTION CRITERIA: Randomized trials in which elements of developmental
   care are compared to routine nursery care for infants < 37 weeks
   gestation and that measured clinically relevant outcomes. Reports were
   in English or a language for which a translator was available.
   Computerized searches were conducted and all potentially relevant titles
   and abstracts were extracted. Retrieved articles were assessed for
   relevance independently by two reviewers, based on predetermined
   criteria. Articles that met all criteria for relevance were assessed for
   methodological quality based on predetermined criteria. Articles judged
   to have the appropriate quality by both reviewers were included in the
   analysis.
   DATA COLLECTION AND ANALYSIS: Data were extracted independently by the
   two authors. Meta-analyses were conducted for each intervention where
   the same outcome measures and/or instruments were used within comparable
   time points.
   MAIN RESULTS: This review detected 31 eligible randomized controlled
   trials involving four major groups of developmental care interventions,
   19 sub-groups and multiple clinical outcomes. The results of the review
   indicate that developmental care interventions demonstrate some benefit
   to preterm infants with respect to: improved short-term growth outcomes,
   decreased respiratory support, decreased length and cost of hospital
   stay, and improved neurodevelopmental outcomes to 24 months corrected
   age. These findings were based on two or three small trials for each
   outcome, and did not involve meta-analyses of more than two trials for
   any one outcome. Although a number of other benefits were demonstrated,
   those results were from single studies with small sample sizes. The lack
   of blinding of the assessors was a significant methodological flaw in
   half of the studies. The cost of the interventions and personnel was not
   considered in any of the studies.
   REVIEWER'S CONCLUSIONS: Because of the inclusion of multiple
   interventions in most studies, the determination of the effect of any
   single intervention is difficult. Although there is evidence of some
   benefit of developmental care interventions overall, and no major
   harmful effects reported, there were a large number of outcomes for
   which no or conflicting effects were demonstrated. The single trials
   that did show a significant effect of an intervention on a major
   clinical outcome were based on small sample sizes, and the findings were
   often not supported in other small trials. Before a clear direction for
   practice can be supported, evidence demonstrating more consistent
   effects of developmental care interventions on important short- and
   long-term clinical outcomes is needed. The economic impact of the
   implementation and maintenance of developmental care practices should be
   considered by individual institutions.
TC 0
ZB 0
Z8 2
ZS 2
Z9 4
UT MEDLINE:11687124
PM 11687124
ER

PT J
AU O'Keefe, GE
   Hawkins, K
   Boynton, J
   Burns, D
TI Indicators of fatigue and of prolonged weaning from mechanical
   ventilation in surgical patients
SO WORLD JOURNAL OF SURGERY
VL 25
IS 1
BP 98
EP 103
PD JAN 2001
PY 2001
AB Indicators of weaning success have been tested primarily in patients who
   have been ventilated for short periods of time, and they may not be as
   accurate in cases where support has been required for longer than a few
   days. In patients requiring longer periods of support it is difficult to
   estimate the likelihood of successful liberation. Therefore we evaluated
   established weaning indices for their accuracy in surgical patients who
   required greater than or equal to 72 hours of mechanical ventilation.
   Surgical patients who required mechanical ventilation for greater than
   or equal to 72 hours were prospectively followed (over 6 months). We
   obtained standard indices of ventilatory function daily once patients
   were ready to wean. These indices included the respiratory rate/tidal
   volume ratio (RSBI), the maximal inspiratory pressure, and the minute
   ventilation. The duration of weaning and explicitly defined episodes of
   fatigue were the outcomes of interest. Statistical analyses evaluated
   the multiple factors that might influence the duration of weaning.
   Ninety-five patients (66% trauma; 34% surgery) survived to begin
   weaning, and 93% were liberated. The median duration of mechanical
   ventilation prior to weaning was 4 days (range 3-16 days), and the
   median duration of weaning was 3 days (range 0-56 days). Fatigue
   occurred in 36 patients and was not reliably predicted by any of the
   weaning measurements. However, a RSBI of >105 on the first day of
   weaning was associated with prolonged weaning. By multivariate analysis,
   an RSBI of > 105 on the first day of weaning predicted prolonged meaning
   (hazard ratio 1.9; p = 0.03). After 72 hours of mechanical ventilation,
   clinical fatigue and successful liberation are not reliably predicted by
   standard indices of respiratory muscle strength and reserve. However, an
   RSBI of >105 observed once the patient is ready to wean is associated
   with prolonged weaning.
CT 38th World Congress of the
   International-Society-of-Surgery/Societe-Internationale-de-Chirurgie
   (ISS/SIC)
CY AUG 15-20, 1999
CL VIENNA, AUSTRIA
SP Int Soc Surg; Soc Int Chirurg
TC 3
ZB 0
Z8 0
ZS 0
Z9 3
SN 0364-2313
UT WOS:000166636000015
PM 11213163
ER

PT J
AU Yamaguchi, Y
   Sakurai, Y
   Mannen, T
   Shimizu, J
TI Rapidly progressive polymyositis with elevated antiacetylcholine
   receptor antibody activity
SO INTERNAL MEDICINE
VL 39
IS 12
BP 1108
EP 1110
DI 10.2169/internalmedicine.39.1108
PD DEC 2000
PY 2000
AB We report a 51-year-old woman with polymyositis accompanied by a high
   titer of antiacetylcholine receptor antibody. The patient presented with
   weakness of grip strength followed by rapidly progressive dyspnea, which
   required mechanical ventilation, She was treated with a glucocorticoid
   and came off the respirator one week later. Antiacetylcholine receptor
   antibody activity was elevated in the acute phase and decreased during
   recovery, although other signs of myasthenia gravis were negative, This
   patient suggested that in cases of rapidly progressive bulbar palsy and
   limb muscle weakness, it is necessary to include polymyositis associated
   with elevated antiacetylcholine receptor antibody activity in the
   differential diagnosis.
TC 2
ZB 1
Z8 0
ZS 0
Z9 2
SN 0918-2918
UT WOS:000166357600026
PM 11197802
ER

PT J
AU Schulze, A
TI Enhancement of mechanical ventilation of neonates by computer technology
SO SEMINARS IN PERINATOLOGY
VL 24
IS 6
BP 429
EP 444
DI 10.1053/sper.2000.20084
PD DEC 2000
PY 2000
TC 6
ZB 3
Z8 0
ZS 0
Z9 6
SN 0146-0005
UT WOS:000166059100006
PM 11153904
ER

PT J
AU Tzeng, AC
   Bach, JR
TI Prevention of pulmonary morbidity for patients with neuromuscular
   disease
SO CHEST
VL 118
IS 5
BP 1390
EP 1396
DI 10.1378/chest.118.5.1390
PD NOV 2000
PY 2000
AB Study objective: To evaluate the effects of a respiratory muscle aid
   protocol on hospitalization rates for respiratory complications of
   neuromuscular disease.
   Design: A retrospective cohort study.
   Methods: A home protocol was developed in which oxyhemoglobin
   desaturation was prevented or reversed by the use of noninvasive
   intermittent positive-pressure ventilation and manually and mechanically
   assisted coughing as needed. The patients who had more than one episode
   of respiratory failure before having access to the protocol were
   considered to have had preprotocol periods (group 1). Other patients
   were given access to the protocol when their assisted peak cough flows
   decreased to < 270 L/min before any episodes of respiratory distress
   (group 2). The number of hospitalizations and days hospitalized were
   compared longitudinally for preprotocol and protocol access periods
   (group 1). In addition, avoided hospitalizations were identified as
   "episodes" of need for continuous ventilatory support and desaturations
   reversed by assisted coughing that were managed at home. Data were
   segregated by access to protocol and by extent of baseline ventilator
   use.
   Results: Of the 47 group 1 patients with preprotocol periods who have
   subsequently had episodes, 10 had episodes before requiring ongoing
   ventilator use. They had 1.06 +/- 0.84 preprotocol hospitalizations per
   year per patient and 20.76 +/- 36.01 hospitalization days per year per
   patient over 3.42 +/- 3.36 years per patient vs 0.03 +/- 0.11
   hospitalizations per year per patient and 0.06 +/- 0.20 hospitalization
   days per year per patient with protocol use over 1.91 +/- 0.74 years per
   patient. Of these 47 group 1 patients, 33 eventually required part-time
   ventilatory aid and, using the protocol as needed, had 0.08 +/- 0.17
   hospitalizations per year per patient and 1.43 +/- 3.71 hospitalization
   days per rear per patient over 3.91 +/- 3.50 years per patient, as
   opposed to 1.40 +/- 1.96 hospitalizations per year per patient and 20.14
   +/- 41.15 hospitalization days per year per patient preprotocol and
   preventilator use over 5.89 +/- 6.89 years per patient. Twelve patients
   in group 1 eventually required continuo-us noninvasive ventilation and,
   using the protocol as needed had 0.07 +/- 0.14 hospitalizations per year
   per patient and 0.39 +/- 0.73 hospitalization days per year per patient
   over 5.35 +/- 5.10 years per patient by comparison with 0.97 +/- 0.74
   hospitalizations per year per patient and 10.39 +/- 8.66 hospitalization
   days per year per patient over 2.18 +/- 1.91 years per patient
   preprotocol and preventilator use. For the 94 patients overall when
   having access to the protocol, 1.02 +/- 0.99 hospitalizations per year
   per patient were avoided by 14 I patients before requiring ongoing
   ventilator use over 4.82 +/- 1.61 years, 0.99 +/- 1.12 hospitalizations
   per year per patient were avoided by 73 part-time ventilator users over
   3.21 +/- 3.15 years, and 0.80 +/- 0.85 hospitalizations per year per
   patient were avoided by 31 full-time ventilator users over 4.78 +/- 4.88
   years. All preprotocol and protocol rate comparisons were statistically
   significant at p < 0.004.
   Conclusion: Patients have significantly fewer hospitalizations per rear
   and clays per year when using the protocol as needed than without the
   protocol. The use of inspiratory and expiratory aids can significantly
   decrease hospitalization rates for respiratory complications of
   neuromuscular disease.
TC 103
ZB 32
Z8 2
ZS 5
Z9 107
SN 0012-3692
UT WOS:000165286600027
PM 11083691
ER

PT J
AU Shenkman, Z
   Sheffer, O
   Erez, I
   Litmanovitc, I
   Jedeikin, R
TI Spinal anesthesia for gastrostomy in an infant with nemaline myopathy
SO ANESTHESIA AND ANALGESIA
VL 91
IS 4
BP 858
EP 859
DI 10.1097/00000539-200010000-00016
PD OCT 2000
PY 2000
TC 5
ZB 3
Z8 0
ZS 1
Z9 6
SN 0003-2999
UT WOS:000089503700016
PM 11004037
ER

PT J
AU Marrie, TJ
TI Community-acquired pneumonia in the elderly
SO CLINICAL INFECTIOUS DISEASES
VL 31
IS 4
BP 1066
EP 1078
DI 10.1086/318124
PD OCT 2000
PY 2000
AB Pneumonia in the elderly is a common and serious problem with a clinical
   presentation that can differ from that in younger patients. Older
   patients with pneumonia complain of significantly fewer symptoms than do
   younger patients, and delirium commonly occurs. Indeed, delirium may be
   the only manifestation of pneumonia in this group of patients.
   Alcoholism, asthma, immunosuppression, and age >70 years are risk
   factors for community-acquired pneumonia in the elderly. Among nursing
   home residents, the following are risk factors for pneumonia: advanced
   age, male sex, difficulty in swallowing, inability to take oral
   medications, profound disability, bedridden state, and urinary
   incontinence. Streptococcus pneumoniae is the most common cause of
   pneumonia among the elderly Aspiration pneumonia is underdiagnosed in
   this group of patients, and tuberculosis always should be considered. In
   this population an etiologic diagnosis is rarely available when
   antimicrobial therapy must be instituted. Use of the guidelines for
   treatment of pneumonia issued by the Infectious Diseases Society of
   America, with modification for treatment in the nursing home setting, is
   recommended.
TC 127
ZB 60
Z8 6
ZS 2
Z9 136
SN 1058-4838
UT WOS:000165387200031
PM 11049791
ER

PT J
AU Montuclard, L
   Garrouste-Orgeas, M
   Timsit, JF
   Misset, B
   De Jonghe, B
   Carlet, J
TI Outcome, functional autonomy, and quality of life of elderly patients
   with a long-term intensive care unit stay
SO CRITICAL CARE MEDICINE
VL 28
IS 10
BP 3389
EP 3395
DI 10.1097/00003246-200010000-00002
PD OCT 2000
PY 2000
AB Objective: To examine the outcome, functional autonomy, and quality of
   life of elderly patients (greater than or equal to 70 yrs old)
   hospitalized for >30 days in an intensive care unit (ICU).
   Design:Prospective cohort study.
   Setting: A ten-bed, medical-surgical ICU in a 460-bed, acute care,
   tertiary, university hospital.
   Patients: A consecutive cohort of 75 patients, >70 yrs old, admitted to
   the IOU from January 1, 1993, to August 1, 1998, for >30 days.
   Interventions: None.
   Measurements and Main Results: Severity at admission and of the
   underlying disease was estimated according to the Simplified Acute
   Physiologic Score (SAPS II), the Organ Dysfunction and/or Infection
   (ODIN) score, the McCabe score, and the Knaus classification.
   Therapeutic intensity was measured through the French Omega scoring
   system. All patients were mechanically ventilated during their IOU stay.
   Outcome measurements were made by two cross-sectional studies using
   telephone interviews on the first week of September 1996 and 1998 with a
   questionnaire including measures of functional capacity by Katz's
   Activities of Daily Living, modified Patrick's Perceived Quality of Life
   score, and the Nottingham Health Profile. The survival rate was 67% in
   the ICU and 47% in the hospital. A total of 30 patients were alive and
   able to participate in at least one of the cross-sectional studies.
   Independence in activities of daily living was decreased significantly
   after the ICU stay, except for feeding. However, most of the 30 patients
   remained independent (class A of the Activities of Daily Living index)
   with the possibility of going home. Perceived Quality of Life scores
   remained good, even if the patients estimated a decrease in their
   quality of life for health and memory. Return to society appeared
   promising regarding patient self respect and happiness with life. The
   estimated cast by survivor was of 55,272 EUR ($66,246 US).
   Conclusions: This study suggests that persistent high levels of IOU
   therapeutic intensity were associated with a reasonable hospital
   survival in elderly patients experiencing prolonged mechanical
   ventilatory support. These patients presented a moderate disability that
   influenced somewhat their perceived quality of life. These results are
   sufficient to justify prolonged IOU stays for elderly patients.
CT 10th Annual Congress of the European-Society-of-Intensive-Care-Medicine
CY SEP 07-10, 1997
CL PARIS, FRANCE
SP European Soc Intens Care Med
TC 128
ZB 33
Z8 0
ZS 3
Z9 133
SN 0090-3493
UT WOS:000089931400002
PM 11057791
ER

PT J
AU Kaptain, GJ
   Lanzino, G
   Kassell, NF
TI Subarachnoid haemorrhage - Epidemiology, risk factors, and treatment
   options
SO DRUGS & AGING
VL 17
IS 3
BP 183
EP 199
DI 10.2165/00002512-200017030-00003
PD SEP 2000
PY 2000
AB The present review focuses on subarachnoid haemorrhage (SAH) secondary
   to the rupture of an intracranial aneurysm, a condition with a high case
   fatality rate. Additionally, many of the surviving patients are left
   with significant disabilities. Risk factors for aneurysmal SAH include
   both genetic and acquired conditions. The most common presenting symptom
   is sudden onset of severe headache. Since headache is very common in the
   general population, it is not unusual that SAH is misdiagnosed at its
   onset with often catastrophic consequences. Unlike other acute
   neurological disorders such as brain injury, in which patient outcome is
   closely related to the extent of the injury occurring at the time of the
   trauma, patients with aneurysmal SAH are at risk of subsequent
   deterioration from 'avoidable' complications such as rebleed, vasospasm,
   hydrocephalus, and several other non-neurological general medical
   complications. Thus, the critical care management of the patient with
   SAH is of utmost importance in order to maximise the chances of
   satisfactory recovery. Although surgical clipping of the ruptured
   aneurysm remains the gold standard therapy, with the continuing
   refinement of endovascular techniques, a new, 'less invasive' option is
   now available, especially for patients considered poor surgical
   candidates.
TC 20
ZB 15
Z8 0
ZS 0
Z9 20
SN 1170-229X
UT WOS:000089441400003
PM 11043818
ER

PT J
AU Lee, H C
   Ko, W C
   Chuang, Y C
TI Tetanus of the elderly.
SO Journal of microbiology, immunology, and infection = Wei mian yu gan ran
   za zhi
VL 33
IS 3
BP 191
EP 6
PD 2000-Sep
PY 2000
AB The medical records of 20 tetanus patients who were treated at a
   university teaching hospital in Taiwan during the period from October
   1991 to July 1999 were retrospectively analyzed. There were 18 adults
   (six males and 12 females) with unknown previous immunization status and
   ages ranging from 34 to 87 years old (mean 63 years). Two patients were
   children, aged 3 and 5 years old, respectively; both of them had
   incomplete tetanus immunization. Of the 17 patients reporting previous
   acute injury, 10 had tetanus-prone wounds. Four of six patients who
   sought medical help for wound management received tetanus toxoid, but
   none received tetanus immunoglobulins. The most common symptoms were
   trismus, dysphagia, and muscular rigidity. Specific treatment consisted
   of active and passive immunization, wound management, parenteral
   antibiotics, and benzodiazepines, muscle relaxants or neuromuscular
   blockades for control of spasms and sedation. All adults were admitted
   to the intensive care unit and an artificial airway was established.
   Fourteen of them required ventilator support during the illness.
   Prophylactic tracheostomy was performed within 24 h after arrival in 12
   (92%) of 13 patients. Two patients died with an overall mortality rate
   of 10%. Sequelae were rare in the patients who survived. Because of
   inclusion of the diphtheria-pertussis-tetanus (DPT) vaccine in the
   national Children's Vaccine Program and improvement in obstetrical
   practices and neonatal care in Taiwan, tetanus mainly occurs in people
   older than 65 years instead of neonates or children. Waning immunity to
   tetanus in the elderly and poor wound management practices by primary
   care physicians were contributory factors.
TC 12
ZB 7
Z8 0
ZS 2
Z9 14
SN 1684-1182
UT MEDLINE:11045384
PM 11045384
ER

PT J
AU Shin, DD
   Adams, EM
TI Heterotopic ossification associated with primary retroperitoneal
   mucinous cystadenocarcinoma and critical illness
SO JOURNAL OF RHEUMATOLOGY
VL 27
IS 9
BP 2270
EP 2271
PD SEP 2000
PY 2000
TC 1
ZB 1
Z8 0
ZS 0
Z9 1
SN 0315-162X
UT WOS:000089146200036
PM 10990247
ER

PT J
AU Polkey, MI
   Duguet, A
   Luo, Y
   Hughes, PD
   Hart, N
   Hamnegard, CH
   Green, M
   Similowski, T
   Moxham, J
TI Anterior magnetic phrenic nerve stimulation: laboratory and clinical
   evaluation
SO INTENSIVE CARE MEDICINE
VL 26
IS 8
BP 1065
EP 1075
DI 10.1007/s001340051319
PD AUG 2000
PY 2000
AB Objective: Anterior magnetic stimulation (aMS) of the phrenic nerves is
   a new method for the assessment of diaphragm contractility that might
   have particular applications for the clinical assessment of critically
   ill patients who are commonly supine.
   Design: We compared aMS with existing techniques for measurement of
   diaphragm weakness and fatigue in 10 normal subjects, 27 ambulant
   patients with suspected diaphragm weakness and 10 critically ill
   patients.
   Setting: Laboratory and intensive care unit of two university hospitals.
   Results: Although aMS was not demonstrably supramaximal in normal
   subjects, the mean value of twitch transdiaphragmatic pressure (Tw Pdi)
   obtained at 100 % of stimulator output, 23.7 cmH(2)O, did not differ
   significantly from that obtained with bilateral supramaximal electrical
   stimulation (ES), 24.9 cmH(2)O, or bilateral anterior magnetic phrenic
   nerve stimulation (BAMPS), 27.3 cmH(2)O. A fatiguing protocol produced a
   20 % fall in aMS-Tw Pdi and a 19% fall in BAMPS-Tw Pdi; the fall in
   aMS-Tw Pdi correlated with the fall in BAMPS-Tw Pdi (r(2) = 0.84, p =
   0.03) indicating that aMS can detect diaphragm fatigue. In ambulant
   patients aMS agreed closely with existing measures of diaphragm
   strength. The maximal sniff Pdi correlated with both the aMS-Tw Pdi
   (r(2) = 0.60, p < 0.0001) and the BAMPS-Tw Pdi (r(2) = 0.65, p < 0.0001)
   and the aMS-Tw Pdi was a mean (SD) 2.2 (4.3) cmH(2)O less than BAMPS-Tw
   Pdi. In addition, aMS correctly identified diaphragm dysfunction in
   patients studied on the ICU.
   Conclusions: We conclude that aMS is of clinical value for the
   investigation of suspected diaphragm weakness.
TC 37
ZB 19
Z8 0
ZS 0
Z9 37
SN 0342-4642
UT WOS:000089068500007
PM 11030162
ER

PT J
AU Chamnanvanakij, S
   Perlman, JM
TI Outcome following cardiopulmonary resuscitation in the neonate requiring
   ventilatory assistance
SO RESUSCITATION
VL 45
IS 3
BP 173
EP 180
DI 10.1016/S0300-9572(00)00184-2
PD AUG 1 2000
PY 2000
AB Background: there is limited data regarding the clinical characteristics
   and outcome of the neonate requiring ventilatory assistance who develops
   persistent bradycardia (PB) requiring cardiopulmonary resuscitation
   (CPR). Objectives: (1) to determine the percentage of newborn infants
   requiring respiratory assistance who develop PB and require CPR as part
   of resuscitation; (2) the associated clinical events; and (3) the short
   term outcome. Methods: the medical charts of infants admitted to a
   neonatal intensive care unit who developed PB, defined as a heart rate <
   80 beats/min requiring CPR, were retrospectively reviewed. Results. for
   3 years, 39 (2.6%) of 1485 infants exhibited 62 episodes of PB requiring
   CPR; this represents 5.6% of 695 intubated infants. Fourteen (36%)
   infants rapidly responded to chest compressions only with restoration of
   heart rate within 2 min; termed brief CPR. None died in-hospital.
   Twenty-five (64%) infants required prolonged chest compressions, i.e. >
   2 min (termed prolonged CPR); 21 also received epinephrine. The median
   postnatal age at onset of CPR was 20 days (range 1-148 days) and the
   duration of CPR was 10 min (range 3-73 min). The more common medical
   conditions that may have contributed to the PB included severe
   bronchospasm associated with chronic lung disease (CLD) (n = 6), shock
   associated with sepsis (n = 4) and necrotizing enterocolitis (NEC) (n =
   2), pneumothorax (n = 2), inadequate or improper ventilation (n = 3),
   other (n = 8). Nineteen (76%) infants died: 13 within 24 h of the event
   and six from 3 to 194 days following CPR. At 18 months follow-up, four
   of the six infants evaluated have a moderate to severe
   neurodevelopmental deficit. Of the nine infants requiring brief CPR who
   were evaluated, five are developing normally and four have a moderate to
   severe neurodevelopmental deficit. Conclusion: CPR in the neonate who
   requires ventilatory assistance is not uncommon. When brief in nature,
   mortality is low and short-term outcome is likely to be determined by
   the underlying medical condition. When CPR is prolonged, mortality is
   high and short-term outcome is poor. (C) 2000 Elsevier Science Ireland
   Ltd. All rights reserved.
TC 11
ZB 7
Z8 0
ZS 0
Z9 11
SN 0300-9572
UT WOS:000088721400004
PM 10959016
ER

PT J
AU Selva-O'Callaghan, A
   Sanchez-Sitjes, L
   Munoz-Gall, X
   Mijares-Boeckh-Behrens, T
   Solans-Laque, R
   Bosch-Gil, JA
   Morell-Brotad, F
   Vilardell-Tarres, M
TI Respiratory failure due to muscle weakness in inflammatory myopathies:
   maintenance therapy with home mechanical ventilation
SO RHEUMATOLOGY
VL 39
IS 8
BP 914
EP 916
DI 10.1093/rheumatology/39.8.914
PD AUG 2000
PY 2000
AB Polymyositis and dermatomyositis are idiopathic inflammatory myopathies.
   Respiratory complications are a common feature, but ventilatory
   insufficiency is rare in these patients. We describe here three patients
   diagnosed with inflammatory myopathy (polymyositis) with respiratory
   failure due to muscle weakness who did not respond to immunosuppressive
   therapy. Mechanical ventilation at home with nasal or tracheal
   intermittent positive pressure resulted in improved chronic
   hypoventilation. This treatment improves the quality of life of patients
   with inflammatory myopathies and can be lifesaving in some cases.
TC 17
ZB 9
Z8 0
ZS 2
Z9 18
SN 1462-0324
UT WOS:000088892500016
PM 10952749
ER

PT J
AU Fischer, JE
   Allen, P
   Fanconi, S
TI Delay of extubation in neonates and children after cardiac surgery:
   impact of ventilator-associated pneumonia
SO INTENSIVE CARE MEDICINE
VL 26
IS 7
BP 942
EP 949
DI 10.1007/s001340051285
PD JUL 2000
PY 2000
AB Objective: This study was undertaken to determine the delay of
   extubation attributable to ventilator-associated pneumonia (VAP) in
   comparison to other complications and complexity of surgery after repair
   of congenital heart lesions in neonates and children. Methods: Cohort
   study in a pediatric intensive care unit of a tertiary referral center.
   All patients who had cardiac operations during a 22-month period and who
   survived surgery were eligible (n = 272, median age 1.3 years). Primary
   outcome was time to successful extubation. Primary variable of interest
   was VAP. Surgical procedures were classified according to complexity.
   Cox proportional hazards models were calculated to adjust for
   confounding. Potential confounders comprised other known risk factors
   for delayed extubation. Results: Median time to extubation was 3 days.
   VAP occurred in 26 patients (9.6 %). The rate of VAP was not associated
   with complexity of surgery (P = 0.22), or cardiopulmonary bypass (P =
   0.23). The adjusted analysis revealed as further factors associated with
   delayed extubation: other respiratory complications (n = 28,
   chylothorax, airway stenosis, diaphragm paresis), prolonged inotropic
   support (n = 48, 17.6 %), and the need for secondary surgery (n = 51,
   18.8 %; e. g., re-operation, secondary closure of thorax). Older age
   promoted early extubation. The median delay of extubation attributable
   to VAP was 3.7 days (hazards ratio HR = 0.29, 95 % CI 0.18-0.49),
   exceeding the effect size of secondary surgery (HR = 0.48) and other
   respiratory complications (HR = 0.50). Conclusion: VAP accounts for a
   major delay of extubation in pediatric cardiac surgery.
TC 36
ZB 14
Z8 2
ZS 1
Z9 39
SN 0342-4642
UT WOS:000088623500017
PM 10990110
ER

PT J
AU Beraldo, PSS
   Mateus, SRM
   Araujo, LM
   Horan, TA
TI Forced oscillation technique to detect and monitor tracheal stenosis in
   a tetraplegic patient
SO SPINAL CORD
VL 38
IS 7
BP 445
EP 447
DI 10.1038/sj.sc.3101005
PD JUL 2000
PY 2000
AB Study design: A case report.
   Objectives: To demonstrate forced oscillation technique's (FOT) utility
   in a tetraplegic patient with tracheostenosis.
   Setting: A Rehabilitation Hospital, Brasilia, Brazil.
   Methods: Serial evaluations of spirometry, bronchoscopy and forced
   oscillation assessment.
   Results: A 16-year-old male with C7 spinal cord injury, initially
   required mechanical ventilation and subsequent tracheostomy over a
   period of 4 weeks. Five months after the accident the onset of
   tracheostenosis was diagnosed. Flow-volume data were compatible with a
   fixed tracheal stenosis. FOT showed an obstructed pattern, manifested by
   high levels of resonance frequency and impedance. The FOT pattern
   returned to normal after dilatation. The FOT abnormalities recurred with
   two subsequent broncoscopicaly confirmed episodes of tracheal restenosis
   without parallel changes in spirometric parameters.
   Conclusion: This case suggests a role for FOT in the non invasive
   detection and follow up of tracheal stenosis. FOT may be particularly
   useful in tetraplegic patients, in whom the restriction from muscle
   weakness may make interpretation of forced expiratory flow-volume data
   problematic.
TC 4
ZB 2
Z8 0
ZS 0
Z9 4
SN 1362-4393
UT WOS:000088969800010
PM 10962606
ER

PT J
AU Fletcher, DD
   Lawn, ND
   Wolter, TD
   Wijdicks, EFM
TI Long-term outcome in patients with Guillain-Barre syndrome requiring
   mechanical ventilation
SO NEUROLOGY
VL 54
IS 12
BP 2311
EP 2315
PD JUN 27 2000
PY 2000
AB Objective: To analyze long-term recovery and predictors of outcome in
   patients with Guillain-Barre syndrome (GBS) requiring mechanical
   ventilation. Methods: The clinical and electrophysiologic data of 114
   patients with GBS admitted to the intensive care unit between 1976 and
   1996 (60 mechanically ventilated, 54 nonventilated) were reviewed.
   Functional disability and predictors of outcome were determined at 1
   year and at maximal recovery using the Hughes scale. Good outcome was
   defined as ability to ambulate without assistance; poor outcome was
   defined as inability to ambulate independently. Results: Mechanical
   ventilation was required in 81% of patients with a poor outcome.
   Mortality was 20% in patients ventilated for GBS. However, ventilated
   patients who survived did well, with 79% eventually regaining
   independent ambulation. Nineteen percent of patients improved at least
   one functional grade beyond 1 year. Univariate predictors of poor
   maximal recovery in ventilated GBS patients were increased age (p <
   0.001), upper Limb paralysis (p = 0.004), duration of ventilation (p =
   0.006), and delay of more than 2 days to transfer to a tertiary center
   (p < 0.001). However, only age (OR 1.99, p = 0.004) and delayed transfer
   (OR 19.8, p = 0.002) were independently predictive of poor outcome on
   multivariate analysis. Conclusion: Mechanically ventilated patients
   constitute the majority of GBS patients with a poor outcome, and
   mortality remains substantial in this subgroup (20%). Although recovery
   from severe GBS may be prolonged, most survivors regain independent
   ambulation.
TC 76
ZB 37
Z8 6
ZS 1
Z9 83
SN 0028-3878
UT WOS:000087804600021
PM 10881259
ER

PT J
AU Cuttini, M
   Nadai, M
   Kaminski, M
   Hansen, G
   de Leeuw, R
   Lenoir, S
   Persson, J
   Rebagliato, M
   Reid, M
   de Vonderweid, U
   Lenard, HG
   Orzalesi, M
   Saracci, R
CA EURONIC Study Grp
TI End-of-life decisions in neonatal intensive care: physicians'
   self-reported practices in seven European countries
SO LANCET
VL 355
IS 9221
BP 2112
EP 2118
DI 10.1016/S0140-6736(00)02378-3
PD JUN 17 2000
PY 2000
AB Background The ethical issue of foregoing life-sustaining treatment for
   newborn infants at high risk of death or severe disability is
   extensively debated, but there is little information on how physicians
   in different countries actually confront this issue to reach end-of-life
   decisions. The EURONIC project aimed to investigate practices as
   reported by physicians themselves.
   Methods The study recruited a large, representative sample of 122
   neonatal intensive-care units (NICUs) by census tin Luxembourg, the
   Netherlands, and Sweden) or stratified random sampling (in France,
   Germany, the UK, Italy, and Spain) with an overall response rate of 86%.
   Physicians' practices of end-of-life decision-making were investigated
   through an anonymous, self-administered questionnaire. 1235 completed
   questionnaires were returned (response rate 89%).
   Findings In all countries, most physicians reported having been involved
   at least once in setting limits to intensive care because of incurable
   conditions (61-96%); smaller proportions reported such involvement
   because of a baby's poor neurological prognosis (46-90%). Practices such
   as continuation of current treatment without intensification and
   withholding of emergency manoeuvres were widespread, but withdrawal of
   mechanical ventilation was reported by variable proportions (28-90%).
   Only in France (73%) and the Netherlands (47%) was the administration of
   drugs with the aim of ending life reported with substantial frequency.
   Age, length of professional experience, and the importance of religion
   in the physician's life affected the likelihood of reporting of
   non-treatment decisions.
   Interpretation A vast majority of neonatologists in European NICUs have
   been involved in end-of-life limitation of treatments, but type of
   decision-making varies among countries, Cultur-related and other
   country-specific factors are more relevant than characteristics of
   individual physicians or units in explaining such variability.
TC 182
ZB 60
Z8 0
ZS 3
Z9 183
SN 0140-6736
UT WOS:000087687100011
PM 10902625
ER

PT J
AU Leker, RR
   Ben-Hur, T
TI Prognostic factors in artificially ventilated stroke patients
SO JOURNAL OF THE NEUROLOGICAL SCIENCES
VL 176
IS 2
BP 83
EP 87
DI 10.1016/S0022-510X(00)00316-6
PD JUN 15 2000
PY 2000
AB Objectives: To evaluate the reasons for implementing artificial
   ventilation (AV) in patients with acute ischemic stroke (AIS), determine
   their outcome and characterize prognostic variables in these patients.
   Methods: Consecutive patients presenting with AIS were evaluated. All
   patients who received AV were treated in a neurological semi-intensive
   care setting. Results: Of the 173 patients included in the study, 27
   (16%) needed AV, 16 (9%) received AV and five of these patients (31%)
   survived. The mean NIH stroke scale score prior to AV was 14.5+/-5.6
   (vs. 9.1+/-6.3 in non-intubated patients, P=0.001). Sis patients were
   ventilated because of neurological deterioration. Most of these patients
   had large hemispheric infarctions with evident herniation and midline
   shift on CT scans. The only one who survived the acute hospitalization
   did not recover and died within 3 months. In the other 10 patients, AV
   was instituted during cardiopulmonary decompensation (CPD). These
   patients generally fared better; four of them survived and were
   discharged after a lengthier hospital stay when compared to
   non-intubated patients. Variables associated with survival among
   intubated patients were a lower neurological disability score on
   admission and on day 7 after the stroke, and intubation during CPD.
   Conclusions: Implementing AV in semi-intensive care settings does not
   seem to improve survival in AIS patients with neurological
   deterioration. Stroke patients who need AV during CPD and those that
   have less severe neurological deficits may have better chances for
   survival. (C) 2000 Elsevier Science B.V. All rights reserved.
TC 12
ZB 3
Z8 0
ZS 1
Z9 12
SN 0022-510X
UT WOS:000089081100001
PM 10930588
ER

PT J
AU Langevin, B
   Petitjean, T
   Philit, F
   Robert, D
TI Nocturnal hypoventilation in chronic respiratory failure (CRF) due to
   neuromuscular disease
SO SLEEP
VL 23
BP S204
EP S208
SU 4
PD JUN 15 2000
PY 2000
AB Decrease of respiratory muscle capacities in neuromuscular disease can
   lead to chronic respiratory failure with permanent alveolar
   hypoventilation. Respiratory centers elaborate a strategy of breathing
   dedicated to prevent overt respiratory muscles fatigue. This strategy
   may worsen chronic hypercapnia. During sleep, ventilation decreases
   because a lessening in respiratory centers function. During NREM sleep
   hypoventilation is only an exacerbation of what is seen during
   wakefulness. During REM sleep, atonia worsens much more hypoventilation
   particularly when diaphragmatic function is impaired. The effects of
   atonia are amplified by a very low reactivity of respiratory centers.
   Nocturnal mechanical ventilation improves nocturnal hypoventilation and
   daytime arterial blood gases (ABG). Mechanism of improvement in ABG and
   how nocturnal hypoventilation and diurnal hypoventilation interract, are
   still a matter of debate.
CT 3rd Symposium on Diagnosis and Treatment of Sleep Breathing Disorders
CY DEC, 1998
CL GRENOBLE, FRANCE
SP Amer Acad Sleep Med; Sleep Res Soc
TC 2
ZB 2
Z8 0
ZS 0
Z9 3
SN 0161-8105
UT WOS:000087868200028
PM 10893104
ER

PT J
AU Lee, YL
   Cesario, T
   Tran, C
   Stone, G
   Thrupp, L
TI Nasal colonization by methicillin-resistant coagulase-negative
   Staphylococcus in community skilled nursing facility patients
SO AMERICAN JOURNAL OF INFECTION CONTROL
VL 28
IS 3
BP 269
EP 272
DI 10.1067/mic.2000.103243
PD JUN 2000
PY 2000
AB Background: Methicillin-resistant coagulase-negative staphylococci
   (MRCNS) are increasing nosocomial pathogens in acute care hospital
   patients. However, there is little information on the epidemiology of
   MRCNS in skilled nursing facilities (SNFs). We report a pilot survey of
   the prevalence of MRCNS colonization in SNF patients.
   Methods: Anterior nasal swabs were plated on oxacillin salt screening
   agar for selection of MRCNS. Suspected MRCNS were confirmed by coagulase
   and catalase tests and standard disc-diffusion antimicrobial
   susceptibility tests.
   Results: The overall prevalence of MRCNS was 40% for in-house continuing
   SNF patients, 49% for newly admitted patients, and 60% for SNF nursing
   personnel. The prevalence was 13% in a "control" group of nonmedical
   personnel. Forty-six percent of MRCNS were resistant to ciprofloxacin.
   The frequency of colonization with MRCNS increased over time. After an
   average 17 months of facility stay, 32% of noncarriers acquired MRCNS.
   High frequency of colonization was associated with greater disability.
   Conclusion: Colonization with MRCNS is common among SNF patients, who
   can serve as a reservoir for transfer of such strains to acute care
   hospitals. Careful infection control practice, including judicious use
   of antibiotics with frequent handwashing, will remain critical policies
   for limiting spread of such strains.
TC 14
ZB 9
Z8 0
ZS 0
Z9 14
SN 0196-6553
UT WOS:000087607000011
PM 10840350
ER

PT J
AU Ewig, S
   Seifert, K
   Kleinfeld, T
   Goke, N
   Schafer, H
TI Management of patients with community-acquired pneumonia in a primary
   care hospital: a critical evaluation
SO RESPIRATORY MEDICINE
VL 94
IS 6
BP 556
EP 563
DI 10.1053/rmed.1999.0775
PD JUN 2000
PY 2000
AB The aim of the study was to evaluate routine management of patients with
   community-acquired pneumonia (CAP) with regard to severity patterns,
   diagnostic approaches and results, as well as initial empiric
   antimicrobial treatment and its impact on outcome.
   Two hundred and thirty-two consecutive patients with CAP admitted to a
   primary care hospital were studied prospectively. Patients were
   classified according to Fine's severity score. Severe pneumonia was
   defined as admission at the ICU. Diagnostic approaches and initial
   antimicrobial treatment were judged according to the guidelines of the
   European Respiratory Society (ERS).
   Fifty-five patients (24%) had mild, 156 (67%) moderate, and 21 (9%)
   severe CAP. At least one microbial examination was performed in 124
   patients (54%). There was no association between microbial investigation
   and severity of CAP. Inadequate initial antimicrobial treatment was
   significantly more frequent in severe (18/21, 86%), than in mild (5/55,
   9%) and moderate CAP (39/156, 25%, P < 0.0001). Conversely,
   antimicrobial overtreatment occurred significantly more often in mild
   (30/55, 55%) and moderate (77/156, 49%) than in severe CAP (0/21, 0%, P
   < 0.0001). Inadequate initial antimicrobial treatment was more frequent
   in non-responders [18/62 (29%) ps. 31/170, (18%), RR 1.6 95% CI 0.9-2.6,
   P = 0.07] and was associated with a longer duration of hospitalization
   (17 +/- 11 rs. 14 +/- 8 days, P=0.03). Mortality was not affected by
   inadequate initial antimicrobial treatment [5/62 (8%) cs. 10/170 (6%),
   RR 1.4 95% CI 0.5-3.9, P = 0.55].
   Principal conceptual weaknesses which might be subject to intervention
   were (1) the hospitalization of patients with mild pneumonia at low risk
   of mortality; (2) the lack of association between microbial
   investigation and severity of CAP; (3) antimicrobial overtreatment of
   patients with non-severe CAP; and (4) inadequate antimicrobial treatment
   with increased number of primary treatment failures and duration of
   hospitalization.
TC 15
ZB 7
Z8 0
ZS 0
Z9 15
SN 0954-6111
UT WOS:000088201700006
PM 10921759
ER

PT J
AU Lenart, S B
   Garrity, J A
TI Eye care for patients receiving neuromuscular blocking agents or
   propofol during mechanical ventilation.
SO American journal of critical care : an official publication, American
   Association of Critical-Care Nurses
VL 9
IS 3
BP 188
EP 91
PD 2000-May
PY 2000
AB BACKGROUND: The presence of a corneal reflex and the ability to maintain
   eye closure are instrumental in protecting the cornea. Use of
   neuromuscular blocking agents or propofol can result in impaired eyelid
   closure and loss of corneal reflex, leading to corneal exposure. The
   cornea is then at risk for drying, infection, and scarring, which may
   lead to permanent visual loss.
   OBJECTIVES: To determine whether applying artificial tear ointment to
   the eyes of paralyzed or heavily sedated patients receiving mechanical
   ventilation decreases the prevalence of exposure keratitis more than
   does passive closure of the eyelid.
   METHODS: A prospective, randomized control trial was done. The sample
   was 50 patients in the intensive care unit receiving either
   neuromuscular blocking agents or propofol during mechanical ventilation.
   In each patient, artificial tear ointment was applied to one eye;
   passive closure of the eyelid was used for the other eye (control eye).
   RESULTS: Nine patients had evidence of exposure keratitis in the
   untreated eye, and 2 had corneal abrasions in both the treated and the
   control eyes. The remaining 39 patients did not have corneal abrasions
   in either eye. Use of the artificial tear ointment was more effective in
   preventing corneal exposure than was passive eyelid closure (P = .004).
   CONCLUSIONS: Eye care with a lubricating ointment on a regular, set
   schedule can effectively reduce the prevalence of corneal abrasions in
   patients who are either paralyzed or heavily sedated and thus can help
   prevent serious complications such as corneal ulceration, infection, and
   visual loss.
TC 15
ZB 1
Z8 2
ZS 0
Z9 17
SN 1062-3264
UT MEDLINE:10800604
PM 10800604
ER

PT J
AU Esteban, A
   Anzueto, A
   Alia, I
   Gordo, F
   Apezteguia, C
   Palizas, F
   Cide, D
   Goldwaser, R
   Soto, L
   Bugedo, G
   Rodrigo, C
   Pimentel, J
   Raimondi, G
   Tobin, MJ
CA Mech Ventilation Int Study Grp
TI How is mechanical ventilation employed in the intensive care unit? An
   international utilization review
SO AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE
VL 161
IS 5
BP 1450
EP 1458
PD MAY 2000
PY 2000
AB A 1-d point-prevalence study was performed with the aim of describing
   the characteristics of conventional mechanical ventilation in intensive
   care units ICUs from North America, South America Spain, and Portugal.
   The study involved 412 medical-surgical ICUs and 1,638 patients
   receiving mechanical ventilation at the moment of the study. The main
   outcome measures were characterization of the indications for initiation
   of mechanical ventilation, the artificial airways used to deliver
   mechanical ventilation, the ventilator modes and settings, and the
   methods of weaning. The median age of the study patients was 67 yr, and
   the median duration of mechanical ventilation at the time of the study
   was 7 d. Common indications for the initiation of mechanical ventilation
   included acute respiratory failure (66%), acute exacerbation of chronic
   obstructive pulmonary disease (13%), coma (10%), and neuromuscular
   disorders (10%). Mechanical ventilation was delivered via an
   endotracheal tube in 75% of patients, a tracheostomy in 24%, and a
   facial mask in 1%. Ventilator modes consisted of assist/control
   ventilation in 47% of patients and 46% were ventilated with synchronized
   intermittent mandatory ventilation, pressure support, or the combination
   of both. The median tidal volume setting was 9 ml/kg in patients
   receiving assist/control and the median setting of pressure support was
   18 cm H2O. Positive end-expiratory pressure was not employed in 31% of
   patients. Method of weaning varied considerably from country to country,
   and even within a country several methods were in use. We conclude that
   the primary indications for mechanical ventilation and the ventilator
   settings were remarkably similar across countries, but the selection of
   modes of mechanical ventilation and methods of weaning varied
   considerably from country to country.
TC 304
ZB 99
Z8 15
ZS 10
Z9 326
SN 1073-449X
UT WOS:000086945400012
PM 10806138
ER

PT J
AU Agre, JC
   Sliwa, JA
TI Neuromuscular rehabilitation and electrodiagnosis. 4. Specialized
   neuropathy
SO ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION
VL 81
IS 3
BP S27
EP S31
DI 10.1053/apmr.2000.0810s27
SU 1
PD MAR 2000
PY 2000
AB This self-directed learning module briefly highlights the differential
   diagnosis for acute weakness in patients with acute respiratory failure
   requiring prolonged mechanical ventilation. It is part of the chapter on
   neuromuscular rehabilitation and electrodiagnosis in the Self-Directed
   Physiatric Education Program for practitioners and trainees in physical
   medicine and rehabilitation. This article includes a discussion on the
   role of exercise in the treatment of patients with the late effects of
   poliomyelitis or with acute inflammatory demyelinating
   polyradiculoneuropathy. (C) 2000 by the American Academy of Physical
   Medicine and Rehabilitation.
TC 5
ZB 2
Z8 0
ZS 0
Z9 5
SN 0003-9993
UT WOS:000085693900006
PM 10721758
ER

PT J
AU Sliwa, JA
TI Acute weakness syndromes in the critically ill patient
SO ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION
VL 81
IS 3
BP S45
EP S54
DI 10.1016/S0003-9993(00)80010-6
SU 1
PD MAR 2000
PY 2000
AB Over the past three decades there has been increasing interest in acute
   weakness syndromes in critically ill mechanically ventilated patients.
   Many of these patients require rehabilitation, and some understanding of
   potential etiologies and functional outcomes for these syndromes is
   useful to rehabilitation practitioners. A clearer understanding of these
   syndromes has evolved over time, as has the terminology to describe
   these conditions. This article will review commonly encountered causes
   of acute weakness in critically ill patients, including disorders of the
   peripheral nerves, the neuromuscular junction, and muscle. (C) 2000 by
   the American Academy of Physical Medicine and Rehabilitation.
TC 5
ZB 2
Z8 0
ZS 0
Z9 5
SN 0003-9993
UT WOS:000085693900008
PM 10721760
ER

PT J
AU Rais-Bahrami, K
   Wagner, AE
   Coffman, C
   Glass, P
   Short, BL
TI Neurodevelopmental outcome in ECMO vs near-miss ECMO patients at 5 years
   of age
SO CLINICAL PEDIATRICS
VL 39
IS 3
BP 145
EP 152
DI 10.1177/000992280003900302
PD MAR 2000
PY 2000
AB The objective of this study was to compare the outcome of children at 5
   years of age who were treated with extracorporeal membrane oxygenation
   (ECMO) and chose who were critically ill but did not meet ECMO criteria,
   identified as near-miss ECMO, In one of the longest studies of its kind,
   we compared the neurodevelopmental outcome of 76 5-year-old ECMO-treated
   children with 20 5-year-old near-miss ECMO patients with similar primary
   diagnoses. The two groups were compared for demographic data, level of
   ventilatory support, and degree of hyperventilation. The comprehensive
   assessment protocol included an assessment of intelligence (Ia),
   attainment of preacademic and early academic skills, and parents' report
   of adaptive behavior. Both groups had similar demographic data and
   primary diagnosis. The near-miss ECMO patients required increased
   ventilatory support but not significantly more than the ECMO patients.
   The cognitive outcome was similar in both groups with mean estimated
   Full-Scale IQ in the normal range for near-miss and ECMO groups (89 and
   97, respectively). Rates of severe mental handicap (FSIQ <70) (near-miss
   = 11%, ECMO = 12%) and risk for school failure (near-miss = 38%, ECMO =
   37%) were also similar. More parents of near-miss ECMO patients reported
   immature adaptive skills than did parents of ECMO patients, although the
   numbers were small in each group. Rates of parent-reported child
   behavior problems were similar in both groups. ECMO and near-miss ECMO
   patients have similar cognitive and adaptive outcomes at 5 years of age.
   A significant number in each group are at risk of school failure and
   should be closely followed up.
TC 16
ZB 7
Z8 0
ZS 0
Z9 16
SN 0009-9228
UT WOS:000085957600002
PM 10752007
ER

PT J
AU Campellone, J V
TI Clinical Approach to Neuromuscular Weakness in the Critically III
   Patient.
SO Journal of clinical neuromuscular disease
VL 1
IS 3
BP 151
EP 8
DI 10.1097/00131402-200003000-00009
PD 2000-Mar
PY 2000
AB Neuromuscular disorders developing m critically ill patients often
   result in increased morbidity and prolonged intensive care
   hospitalization Detection and assessment of affected patients are
   frequently hindered by the severe nature of the underlying medical
   illness. The various syndromes have overlapping clinical and
   electrodiagnostic features, presenting further obstacles to prompt
   classification. Nonetheless, an accurate diagnosis can usually be
   attained through an organized approach to the evaluation and management
   of critically ill patients with acquired weakness.
TC 3
ZB 2
Z8 1
ZS 0
Z9 3
UT MEDLINE:19078577
PM 19078577
ER

PT J
AU de Lucas, C
   Moreno, M
   Lopez-Herce, J
   Ruiz, F
   Perez-Palencia, M
   Carrillo, A
TI Transpyloric enteral nutrition reduces the complication rate and cost in
   the critically ill child
SO JOURNAL OF PEDIATRIC GASTROENTEROLOGY AND NUTRITION
VL 30
IS 2
BP 175
EP 180
DI 10.1097/00005176-200002000-00015
PD FEB 2000
PY 2000
AB Background: Studies in adults have shown that transpyloric enteral
   nutrition (TEN) is useful in certain patients who cannot tolerate oral
   or gastric feeding. This study was conducted to compare TEN with
   parenteral nutrition (PN) in critically ill pediatric patients.
   Methods: A retrospective descriptive study conducted in the pediatric
   intensive care unit of a tertiary pediatric referral center. All
   patients in the pediatric intensive care unit (PICU) receiving PN and/or
   TEN from January 1993 through December 1996 were included in the study.
   Results: Two hundred forty patients (14.6% of all patients admitted to
   the PICU) received PN and/or TEN (168 exclusively PN, 21 exclusively
   TEN, and 51 a combined regimen). The number of patients receiving PN and
   duration of PN declined significantly from 1993 (65 patients, 703 days)
   through 1996 (48 patients, 395 days). This was mirrored by the increase
   in the number of patients receiving TEN and duration of TEN. The
   incidence of complications (hyperglycemia, hypertriglyceridemia, and
   cholestasis) was higher in the PN group. There was no difference in the
   incidence of hospital-acquired infection or mortality between the two
   groups. The cost of TEN was lower than that of PN, with an estimated
   annual saving of $5,422.
   Conclusions: Transpyloric enteral nutrition is a suitable method of
   nutritional support for critically ill pediatric patients. It has fewer
   complications and a lower cost than PN.
TC 29
ZB 11
Z8 0
ZS 1
Z9 29
SN 0277-2116
UT WOS:000085455300015
PM 10697137
ER

PT J
AU Midgren, B
   Olofson, J
   Harlid, R
   Dellborg, C
   Jacobsen, E
   Norregaard, O
TI Home mechanical ventilation in Sweden, with reference to Danish
   experiences
SO RESPIRATORY MEDICINE
VL 94
IS 2
BP 135
EP 138
DI 10.1053/rmed.1999.0699
PD FEB 2000
PY 2000
AB The Swedish Society of Chest Medicine has started a national register of
   patients on home mechanical ventilation, to establish reliable national
   prevalence data and to accurately document patient and treatment
   characteristics to enable a scientific evaluation of this treatment.
   In this first collection of retrospective register data, covering
   patients on home mechanical ventilation at the register start on I
   January 1996, we found 541 patients, corresponding to 6.1/100 000
   inhabitants, using home mechanical ventilation. Non-invasive
   ventilation, night-time ventilation and volume controlled ventilation
   dominated.
   We found four diagnosis categories of approximately equal size, namely
   post-polio, chest wall deformities, neuromuscular diseases and 'other
   diseases'. The age distribution was bimodal, with one small peak in the
   20-29 year group and a large peak in the 60-69 year group. A survey of
   Danish patients on home mechanical ventilation showed that they were
   considerably younger and that almost half of them suffered from
   neuromuscular diseases. Further work will be done to follow the
   situation in Sweden and in Denmark to elucidate the obvious differences
   in the selection of patients for home mechanical ventilation (C) 2000
   HARCOURT PUBLISHERS LTD.
TC 18
ZB 9
Z8 1
ZS 0
Z9 19
SN 0954-6111
UT WOS:000085547000006
PM 10714418
ER

PT J
AU Larsson, L
   Li, XP
   Edstrom, L
   Eriksson, LI
   Zackrisson, H
   Argentini, C
   Schiaffino, S
TI Acute quadriplegia and loss of muscle myosin in patients treated with
   nondepolarizing neuromuscular blocking agents and corticosteroids:
   Mechanisms at the cellular and molecular levels
SO CRITICAL CARE MEDICINE
VL 28
IS 1
BP 34
EP 45
DI 10.1097/00003246-200001000-00006
PD JAN 2000
PY 2000
AB Objective: Long-term treatment with nondepolarizing neuromuscular
   blocking agents and corticosteroids in the intensive care unit is not
   benign, and an increasing number of patients with acute quadriplegic
   myopathy have been reported with increased use of these drugs, The
   purpose of this study was to investigate the mechanisms underlying acute
   quadriplegic myopathy,
   Design: Percutaneous muscle biopsy samples were obtained, and
   electrophysiologic examinations were performed during the acute phase
   and during recovery in patients with acute quadriplegic myopathy,
   Regulation of muscle contraction and myofibrillar protein synthesis was
   studied using cell physiologic techniques, ultrasensitive
   electrophoresis, in situ hybridization, and histopathologic techniques.
   Setting: All patients were seen in the intensive care unit of different
   university hospitals.
   Patients: All patients were critically ill with sepsis, They had been
   given massive doses of corticosteroids in combination with variable
   doses of neuromuscular blocking agents. All patients developed paralysis
   of spinal nerve-innervated muscles. On the other hand, cranial
   nerve-innervated muscle and sensory and cognitive functions were well
   maintained after discontinuation of treatment with neuromuscular
   blocking agents.
   Intervention: Muscle biopsy samples were obtained and electrophysiologic
   examinations were performed in all patients.
   Measurements and Main Results: The major observations in patients with
   acute quadriplegic myopathy were, as follows: a) a general decrease in
   myofibrillar protein content; b) specific but highly variable partial or
   complete loss of myosin and myosin-associated proteins; c) very low
   thick-filament/thin-filament protein ratios; d) absence of myosin
   messenger RNA; and e) a dramatically impaired muscle cell
   force-generating capacity in the acute phase of acute quadriplegic
   myopathy, During clinical improvement, normal expression of myosin
   messenger RNAs, reexpression of thick-filament proteins, and increased
   specific tension were observed.
   Conclusions: Acute quadriplegic myopathy is associated with a specific
   decrease in thick-filament proteins related to an altered transcription
   rate. Although the decreased content of thick-filament proteins is
   important far prolonged muscle weakness, it is not the primary cause of
   muscle paralysis in the acute stage, during which impaired muscle
   membrane excitability probably plays a more significant role. Several
   factors contribute to this condition, but the action of corticosteroids
   seems to be the predominant one, along with potentiation by
   neuromuscular blocking agents, immobilization, and probably also
   concurrent sepsis.
TC 108
ZB 68
Z8 2
ZS 0
Z9 111
SN 0090-3493
UT WOS:000085057400006
PM 10667496
ER

PT J
AU Annane, D
   Chevrolet, J C
   Chevret, S
   Raphael, J C
TI Nocturnal mechanical ventilation for chronic hypoventilation in patients
   with neuromuscular and chest wall disorders.
SO The Cochrane database of systematic reviews
IS 2
BP CD001941
EP CD001941
PD 2000
PY 2000
AB BACKGROUND: Chronic alveolar hypoventilation is a common complication of
   many neuromuscular and chest wall disorders. Long term nocturnal
   mechanical ventilation is used to treat an increasing number of
   patients.
   OBJECTIVES: To examine the efficacy of nocturnal mechanical ventilation
   in relieving hypoventilation related symptoms in patients with
   neuromuscular or chest wall disorders.
   SEARCH STRATEGY: Search of the Cochrane Neuromuscular Disease Group
   register for randomized trials and enquiry from authors of trials and
   other experts in the field.
   SELECTION CRITERIA: Types of studies: quasi-randomized or randomized
   controlled trials
   TYPES OF PARTICIPANTS: patients with neuromuscular or chest wall
   disorder-related stable chronic hypoventilation of all ages and all
   degrees of severity. Types of interventions: any type and any mode of
   nocturnal mechanical ventilation. Types of outcome measures: Primary:
   short term and long term reversal of hypoventilation related clinical
   symptoms Secondary: unplanned hospital admission rate, one year
   mortality, short term and long term reversal of day time hypercapnia,
   improvement of lung function and improvement of sleep breathing
   disorders.
   DATA COLLECTION AND ANALYSIS: We identified four randomized trials. One
   author extracted the data and another checked them. Individual data were
   available from the authors of the largest study.
   MAIN RESULTS: The four eligible trials included a total of 51 patients.
   The risk difference (proportion of patients) of no improvement of
   hypoventilation related clinical symptoms in the short term following
   nocturnal mechanical ventilation was significant and favoured treatment,
   -0.417 (95% CI -0.639 to -0.194). However, there was significant
   heterogeneity across the studies (p<0.001). Similarly, the risk
   difference of no reversal of day time hypercapnia in the short term
   following nocturnal ventilation was significant and favoured treatment,
   -0.635 (95% CI -0.874 to -0.396). The weighted mean difference of
   nocturnal mean oxygen saturation percent was 5.5 (95% CI 1.5 to 9.4)
   more improvement in patients treated with nocturnal mechanical
   ventilation. For the primary and most of the secondary outcome measures
   there was no significant difference between nocturnal mechanical
   ventilation and no ventilation in the long term, except for one-year
   mortality. Indeed, the risk difference of death one year following
   implementation of nocturnal mechanical ventilation was significant and
   favoured treatment, -0.259 (95% CI -0.478 to -0. 041). However, there
   was significant heterogeneity across the studies (p<0.001). Most of the
   secondary outcomes were not assessed in the eligible trials. No data
   could be summarised for the comparisons between invasive and
   non-invasive mechanical ventilation, between intermittent positive
   pressure and negative pressure ventilation, and between volume-cycled
   and pressure-cycled ventilation.
   REVIEWER'S CONCLUSIONS: Current evidence about the therapeutic benefit
   of mechanical ventilation is weak, but consistent, suggesting
   alleviation of the symptoms of chronic hypoventilation in the short
   term, and in two small studies survival was prolonged. Mechanical
   ventilation should be offered as a therapeutic option to patients with
   chronic hypoventilation due to neuromuscular diseases. Further larger
   randomized trials are needed to confirm long term beneficial effects of
   nocturnal mechanical ventilation on quality of life, morbidity and
   mortality, to assess its cost-benefit ratio, and to compare the
   different types and modes of ventilation.
TC 1
ZB 1
Z8 0
ZS 1
Z9 1
UT MEDLINE:10796839
PM 10796839
ER

PT J
AU Cools, F
   Offringa, M
TI Neuromuscular paralysis for newborn infants receiving mechanical
   ventilation.
SO The Cochrane database of systematic reviews
IS 4
BP CD002773
EP CD002773
PD 2000
PY 2000
AB BACKGROUND: Ventilated newborn infants breathing in asynchrony with the
   ventilator are at risk for complications during mechanical ventilation,
   such as pneumothorax or intraventricular hemorrhage, and are exposed to
   more severe barotrauma, which consequently could impair their clinical
   outcome. Neuromuscular paralysis, which eliminates spontaneous breathing
   efforts of the infant, has potential advantages in this respect.
   However, a number of complications have been reported with muscle
   relaxation in infants, so that concerns exist regarding the safety of
   prolonged neuromuscular paralysis in newborn infants.
   OBJECTIVES: To determine whether routine neuromuscular paralysis of
   newborn infants receiving mechanical ventilation compared with no
   routine paralysis results in clinically important benefits or harms.
   SEARCH STRATEGY: MEDLINE (from 1966 to May 2000) and EMBASE (from 1988
   to May 2000) were searched, as well as The Cochrane Controlled Trials
   Register (issue 2, 2000). References of review articles were hand
   searched. Language restriction was not imposed.
   SELECTION CRITERIA: All trials using random or quasi-random patient
   allocation, in which the routine use of neuromuscular blocking agents
   during mechanical ventilation was compared to no paralysis or selective
   paralysis in newborn infants. Methodological quality was assessed
   blindly and independently by the two authors.
   DATA COLLECTION AND ANALYSIS: Data were abstracted using standard
   methods of the Cochrane Collaboration and its Neonatal Review Group,
   with independent evaluation of trial quality, and abstraction and
   synthesis of data by both authors. Treatment effect was analysed using
   relative risk, risk difference and weighted mean difference.
   MAIN RESULTS: Ten possibly eligible trials were identified, of which
   five were included in the review. All the included trials studied
   preterm infants ventilated for respiratory distress syndrome, and used
   pancuronium as the neuromuscular blocking agent. In the analysis of the
   results of all trials, no difference was found in mortality, air leak or
   chronic lung disease, but there was a significant reduction in
   intraventricular hemorrhage and a trend towards less severe
   intraventricular hemorrhages. In the subgroup analysis of trials
   studying a selected population of ventilated infants with evidence of
   asynchronous respiratory efforts, a significant reduction in
   intraventricular hemorrhage (any grade and severe IVH) was found, and a
   trend towards less air leak. In the subgroup analysis of trials studying
   an unselected population of ventilated infants, no differences were
   found for any of the outcomes.
   REVIEWER'S CONCLUSIONS: For ventilated preterm infants with evidence of
   asynchronous respiratory efforts, neuromuscular paralysis with
   pancuronium seems to have a favourable effect on intraventricular
   hemorrhage and possibly on air leak. Uncertainty remains, however,
   regarding the long term pulmonary and neurologic effects, and regarding
   the safety of prolonged use of pancuronium in ventilated newborn
   infants. There is no evidence from randomized trials on the effects of
   neuromuscular blocking agents other than pancuronium. Therefore, the
   routine use of pancuronium or any other neuromuscular blocking agent in
   ventilated newborn infants cannot be recommended based on current
   evidence.
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
UT MEDLINE:11034760
PM 11034760
ER

PT J
AU Symington, A
   Pinelli, J
TI Developmental care for promoting development and preventing morbidity in
   preterm infants.
SO The Cochrane database of systematic reviews
IS 4
BP CD001814
EP CD001814
PD 2000
PY 2000
AB BACKGROUND: Preterm infants experience a range of morbidity related to
   the immaturity of their organ systems and to concurrent disease states.
   An unfavourable environment in the neonatal intensive care unit (NICU)
   may compound this morbidity. Modification of the environment could
   minimize the iatrogenic effects. Developmental care is a broad category
   of interventions designed to minimize the stress of the NICU
   environment. These interventions may include one or more elements such
   as control of external stimuli (vestibular, auditory, visual, tactile),
   clustering of nursery care activities, and positioning or swaddling of
   the preterm infant. Individual strategies have also been combined to
   form programs, such as the 'Neonatal Individualized Developmental Care
   and Assessment Program' (NIDCAP) (Als 1986).
   OBJECTIVES: In preterm infants, do developmental care interventions
   reduce neurodevelopmental delay, poor weight gain, length of hospital
   stay, length of mechanical ventilation, physiological stress and other
   clinically relevant adverse outcomes?
   SEARCH STRATEGY: The Neonatal Review Group search strategy was utilized.
   Searches were made of Medline from 1966 to July, 2000, and of CINAHL,
   The Cochrane Library, and conference and symposia proceedings in the
   English language from 1990 to July, 2000. A list of all relevant
   articles was sent to two experts in the field to identify any omissions
   or additional unpublished studies.
   SELECTION CRITERIA: Randomized trials in which elements of developmental
   care are compared to routine nursery care for infants < 37 weeks
   gestation and that measured clinically relevant outcomes. Reports were
   in English or a language for which a translator was available.
   Computerized searches were conducted and all potentially relevant titles
   and abstracts were extracted. Retrieved articles were assessed for
   relevance independently by two reviewers, based on predetermined
   criteria. Articles that met all criteria for relevance were assessed for
   methodological quality based on predetermined criteria. Articles judged
   to have the appropriate quality by both reviewers were included in the
   analysis.
   DATA COLLECTION AND ANALYSIS: Data were extracted independently by the
   two authors. Meta-analyses were conducted for each intervention where
   the same outcome measures and/or instruments were used within comparable
   time points.
   MAIN RESULTS: This review detected 31 eligible randomized controlled
   trials involving four major groups of developmental care interventions,
   19 sub-groups and multiple clinical outcomes. The results of the review
   indicate that developmental care interventions demonstrate some benefit
   to preterm infants with respect to: improved short-term growth outcomes,
   decreased respiratory support, decreased length and cost of hospital
   stay, and improved neurodevelopmental outcomes to 24 months corrected
   age. These findings were based on two or three small trials for each
   outcome, and did not involve meta-analyses of more than two trials for
   any one outcome. Although a number of other benefits were demonstrated,
   those results were from single studies with small sample sizes. The lack
   of blinding of the assessors was a significant methodological flaw in
   half of the studies. The cost of the interventions and personnel was not
   considered in any of the studies.
   REVIEWER'S CONCLUSIONS: Because of the inclusion of multiple
   interventions in most studies, the determination of the effect of any
   single intervention is difficult. Although there is evidence of some
   benefit of developmental care interventions overall, and no major
   harmful effects reported, there were a large number of outcomes for
   which no or conflicting effects were demonstrated. The single trials
   that did show a significant effect of an intervention on a major
   clinical outcome were based on small sample sizes, and the findings were
   often not supported in other small trials. Before a clear direction for
   practice can be supported, evidence demonstrating more consistent
   effects of developmental care interventions on important short- and
   long-term clinical outcomes is needed. The economic impact of the
   implementation and maintenance of developmental care practices should be
   considered by individual institutions.
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
UT MEDLINE:11034730
PM 11034730
ER

PT J
AU French, CJ
TI Work of breathing measurement in the critically ill patient
SO ANAESTHESIA AND INTENSIVE CARE
VL 27
IS 6
BP 561
EP 573
PD DEC 1999
PY 1999
AB Weaning patients from mechanical ventilation in the intensive care unit
   can be difficult. In patients requiring prolonged ventilatory support it
   has been demonstrated that conventional weaning criteria are frequently
   incorrect. In this group measurement of respiratory work may be of
   benefit. Until recently estimation of the work of breathing in patients
   receiving mechanical ventilation was logistically difficult. The
   availability of a computerized bedside monitoring device potentially
   allows easier estimation of the work of breathing at the bedside. The
   results of preliminary studies utilizing such monitoring are
   provocative: they highlight the phenomenon of nosocomial respiratory
   failure and challenge our clinical ability to determine patient
   workloads and timing of extubation. The potential benefits of work of
   breathing measurement, in particular the avoidance of respiratory muscle
   fatigue, earlier extubation, reduced duration of mechanical ventilation,
   reduction in ICU and hospital length of stay, and most importantly: a
   reduction in patient morbidity are yet to be demonstrated and concerns
   still exist about the monitor's accuracy.
TC 7
ZB 1
Z8 0
ZS 0
Z9 7
SN 0310-057X
UT WOS:000084393700002
PM 10631408
ER

PT J
AU de Lemos, JM
   Carr, RR
   Shalansky, KF
   Bevan, DR
   Ronco, JJ
TI Paralysis in the critically ill: Intermittent bolus pancuronium compared
   with continuous infusion
SO CRITICAL CARE MEDICINE
VL 27
IS 12
BP 2648
EP 2655
DI 10.1097/00003246-199912000-00007
PD DEC 1999
PY 1999
AB Objectives: To compare recovery times from neuromuscular blockade
   between two groups of critically ill patients in whom pancuronium was
   administered by continuous infusion or intermittent bolus injection. To
   compare the mean pancuronium requirements (milligrams per kilogram per
   hour) and to assess the incidence of prolonged recovery times (>12 hrs)
   and residual muscle weakness.
   Design: Prospective, observational cohort.
   Setting: Intensive care unit in a university-affiliate hospital.
   Patients: A total of 30 mechanically ventilated patients who required
   pharmacologic paralysis. Patients were excluded if they had renal
   failure (creatinine clearance <30 mL/min), heart rate >130 beats/min,
   hepatic failure, peripheral nerve disease or myopathy, stroke, spinal
   cord damage, or myasthenia gravis.
   Interventions: Patients were assigned to receive pancuronium either by
   continuous infusion (n = 14) or intermittent bolus (n = 16). Depth of
   paralysis was titrated to maintain one or two responses to Train-of-Four
   stimulation with an accelerograph and desired clinical goals. Recovery
   time was defined as time from discontinuation of muscle relaxant until
   the amplitude of the fourth twitch, measured every 15-30 min using an
   accelerograph, was 70% the amplitude of the first twitch (Train-of-Four
   greater than or equal to 0.7).
   Measurements and Main Results: These patients included the only three
   patients with status asthmaticus in our study. The groups were similar
   with respect to age, sex, weight, Acute Physiology and Chronic Health
   Evaluation II score, mode of ventilation, creatinine clearance,
   indications for paralysis, and duration of pancuronium administration.
   The median time for patients to recover from paralysis was 3.5 hrs (95%
   confidence interval, 1.82-5.18) in the infusion group vs. 6.3 hrs (95%
   confidence interval, 3.40-9.19) in the intermittent bolus group (p =
   .10). Less drug was administered in the intermittent group (mean, 0.02
   +/- 0.01 mg/kg/hr) than by infusion (mean, 0.04 +/- 0.01 mg/kg/hr; p <
   .001). Six patients (five in the infusion group and one in the
   intermittent group) developed persistent severe muscle weakness. In
   addition, six different patients (three from each group) had prolonged
   recovery >12 hrs.
   Conclusions: Our study suggests that recovery time after paralysis with
   continuous infusion is faster than that after intermittent bolus
   injection. Although more pancuronium was administered in the
   continuous-infusion group, recovery time was not prolonged as a
   consequence. It is uncertain whether pancuronium given by infusion
   increases the risk of persistent muscle weakness.
TC 10
ZB 2
Z8 0
ZS 0
Z9 10
SN 0090-3493
UT WOS:000084523600007
PM 10628604
ER

PT J
AU Rossi, A
   De Ninno, G
   Mergoni, M
TI Respiratory muscles in intensive care medicine.
SO Monaldi archives for chest disease = Archivio Monaldi per le malattie
   del torace / Fondazione clinica del lavoro, IRCCS [and] Istituto di
   clinica tisiologica e malattie apparato respiratorio, Universita di
   Napoli, Secondo ateneo
VL 54
IS 6
BP 532
EP 8
PD 1999-Dec
PY 1999
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 1122-0643
UT MEDLINE:10695326
PM 10695326
ER

PT J
AU Sivak, E D
   Shefner, J M
   Sexton, J
TI Neuromuscular disease and hypoventilation.
SO Current opinion in pulmonary medicine
VL 5
IS 6
BP 355
EP 62
DI 10.1097/00063198-199911000-00006
PD 1999-Nov
PY 1999
AB Alveolar hypoventilation associated with neuromuscular disease can occur
   in acute and chronic forms. In the acute form, progressive weakness of
   respiratory muscles leads to rapid reduction in vital capacity followed
   by respiratory failure with hypoxemia and hypercarbia. Symptoms are
   those of acute respiratory failure, including dyspnea, tachypnea, and
   tachycardia. In the chronic form, impairment of the respiratory muscles
   affects mechanical properties of the lungs and chest wall, decreases the
   ability to clear secretions, and eventually may alter the function of
   the central respiratory centers. Symptoms include orthopnea, fatigue,
   disturbed sleep, and hypersomnolence. Treatment and outcome of the
   disease's chronic form are dependent on the underlying clinical cause of
   the alveolar hypoventilation. For chronic but stable diseases such as
   old polio, quadriplegia, or kyposcoliosis, mechanical support of minute
   ventilation can reverse symptoms. For chronic and progressive disease
   such as muscular dystrophy and amyotrophic lateral sclerosis, mechanical
   support of minute ventilation provides only symptomatic relief and is
   usually associated with deterioration to the point of complete
   ventilator dependency for survival. For the chronic progressive forms of
   alveolar hypoventilation, there is currently a need for quality
   randomized controlled clinical trials to define physiologic indicators
   and appropriate timing for mechanical support of minute ventilation.
TC 15
ZB 10
Z8 0
ZS 1
Z9 17
SN 1070-5287
UT MEDLINE:10570736
PM 10570736
ER

PT J
AU Latronico, N
   Guarneri, B
   Alongi, S
   Bussi, G
   Candiani, A
TI Acute neuromuscular respiratory failure after ICU discharge - Report of
   five patients
SO INTENSIVE CARE MEDICINE
VL 25
IS 11
BP 1302
EP 1306
DI 10.1007/s001340051062
PD NOV 1999
PY 1999
AB Objective: To describe a syndrome of acute neuromuscular respiratory
   failure (NM-ARF) caused by ICU-acquired acute myopathy and neuropathy.
   Design: Case series.
   Setting: General Regional University Hospital in Brescia, Italy.
   Patients: Five adult patients with NM-ARF after prolonged ICU stay and
   successful weaning from the ventilator and ICU discharge.
   Interventions: None.
   Measurements: Clinical signs of NM-ARF, electroneurography and
   electromyography (ENMG) of peripheral nerves and muscles, and functional
   assessment of respiratory muscles.
   Results: NM-ARF was diagnosed at the time of tone case), or 1-3 days
   after, ICU discharge. Limb weakness alarmed the physicians, while the
   signs of the NM-ARF were initially undetected. In the first observed
   case the acute respiratory failure was near fatal, and necessitated ICU
   readmission, while in the other cases 2 weeks of aggressive chest
   physiotherapy permitted resolution of the respiratory failure. History,
   clinical course and ENMG indicated the diagnosis of critical illness
   myopathy and neuropathy (CRIMYNE). Three patients recovered fully, while
   two had persisting evidence of axonal polyneuropathy several months
   after the onset.
   Conclusions: Critically ill patients with prolonged ICU stay, sepsis and
   MOF are at great risk of developing CRIMYNE, which in turn may be
   responsible for NM-ARE This latter complication may arise after
   resolution of the respiratory and cardiac dysfunctions and successful
   weaning from the ventilator. As NM-ARF may cause unplanned ICU
   readmission or even unexpected death, strict clinical surveillance and
   monitoring of respiratory muscle function is recommended after discharge
   to the general ward of patients with proven NM-ARF Early intensive chest
   physiotherapy can resolve the condition.
RI Latronico, Nicola/F-1557-2010
OI Latronico, Nicola/0000-0002-2521-5871
TC 22
ZB 3
Z8 1
ZS 0
Z9 22
SN 0342-4642
UT WOS:000084081200019
PM 10654218
ER

PT J
AU Petersen, B
   Schneider, C
   Strassburg, HM
   Schrod, L
TI Critical illness neuropathy in pediatric intensive care patients
SO PEDIATRIC NEUROLOGY
VL 21
IS 4
BP 749
EP 753
DI 10.1016/S0887-8994(99)00076-4
PD OCT 1999
PY 1999
AB Critical illness neuropathy is an axonal polyneuropathy recognized more
   frequently in adult intensive care patients with sepsis and multiple
   organ dysfunction, In children the diagnosis is rarely made. Within 1
   year the authors observed two children with critical illness neuropathy,
   Both patients, a male 6 years, 6 months of age with a brain contusion
   and a male 2 years, 6 months of age who underwent craniectomy for
   Crouzon's disease, required prolonged mechanical ventilation and
   developed sepsis with multiple organ dysfunction. Three to 4 weeks after
   successful treatment of the sepsis, a flaccid tetraparesis was noticed
   in both patients. Laboratory investigations of blood and cerebrospinal
   fluid and spinal magnetic resonance imaging revealed normal results.
   Electrophysiologic examinations were indicative of an axonal
   polyneuropathy, Spontaneous improvement occurred within several months.
   It is likely that critical illness neuropathy occurs more often in
   critically ill children than previously thought. Careful neurologic
   examination and early electrophysiologic investigations are necessary to
   establish the diagnosis. Important differential diagnoses of acquired
   lower motor neuron weakness in pediatric intensive care medicine are
   discussed. (C) 1999 by Elsevier Science Inc. All rights reserved.
TC 15
ZB 8
Z8 0
ZS 0
Z9 15
SN 0887-8994
UT WOS:000083651700012
PM 10580891
ER

PT J
AU Dales, RE
   O'Connor, A
   Hebert, P
   Sullivan, K
   McKim, D
   Llewellyn-Thomas, H
TI Intubation and mechanical ventilation for COPD - Development of an
   instrument to elicit patient preferences
SO CHEST
VL 116
IS 3
BP 792
EP 800
DI 10.1378/chest.116.3.792
PD SEP 1999
PY 1999
AB Background: whether to simply provide palliative care or to intubateate
   and use mechanical ventilation (MV) in a patient with severe COPD in
   acute respiratory failure is a difficult decision. The outcome of MV
   cannot be accurately predicted. Some patients cannot be weaned fi from
   the ventilator; those who are weaned often I return to chronic severe
   respiratory disability, it is important that patients participate in
   this decision, but assistance is I required. To address these issues, we
   developed and pilot-tested an aid to assist patients with MV decisions.
   Methods: A scenario-based decision aid was developed consisting of an
   audiocassette and a booklet describing intubation and MV and its
   possible outcomes. We used a probability! tradeoff technique to elicit
   the patients' preferences and a decisional conflict scale to evaluate
   satisfaction,
   Results: With the assistance of the decision aid, all patients (10 men
   and. 10 women) reached a decision. Two men and all 10 women declined MV.
   Mean decisional conflict was low (2.2 of a possible 5; SD, 0,9), At 1
   year, only two patients (11%) had changed their decision. The agreement
   between physicians and patients was 65%; between nest-of-kin :and
   patients, there,e was uniform disagreement.
   Conclusion: With the decision aid, stable decisions were made with
   satisfaction and confidence. Pr xy decisions were incongruent,
   especially when made by family members. The strong gender effect should
   be further investigated. We suggest that the COPD decision aid he
   further tested in a community clinical setting.
TC 54
ZB 16
Z8 1
ZS 0
Z9 55
SN 0012-3692
UT WOS:000082475900034
PM 10492288
ER

PT J
AU Venkataraman, ST
TI Noninvasive mechanical ventilation and respiratory care
SO NEW HORIZONS-THE SCIENCE AND PRACTICE OF ACUTE MEDICINE
VL 7
IS 3
BP 353
EP 358
PD FAL 1999
PY 1999
AB Noninvasive ventilation refers to a technique of respiratory support
   that is provided without an artificial airway in the trachea, using
   either positive- or negative-pressure ventilators. It is very useful in
   patients with obstructive sleep apnea, chronic obstructive lung disease,
   chronic respiratory insufficiency due to skeletal or neuromuscular
   disorders, and central hypoventilation. In children, the use of
   noninvasive positive-pressure ventilation resulted in a significant
   improvement in hospital days, respiratory rate, heart rate, serum
   bicarbonate, PaCO2, dyspnea, activity tolerance, and quality of sleep.
   Recently, it has been used in patients with acute respiratory failure as
   well with an improvement in both oxygenation and ventilation with a
   reduction in the need for endotracheal intubation and an increase in
   patient comfort. Not all patients benefit from noninvasive mechanical
   ventilation. A recent randomized study showed that preventive nasal
   positive-pressure ventilation did not improve respiratory handicap and
   reduced the survival rate in patients with Duchenne's muscular dystrophy
   with a forced vital capacity between 20% and 50% predicted.
   Negative-pressure ventilation has been found to be useful in patients
   with respiratory failure including those patients with paralytic
   respiratory failure, neonatal respiratory distress syndrome, and in
   selected patients after surgery for congenital heart surgery.
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 1063-7389
UT WOS:000083734500008
ER

PT J
AU Rini, BI
   Gajewski, TF
TI Polymyositis with respiratory muscle weakness requiring mechanical
   ventilation in a patient with metastatic thymoma treated with octreotide
SO ANNALS OF ONCOLOGY
VL 10
IS 8
BP 973
EP 979
DI 10.1023/A:1008321802223
PD AUG 1999
PY 1999
AB Although most patients with thymoma present with a mediastinal mass
   amenable to surgical resection, some patients develop metastatic disease
   requiring systemic therapy. The majority of thymomas express
   somatostatin receptors as demonstrated by octreotide scanning, an
   observation which has prompted the clinical use of octreotide in
   patients with this disease. Many patients with thymoma exhibit
   autoimmune paraneoplastic syndromes, most frequently myesthenia gravis.
   We report here the case of a patient with metastatic thymoma who
   developed a profound autoimmune polymyositis and lupus-like syndrome
   that flared following treatment with octreotide and was associated with
   a clinical response to this agent. No evidence for myesthenia gravis was
   discovered. The severity of the myopathy necessitated mechanical
   ventilation for 12 weeks. The natural history of thymoma, treatment
   options including recent combination chemotherapy regimens, and
   potential mechanisms for flaring of autoimmune paraneoplastic syndromes
   triggered by therapy of thymoma are discussed.
TC 6
ZB 3
Z8 0
ZS 0
Z9 6
SN 0923-7534
UT WOS:000082440000024
PM 10509161
ER

PT J
AU Tomaszewska, M
   Stork, E
   Minich, NM
   Friedman, H
   Berlin, S
   Hack, M
TI Pulmonary hemorrhage - Clinical course and outcomes among very
   low-birth-weight infants
SO ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE
VL 153
IS 7
BP 715
EP 721
PD JUL 1999
PY 1999
AB Objective: To describe the clinical course, neonatal morbidity, and
   neurodevelopmental outcomes of very low-birth-weight (<1500 g) children
   who develop pulmonary hemorrhage.
   Design: A retrospective case-control study in which 58 very low
   birth-weight infants who developed pulmonary hemorrhage during 1990
   through 1994, of whom 29 survived, were each matched to the next
   admitted infant who required mechanical ventilation for respiratory
   distress syndrome and was of the same sex, race, and birth weight
   (within 250 g).
   Setting: A regional tertiary neonatal intensive care unit and follow-up
   clinic for high-risk infants at University Hospitals of Cleveland,
   Cleveland, Ohio.
   Main Outcome Measures: Survival, neonatal morbidity, and
   neurodevelopmental outcome at 20 months' corrected age.
   Results: Pulmonary hemorrhage occurred in 5.7% of the total population
   of very low-birth-weight infants. Despite similar severity of lung
   disease, significantly more infants who developed pulmonary hemorrhage
   received surfactant therapy compared with controls (91% vs 69%, P=.005).
   Infants with pulmonary hemorrhage who died had a lower birth weight and
   gestational age compared with those who survived (766 g vs 1023 g; 25
   weeks vs 28 weeks, P<.001) and more received surfactant therapy (100% vs
   83%, P=.05). Survivors with pulmonary hemorrhage did not differ
   significantly from controls in rates of oxygen dependence at 36 weeks
   corrected age (52% vs 38%), grade 3 to 4 periventricular hemorrhage (28%
   vs 17%), or necrotizing enterocolitis (3% vs 7%), but tended to have
   more seizures (24% vs 3%, P = .05), periventricular leucomalacia (17% vs
   0%, P = .06), and patent ductus arteriosus (79% vs 55%, P = .09). There
   were no significant differences in neurodevelopmental outcomes at 20
   months' corrected age, (cerebral palsy, 16% vs 14%; subnormal [<70]
   Bayley Mental Developmental Index, 59% vs 43%; and deafness, 13% vs
   10%).
   Conclusion: Although mortality is high, pulmonary hemorrhage does not
   significantly increase the risk of later pulmonary or neurodevelopmental
   disabilities among those who survive.
TC 22
ZB 12
Z8 0
ZS 2
Z9 23
SN 1072-4710
UT WOS:000081290800007
PM 10401804
ER

PT J
AU Feldman, M A
   Ducharme, J M
   Case, L
TI Using self-instructional pictorial manuals to teach child-care skills to
   mothers with intellectual disabilities.
SO Behavior modification
VL 23
IS 3
BP 480
EP 97
DI 10.1177/0145445599233007
PD 1999-Jul
PY 1999
AB Children of parents with intellectual disabilities (i.e., IQs less than
   80, labeled as having mental retardation) are at risk for neglect due to
   inadequate parenting abilities. Previous studies have shown that these
   parents are responsive to parent-training packages consisting of
   instructions, pictorial cues, modeling, feedback, and reinforcement.
   This study evaluated the effectiveness of self-learning
   pictorial-parenting manuals in teaching basic child-care skills
   (diapering, treating diaper rash, bathing, safety) to parents with
   intellectual disabilities who are monitored by child protection
   agencies. The manuals alone increased child-care skills (to levels seen
   in parents without disabilities) in 9 out of the 10 mothers in the study
   and in 12 of 13 child-care skills. The remaining skill was acquired with
   the full training package. Follow-up indicated that the acquired skills
   were maintained for up to 3 years. Mean correct performance with the
   manual was positively correlated with the trainer's rating of the
   mother's reading level and acceptance of the manual when the mother was
   first given the manual. Consumer satisfaction ratings of the manuals
   were high. These results indicate that many parents with intellectual
   disabilities may improve their child-care skills without intensive
   training and that self-instruction may be an easily disseminable and
   cost-effective way of reducing the risk of child neglect due to
   parenting skill deficiencies.
TC 11
ZB 1
Z8 0
ZS 1
Z9 12
SN 0145-4455
UT MEDLINE:10467893
PM 10467893
ER

PT J
AU Devlin, JW
   Boleski, G
   Mlynarek, M
   Nerenz, DR
   Peterson, E
   Jankowski, M
   Horst, HM
   Zarowitz, BJ
TI Motor Activity Assessment Scale: A valid and reliable sedation scale for
   use with mechanically ventilated patients in an adult surgical intensive
   care unit
SO CRITICAL CARE MEDICINE
VL 27
IS 7
BP 1271
EP 1275
DI 10.1097/00003246-199907000-00008
PD JUL 1999
PY 1999
AB Objective: To establish the validity and reliability of a new sedation
   scale, the Motor Activity Assessment Scale (MAAS).
   Design:Prospective, psychometric evaluation.
   Setting: Sixteen-bed surgical intensive care unit (SICU) of a 937-bed
   tertiary care, university-affiliated teaching hospital.
   Patients: Twenty-five randomly selected, adult, mechanically ventilated,
   nonneurosurgical patients who were admitted to the SICU greater than or
   equal to 12 hrs after surgery and were not receiving neuromuscular
   blockers.
   Intervention: Four hundred assessments (eight per patient) were
   completed consecutively but independently, in pairs, at standardized
   times (both day and night) by two nurses who were preselected for each
   assessment from a pool of 32 pretrained SICU nurses.
   Measurements and Main Results:To estimate validity, paired assessments
   (four/patient) compared the MAAS result with the subjective assessment
   using a 10-cm visual analog sedation scale, the percent change in blood
   pressure and heart rate from the previous 4-hr baselines, and the number
   of recent agitation-related sequelae. To estimate reliability, paired
   assessments (four/patient) measured correlation between assessments of
   the same type (e.g., MAAS-MAAS). Generalized estimating equations, which
   accounted for the four repeated measures in each patient, supported MAAS
   validity by finding a linear trend between MAAS and the visual analog
   scale (p < .001), blood pressure (p < .001), heart rate (p < .001), and
   agitation-related sequelae (p < .001) end points. The MAAS (kappa = 0.83
   [95% confidence interval, 0.72 to 0.94]) was found to be more reliable
   than subjective assessment using the visual analog scale (intraclass
   correlation coefficient = 0.32 [95% confidence interval, 0.05 to 0.55]).
   Conclusions: The MAAS is a valid and reliable sedation scale for use
   with mechanically ventilated patients in the SICU. Further studies are
   warranted regarding the effect of MAAS implementation in our SICU on
   patient outcomes, such as quality of sedation and length of mechanical
   ventilation, as well as the use of the MAAS in other patient populations
   (e.g., medical).
TC 161
ZB 41
Z8 1
ZS 2
Z9 165
SN 0090-3493
UT WOS:000081906300007
PM 10446819
ER

PT J
AU Gronert, GA
   Fung, DL
   Haskins, SC
   Steffey, EP
TI Deep sedation and mechanical ventilation without paralysis for 3 weeks
   in normal beagles - Exaggerated resistance to metocurine in
   gastrocnemius muscle
SO ANESTHESIOLOGY
VL 90
IS 6
BP 1741
EP 1745
DI 10.1097/00000542-199906000-00032
PD JUN 1999
PY 1999
AB Background: Patients in the intensive care unit may have muscle weakness
   in the recovery phase, and disuse atrophy may play a role in this
   weakness. To assess this problem, the authors measured changes in the
   potency of the nondepolarizing neuromuscular blocking agent metocurine
   in a canine model that involved 3 weeks of intensive care, nonparalyzing
   anesthesia with pentobarbital and positive-pressure ventilation.
   Methods: Six dogs were anesthetized with pentobarbital to a sufficient
   depth that spontaneous and reflex muscle movements were absent. Their
   tracheas were intubated, their lungs were mechanically ventilated, and
   they received round-the-clock intensive medical and nursing care for 3
   weeks, Transduced gastrocnemius muscle responses to metocurine were
   determined weekly. A 4- to 15-min infusion of 148-4,300 mu g/min (longer
   durations and greater concentrations on progressive weeks) yielded more
   than 80% paralysis. Serial metocurine plasma concentrations during the
   onset of the block and recovery provided data to determine
   pharmacokinetics using NON-MEM. Metocurine plasma concentrations and the
   degree of paralysis were used to model the effect compartment
   equilibration constant, and the Hill equation was used to yield the
   slope factor and potency within the effect compartment,
   Results: The metocurine effect compartment concentration associated with
   a 50% diminution of twitch height after 3 weeks was 1,716 +/- 1,208
   ng/ml (mean +/- SD), which was significantly different from 257 +/- 34
   ng/ml, the value on day 0, There were no pharmacokinetic differences.
   Conclusion: The absence of muscle tone and reflex responsiveness for 3
   weeks was associated with exaggerated resistance to the neuromuscular
   blocker metocurine.
CT International-Anesthesia-Research-Society Annual Meeting
CY MAR 08-12, 1996
CL WASHINGTON, D.C.
SP Int Anesthesia Res Soc
TC 7
ZB 6
Z8 0
ZS 0
Z9 7
SN 0003-3022
UT WOS:000080553400032
PM 10360874
ER

PT J
AU Singhi, SC
   Jayshree, M
   Singhi, P
   Banerjee, S
   Prabhakar, S
TI Intravenous immunoglobulin in very severe childhood Guillain-Barre
   syndrome
SO ANNALS OF TROPICAL PAEDIATRICS
VL 19
IS 2
BP 167
EP 174
DI 10.1080/02724939992491
PD JUN 1999
PY 1999
AB To evaluate intravenous immunoglobulin (IVIG) therapy in children with
   very severe Guilain-Barre syndrome (GBS) with reference to the need for
   respiratory support, ICU stay and long-term outcome, we studied 33
   children with very severe GBS and quadriparesis and/or respiratory
   muscle weakness admitted to the Pediatric Intensive Care Unit (PICU) of
   PGIMER, Chandigarh. Cases (n = 22, MG group) were enrolled
   prospectively, and controls (n = 11), similar to cases in age and
   severity of illness, retrospectively. All children received similar
   supportive and respiratory care. In addition, cases were given IVIG
   (Sandoglobulin, Sandoz) 0.4 g/kg bodyweight per day for 5 days. The mean
   age, duration of symptoms prior to admission and severity of illness in
   the two groups were similar. In the IVIG group, onset of recovery of
   muscle power was significantly earlier (day 14.8 (6.8) of illness vs day
   20.9 (8.6), p < 0.05) and the length of PICU stay significantly shorter
   (20.5 (13.0) days vs 50.5 (33.3) days, p < 0.01). Sixteen (72.7%)
   children in the IVIG group had improved by at least one functional grade
   after 1 month and 15 (68%) were walking independently after 3 months
   compared with two (18%) and four (36%) controls, respectively (p <
   0.05). The number of children who needed endotracheal intubation and
   mechanical ventilation and the duration of mechanical ventilation was
   significantly less in the IVIG-treated group. We conclude that in very
   severe GBS in children IVIG therapy improves outcome to a remarkable
   extent, reduces the need for intubation and mechanical ventilation,
   shortens the length of stay in ICU, and promotes ambulation sooner.
TC 9
ZB 8
Z8 0
ZS 0
Z9 9
SN 0272-4936
UT WOS:000080731300006
PM 10690257
ER

PT J
AU Behbehani, NA
   Al-Mane, F
   D'yachkova, Y
   Pare, P
   FitzGerald, JM
TI Myopathy following mechanical ventilation for acute severe asthma - The
   role of muscle relaxants and corticosteroids
SO CHEST
VL 115
IS 6
BP 1627
EP 1631
PD JUN 1999
PY 1999
AB Background: Acute myopathy following mechanical ventilation for
   near-fatal asthma (NFA) has been described recently, and some
   researchers have suggested that this complication is related to the use
   of neuromuscular blocking agents (NMBAs) and corticosteroids (CSs).
   Objectives: To determine the incidence of acute myopathy in a group of
   patients and to examine the most important predictors of its
   development.
   Design and methods: A retrospective cohort study. over a 10-year period
   (1985 to 1995) of all asthma patients who received mechanical
   ventilation at two centers in Vancouver (designated center 1 and center
   2).
   Results: In center 1, there were 58 patients who had 64 episodes of NFA,
   and in center 2, there were 28 patients who had 30 episodes. NMBAs were
   used in 30 of 86 admissions for acute severe asthma (35%). The mean (+/-
   SD) duration of muscle paralysis was 3.1 +/- 2.3 days. A total of 9
   patients (10.4%) developed significant myopathy. The incidence of
   myopathy was 9 of 30 (30%) among patients who received NMBAs. In a
   multiple logistic regression model, the development of myopathy was only
   significantly associated with the duration of muscle relaxation. The
   odds ratio for the development of myopathy increased by 2.1 (95%
   confidence interval, 1.4 to 3.2) with each additional day of muscle
   relaxation. The dose and the type of the CS were not significantly
   associated with the myopathy in the multiple logistic regression
   analysis.
   Conclusion: Our study showed that there is a high incidence of acute
   myopathy when NMBAs are used for NFA. The incidence of myopathy
   increases with each additional day of muscle relaxation.
TC 72
ZB 17
Z8 1
ZS 1
Z9 73
SN 0012-3692
UT WOS:000080867600026
PM 10378560
ER

PT J
AU Anzueto, A
TI Muscle dysfunction in the intensive care unit
SO CLINICS IN CHEST MEDICINE
VL 20
IS 2
BP 435
EP +
DI 10.1016/S0272-5231(05)70151-9
PD JUN 1999
PY 1999
AB Impaired respiratory muscle function is a common problem in intensive
   care patients. These abnormalities in muscle function are multifactorial
   and may he related to the patient's underlying disease, direct damage to
   the neuromuscular system, or secondary to drug therapy Clinical signs of
   impaired muscle function are of limited value. Therefore, a
   comprehensive assessment of muscle function is necessary.
TC 10
ZB 4
Z8 1
ZS 0
Z9 11
SN 0272-5231
UT WOS:000081162700014
PM 10386266
ER

PT J
AU Koury, R
   Stone, C K
   Stapczynski, J S
   Blake, J
TI Sympathetic overactivity from fenfluramine-phentermine overdose.
SO European journal of emergency medicine : official journal of the
   European Society for Emergency Medicine
VL 6
IS 2
BP 149
EP 52
PD 1999-Jun
PY 1999
AB A 24-year-old male presented to the emergency department with
   hyperadrenergic manifestations of fenfluramine-phentermine overdose:
   tachycardia, mydriasis, fever, diaphoresis, hyperventilation, and
   combativeness. Sedatives, neuromuscular paralytics, adrenergic
   antagonists, and mechanical ventilation were required to care for the
   patient. In addition, the patient had self-inflicted 15% TBSA
   second-degree burns and developed adult respiratory distress syndrome
   which required continued intubation and mechanical ventilation for 12
   days. The patient had split thickness skin grafts for his leg burns on
   day 11. He was discharged after a 26-day hospital stay. We are unaware
   of any previously reported cases of fenfluramine-phentermine overdose
   with such profound degree of sympathetic storm.
TC 2
ZB 0
Z8 0
ZS 0
Z9 2
SN 0969-9546
UT MEDLINE:10461560
PM 10461560
ER

PT J
AU Latronico, N
   Candiani, A
TI Neuromuscular disorders acquired in the ICU
SO INTENSIVE CARE MEDICINE
VL 25
IS 6
BP 641
EP 641
DI 10.1007/s001340050921
PD JUN 1999
PY 1999
RI Latronico, Nicola/F-1557-2010
OI Latronico, Nicola/0000-0002-2521-5871
TC 1
ZB 1
Z8 0
ZS 0
Z9 1
SN 0342-4642
UT WOS:000081093800022
PM 10416926
ER

PT J
AU Yoshida, Y
   Kato, B
   Mizushima, Y
   Arai, N
   Matsui, S
   Maruyama, M
   Kobayashi, M
TI Syndrome of inappropriate secretion of antidiuretic hormone associated
   with amyotrophic lateral sclerosis in respiratory failure.
SO Respirology (Carlton, Vic.)
VL 4
IS 2
BP 185
EP 7
DI 10.1046/j.1440-1843.1999.00172.x
PD 1999-Jun
PY 1999
AB A 65-year-old man who had muscle weakness and dysarthria was admitted
   for investigation of motor neuron disease. He had lost 12 kg of weight
   in 6 months. Neurological findings disclosed upper and lower motor
   neuron disturbances with normal sensory nerve function, and needle
   electromyography showed a neurogenic pattern. Laboratory findings on
   admission demonstrated dilutional hyponatraemia due to an excessive
   secretion of antidiuretic hormone (ADH). Based on these findings, the
   patient was diagnosed as having the syndrome of inappropriate secretion
   of antidiuretic hormone (SIADH) associated with amyotrophic lateral
   sclerosis (ALS). During the night of first hospital day, the patient
   complained of severe dyspnoea, and mechanical ventilation was commenced.
   Following the mechanical ventilation, plasma ADH levels and serum sodium
   concentration were normalized. We propose that respiratory failure
   secondary to the atrophy of respiratory muscle might be responsible for
   the development of SIADH.
TC 2
ZB 2
Z8 0
ZS 0
Z9 2
SN 1323-7799
UT MEDLINE:10382239
PM 10382239
ER

PT J
AU Miro, O
   Salmeron, JM
   Masanes, F
   Alonso, JR
   Graus, F
   Mas, A
   Grau, JM
TI Acute quadriplegic myopathy with myosin-deficient muscle fibres after
   liver transplantation - Defining the clinical picture and delimiting the
   risk factors
SO TRANSPLANTATION
VL 67
IS 8
BP 1144
EP 1151
PD APR 27 1999
PY 1999
AB Background. In the last few years, rare cases of acute quadriplegic
   myopathy (AQM*) with myosin deficient muscle fibres occurring after
   solid organ transplantation has been reported. The aim of the present
   study was to review all cases of AQM with myosin deficient-fibres seen
   at our institution among a large series of patients after orthotopic
   liver transplants (OLT), with special attention to clinical aspects and
   associated risk factors. Additionally, an extensive review of all
   ultrastructurally demonstrated cases of AQM in transplant recipients is
   also included.
   Patients and Methods. Among patients involved in 281 consecutive Liver
   transplant procedures performed in a 4-year period, 3 men and 1 woman
   developed an arreflexic, flaccid quadriplegia in the immediate
   postoperative period of OLT, After ruling out other causes of weakness,
   a muscle biopsy was performed and a loss of thick (myosin) filaments was
   confirmed by ultrastructural analysis in all cases. Accurate clinical,
   epidemiological, and evolutive data were recorded.
   Results, Corticosteroids had been used at usual dosage given to liver
   transplant recipients; all four patients had several intra- and
   postoperative complications leading to receiving significantly higher
   amounts of hemoderivates, to develop renal failure in all cases, and to
   require a significantly higher number of reoperations within a few days
   after transplantation than our contemporaneous global series of liver
   transplant recipients. AQM patients required a significantly longer
   intensive care unit and hospital stay. Muscular recovery was the rule,
   but currently a mild myopathic gait remains in three patients. These and
   other reported cases of AQM do not histologically and clinically differ
   from AQM seen in other critically ill patients who have not had
   transplants.
   Conclusions, Patients with a complicated intra- and postoperative course
   of OLT who develop newly acquired acute muscle weakness should be
   suspected as having acute AQM with myosin-deficient muscle fibres, In
   this setting, differential diagnosis with other causes of weakness
   should be carried out, because the prognosis of this myopathy is good
   with early muscle rehabilitation therapy.
TC 15
ZB 10
Z8 0
ZS 0
Z9 15
SN 0041-1337
UT WOS:000080102300010
PM 10232565
ER

PT J
AU Takeda, S
   Miyoshi, S
   Maeda, H
   Minami, M
   Yoon, HE
   Tanaka, H
   Nakahara, K
   Matsuda, H
TI Ventilatory muscle recruitment and work of breathing in patients with
   respiratory failure after thoracic surgery
SO EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY
VL 15
IS 4
BP 449
EP 455
DI 10.1016/S1010-7940(99)00020-2
PD APR 1999
PY 1999
AB Objectives: Increased work of breathing (WOB) and respiratory muscle
   weakness have been identified as major causes of respiratory failure
   after thoracic surgery. This study was undertaken firstly to
   characterize the mechanical impairment in patients with respiratory
   failure after cardio-thoracic surgery, and secondly, to determine how
   diaphragmatic paralysis affects deterioration in the ventilatory
   mechanics. Methods: We evaluated the respiratory mechanics of 24
   patients following cardiac and thoracic surgery. Ten patients without
   respiratory problems were examined as control subjects. There were nine
   patients with phrenic nerve injury and five patients without phrenic
   nerve injury who required mechanical ventilation for more than 7 days.
   Phrenic nerve injury was assessed with a phrenic nerve stimulation test.
   We measured the respiratory variables, the esophageal, gastric and
   transdiaphragmatic pressure swing (Delta Pes, Delta Pga and Delta Pdi,
   respectively), and the work of breathing during quiet tidal breathing.
   Results: Both the groups requiring mechanical ventilation exhibited
   abnormally negative Delta Pga/Delta Pes values, compared with the
   control subjects. A significant increase in WOB with the normal
   generation of Delta Pdi was seen in the patients without phrenic nerve
   injury. In contrast, the poor generation of Delta Pdi with a slight
   increase in work of breathing was noted in patients with phrenic nerve
   injury. Conclusions: These results demonstrated two different types of
   respiratory failure in thoracic surgery patients, focusing on the impact
   of phrenic nerve paralysis. Diaphragmatic dysfunction should not be
   overlooked in postoperative care, and the amelioration of this
   compromise in respiratory mechanics is an important aspect of good
   patient management. (C) 1999 Elsevier Science B.V. All rights reserved.
TC 4
ZB 2
Z8 0
ZS 0
Z9 4
SN 1010-7940
UT WOS:000080227000020
PM 10371120
ER

PT J
AU Ratanatharathorn, V
   Powers, WE
   Moss, WT
   Perez, CA
TI Bone metastasis: Review and critical analysis of random allocation
   trials of local field treatment
SO INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS
VL 44
IS 1
BP 1
EP 18
DI 10.1016/S0360-3016(98)00510-0
PD APR 1 1999
PY 1999
AB Purpose: Compare and contrast reports of random allocation clinical
   trials of local field radiation therapy of metastases to bone to
   determine the techniques producing the best results (frequency,
   magnitude, and duration of benefit), and relate these to the goals of
   complete relief of pain and prevention of disability for the remaining
   life of the patient.
   Methods and Materials: Review all published reports of random allocation
   clinical trials, and perform a systematic analysis of the processes and
   outcomes of the several trial reports.
   Results: All trials were performed on selected populations of patients
   with symptomatic metastases and most studies included widely diverse
   groups with regard to: (a) site of primary tumor, (b) location, extent,
   size, and nature of metastases, (c) duration of survival after
   treatment. All trial reports lack sufficient detail for full and
   complete analysis. Much collected information is not now available for
   reanalysis and many important data sets were apparently never collected.
   Several of the variations in patient and tumor characteristics were
   found to be much more important than treatment dose in the outcome
   results. Treatment planning and delivery techniques were unsophisticated
   and probably resulted in a systematic delivery of less than the assigned
   dose to some metastases. In general the use and benefit of retreatment
   was greater in those patients who initially received lower doses but the
   basis and dose of retreatment was not documented. Follow-up of patients
   was varied with a large proportion of surviving patients lost to
   follow-up in several studies. The greatest difference in the reports is
   the method of calculation of results. The applicability of Kaplan-Meier
   actuarial analysis, censoring the lost and dead patients, as used in
   studies with loss to follow-up of a large number of patients is
   questionable. The censoring involved is "Informative" (the processes of
   loss relate to the outcome) and not acceptable since it results in
   artificial elevation of the frequency of response. Overall, higher dose
   fractionated treatment regimens produced a better frequency, magnitude,
   and duration of response than lower dose single-fraction regimens.
   Relapse after initial response was frequent. The "median duration of
   relief" was much shorter than the "median duration of survival"
   post-treatment. Thus the "net pain relief" is far less than the goal of
   pain relief for the total duration of life after treatment.
   Conclusions: The pain relief obtained in all studies is poor and our
   care practices need to be improved. Many patients never achieved
   complete relief and for most who did, the duration of relief was much
   less than their period of survival after treatment. Higher dose,
   fractionated treatments produced a greater frequency, magnitude, and
   duration of response with an improved "net pain relief." Additional
   trials with selection of comparable cases, good definition of extent of
   disease, exemplary treatment, and complete follow-up are required. (C)
   1999 Elsevier Science Inc.
TC 96
ZB 40
Z8 5
ZS 0
Z9 101
SN 0360-3016
UT WOS:000079783800001
PM 10219789
ER

PT J
AU Birnkrant, DJ
   Pope, JF
   Eiben, RM
TI Management of the respiratory complications of neuromuscular diseases in
   the pediatric intensive care unit
SO JOURNAL OF CHILD NEUROLOGY
VL 14
IS 3
BP 139
EP 143
DI 10.1177/088307389901400301
PD MAR 1999
PY 1999
AB Pediatric neuromuscular diseases such as Duchenne muscular dystrophy and
   spinal muscular atrophy cause pulmonary compromise. In severely affected
   patients, upper respiratory tract infections exacerbate lower
   respiratory tract secretion retention, with the potential for pneumonia,
   pulmonary atelectasis, and respiratory failure. In the pediatric
   intensive care unit, effective treatment includes noninvasive positive
   pressure ventilation and manual and mechanical mucus clearance
   techniques. A practical approach to commonly encountered respiratory
   complications in pediatric neuromuscular diseases is presented in this
   review.
TC 21
ZB 5
Z8 0
ZS 3
Z9 23
SN 0883-0738
UT WOS:000078988900001
PM 10190262
ER

PT J
AU Goh, A Y
   Chan, P W
TI Acute myopathy after status asthmaticus: steroids, myorelaxants or
   carbon dioxide?
SO Respirology (Carlton, Vic.)
VL 4
IS 1
BP 97
EP 9
DI 10.1046/j.1440-1843.1999.00158.x
PD 1999-Mar
PY 1999
AB Acute myopathy complicating treatment of status asthmaticus has been
   increasingly recognized since its original description in 1977. We
   report a case of an 11-year-old boy with severe asthma requiring
   mechanical ventilation. He was given high doses of parenteral steroids
   and neuromuscular blockade with non-depolarizing agents in order to
   achieve controlled hypoventilation with an ensuing hypercapnoea. He
   developed rhabdomyolysis with elevated creatinine kinase and renal
   impairment secondary to myoglobinuria. Electrophysiological studies
   revealed myopathic abnormalities. The aetiology for this myopathy
   appears to be related to therapy with parenteral steroids,
   muscle-relaxant agents and respiratory acidosis. Patients treated with
   steroids and neuromuscular blocking agents should be regularly monitored
   for development of myopathy.
TC 11
ZB 6
Z8 1
ZS 0
Z9 12
SN 1323-7799
UT MEDLINE:10339738
PM 10339738
ER

PT J
AU Raphael, J C
   Chevret, S
   Annane, D
TI Is early noninvasive mechanical ventilation of first choice in stable
   restrictive patients with chronic respiratory failure?
SO Monaldi archives for chest disease = Archivio Monaldi per le malattie
   del torace / Fondazione clinica del lavoro, IRCCS [and] Istituto di
   clinica tisiologica e malattie apparato respiratorio, Universita di
   Napoli, Secondo ateneo
VL 54
IS 1
BP 90
EP 7
PD 1999-Feb
PY 1999
AB Noninvasive long-term ventilation is consensually advocated when daytime
   hypercapnia > 6 kPa at steady state in chronic restrictive pulmonary
   syndromes. Several mechanisms can cause the occurrence of hypercapnia in
   these diseases. They may involve impairment of lung mechanics or airway
   function and cough, ventilation-perfusion mismatching, blunted central
   ventilatory drive or respiratory muscle fatigue. These abnormalities may
   occur while awake or during sleep. From a practical point of view,
   imperative ventilation, a palliative technique that aims to supply
   respiratory muscle weakness, and preventive ventilation, aimed at
   delaying respiratory handicap, should be distinguished between. The
   latter is offered to patients who do not fulfil any criteria for
   mechanical ventilation. Otherwise, the underlying disease markedly
   influences both pathophysiology and outcome. This implies that the
   available modes of ventilatory support should be assessed in each
   disease. Several findings have been published about Duchenne's muscular
   dystrophy. Mechanical ventilation, usually using noninvasive methods, is
   offered to patients with either hypercapnia or a forced vital capacity <
   20% of the predicted value. Nevertheless, based on our experience,
   deterioration of the restrictive syndrome should be followed by a
   tracheostomy. By contrast, early ventilation, offered to patients free
   of symptoms and whose forced vital capacity are within 20-50% pred and
   with normal arterial blood gas levels, achieves no benefit.
TC 4
ZB 0
Z8 0
ZS 1
Z9 5
SN 1122-0643
UT MEDLINE:10218381
PM 10218381
ER

PT J
AU Jardine, E
   O'Toole, M
   Paton, JY
   Wallis, C
TI Current status of long term ventilation of children in the United
   Kingdom: questionnaire survey
SO BMJ-BRITISH MEDICAL JOURNAL
VL 318
IS 7179
BP 295
EP 299
PD JAN 30 1999
PY 1999
AB Objectives To identify the number and current location of children, aged
   0 to 16 years, requiring long term ventilation in the United Kingdom,
   and to establish their underlying diagnoses and ventilatory needs.
   Design Postal questionnaires sent to consultant respiratory
   paediatricians and all lead clinicians of intensive care and special
   care baby units in the United Kingdom.
   Subjects AU children in the United Kingdom who, when medically stable,
   continue to need a mechanical aid for breathing.
   Results 141 children requiring long term ventilation were identified
   from the initial questionnaire. Detailed information was then obtained
   on 136 children from 30 units. Thirty three children (24%) required
   continuous positive pressure ventilation by tracheostomy over 24 hours,
   and 103 received ventilation when asleep by a non-invasive mask (n = 62;
   46%), tracheostomy (n = 32; 24%), or negative pressure ventilation (n =
   9; 7%). Underlying conditions included neuromuscular disease (n = 62;
   46%), congenital central hypoventilation syndrome (n = 18; 13%), spinal
   injury (n = 16; 12%), craniofacial syndromes (n = 9; 7%),
   bronchopulmonary dysplasia (n = 6; 4%), and others (n = 25; 18%). 93
   children were cared for ar home. 43 children remained in hospital
   because of home circumstances, inadequate funding, or lack of provision
   of home carers. 96 children were of school age and 43 were attending
   mainstream school.
   Conclusions A significant increase in the number of children requiring
   long term ventilation in the United Kingdom has occurred over the past
   decade. Contributing factors include improved technology, developments
   in paediatric non-invasive ventilatory support, and a change in attitude
   towards home care. Successful discharge home and return to school is
   occurring even for severely disabled patients. Funding and home carers
   are common obstacles to discharge.
RI Paton, James/B-9541-2008
TC 66
ZB 18
Z8 0
ZS 1
Z9 67
SN 1756-1833
UT WOS:000078436700022
PM 9924054
ER

PT J
AU Portel, L
   Hilbert, G
   Gruson, D
   Favier, JC
   Gbikpi-Benissan, G
   Cardinaud, JP
TI Malignant hyperthermia and neuroleptic malignant syndrome in a patient
   during treatment for acute asthma
SO ACTA ANAESTHESIOLOGICA SCANDINAVICA
VL 43
IS 1
BP 107
EP 110
DI 10.1034/j.1399-6576.1999.430123.x
PD JAN 1999
PY 1999
AB Acute asthma is well known to provoke complications. We report the case
   of a patient who needed intubation and mechanical ventilation for acute
   asthma. Despite a treatment with corticosteroids, bronchodilators,
   neuromuscular blocking drugs and magnesium sulfate, the situation
   remained uncontrolled and as a last resort, halothane became necessary.
   The patient then developed an episode of malignant hyperthermia with
   fever at 40 degrees C and rhabdomyolysis. At this time, halothane could
   be stopped and all the symptoms disappeared without modifying the rest
   of the treatment. Eight days later, he presented with a neuroleptic
   malignant syndrome following an injection of droperidol. Temperature
   rose to 42 degrees C, associated with muscle rigidity, sweating,
   tachycardia and severe circulatatory collapse. The use of dantrolene in
   association with a symptomatic treatment of the collapse led to a
   favourable outcome in. Unfortunately, in vitro contracture test could
   not be performed in this case. The links between malignant hyperthermia
   and neuroleptic malignant syndrome remain unclear. Although these two
   pathologies share the same physiopathology, symptomatology and
   treatment, they are clearly individualized. This case seems to be the
   first description of their occurrence in the same patient.
TC 6
ZB 3
Z8 0
ZS 0
Z9 6
SN 0001-5172
UT WOS:000077812500023
PM 9926200
ER

PT J
AU Tagliati, M
   Grinnell, J
   Godbold, J
   Simpson, DM
TI Peripheral nerve function in HIV infection - Clinical,
   electrophysiologic, and laboratory findings
SO ARCHIVES OF NEUROLOGY
VL 56
IS 1
BP 84
EP 89
DI 10.1001/archneur.56.1.84
PD JAN 1999
PY 1999
AB Objective: To determine the effects of immunodeficiency, nutritional
   status, and concurrent systemic disease on peripheral nerve function in
   acquired immunodeficiency syndrome.
   Design: Survey of subjects infected with human immunodeficiency virus
   (HIV), recruited as part of a prospective study of neuromuscular
   complications of HIV infection.
   Setting: A neuro-acquired immunodeficiency syndrome outpatient clinic in
   a university medical center.
   Patients: A consecutive sample of 251 HIV-infected individuals. primary
   care providers referred subjects to the study for evaluation of
   neurologic symptoms or for prospective neurologic assessment.
   Main Outcome Measures: Standardized history and neurologic examination,
   laboratory tests (complete blood cell count, serum albumin level,
   vitamin B-12 level, and T-lymphocyte subsets),and electrophysiologic
   testing of sural, tibial, and ulnar nerves.
   Results: The most frequent neurologic diagnosis was distal symmetrical
   polyneuropathy (DSP) (38%). The most common clinical features were
   nonpainful paresthesias (71%), abnormalities of pain and temperature
   perception (71%), and reduced or absent ankle reflexes (66%). Patients
   with DSP were significantly older (P = .009), and had lower CD4
   lymphocyte cell counts (P =. 004) and lower hemoglobin levels (P = .004)
   than those without DSP. Deterioration of values on nerve conduction
   studies, irrespective of the clinical diagnosis of DSP, was
   significantly correlated with low CD4 counts, aging, abnormal serum
   albumin and hemoglobin levels, and weight loss. Most of these factors
   co-correlated, and, with the exception of age, no single variable
   significantly accounted for changes in results of nerve conduction
   studies when the influence of other factors was eliminated
   Conclusion: The combination of several factors, including age,
   immunosuppression, nutritional status, and chronic disease, contributes
   to distal peripheral nerve dysfunction in HIV infection.
CT 47th Annual Meeting of the American-Academy-of-Neurology
CY MAY   11, 1995
CL SEATTLE, WASHINGTON
SP Amer Acad Neurol
RI Andrade, Hugo/M-6631-2013
OI Andrade, Hugo/0000-0001-6781-6125
TC 73
ZB 50
Z8 0
ZS 1
Z9 75
SN 0003-9942
UT WOS:000078053300012
PM 9923765
ER

PT J
AU Sander, H W
   Saadeh, P B
   Chandswang, N
   Greenbaum, D
   Chokroverty, S
TI Diaphragmatic denervation in intensive care unit patients.
SO Electromyography and clinical neurophysiology
VL 39
IS 1
BP 3
EP 5
PD 1999 Jan-Feb
PY 1999
AB The causes of prolonged requirement for mechanical ventilation in the
   intensive care unit (ICU) are currently a subject of investigation.
   Critical illness polyneuropathy (CIP), an axonal polyneuropathy that
   frequently occurs with prolonged sepsis and multi-organ failure, has
   been cited as a frequent cause of difficulty with weaning from a
   ventilator. The relative contribution of diaphragmatic denervation in
   ICU patients with and without CIP has not been definitively determined.
   We reviewed 102 ventilator dependent intensive care unit (ICU) patients.
   Critical illness polyneuropathy (CIP) was diagnosed based upon
   electrodiagnostic criteria. Electrodiagnostic studies included
   diaphragmatic needle electromyography (EMG) to evaluate for
   diaphragmatic denervation. The medical charts of the patients with
   diaphragmatic denervation were reviewed for etiologies other than CIP
   for the diaphragmatic denervation. Our results suggest: 1) Respiratory
   impairment in ICU patients may often be unrelated to either CIP or
   diaphragmatic denervation; 2) Only about half of ventilator dependent
   CIP patients have diaphragmatic denervation; 3) Diaphragmatic
   denervation in ICU patients frequently may be attributable to causes
   other than CIP.
TC 14
ZB 4
Z8 1
ZS 0
Z9 15
SN 0301-150X
UT MEDLINE:10076754
PM 10076754
ER

PT J
AU Cheung, PY
   Barrington, KJ
   Finer, NN
   Robertson, CMT
TI Early childhood neurodevelopment in very low birth weight infants with
   predischarge apnea
SO PEDIATRIC PULMONOLOGY
VL 27
IS 1
BP 14
EP 20
DI 10.1002/(SICI)1099-0496(199901)27:1<14::AID-PPUL4>3.0.CO;2-0
PD JAN 1999
PY 1999
AB Apnea commonly occurs in preterm infants and may persist beyond term. We
   prospectively investigated the relationship between apnea that persisted
   beyond 35 weeks postconceptional age and subsequent neurodevelopment in
   early childhood. Between January, 1990-November, 1993, we performed
   predischarge respiratory recordings, using 24-hr, 4-channel
   pneumography, at 35 weeks or more of postconceptional age in 164 infants
   (birth weight, <1,250 g; gestational age, less than or equal to 32
   weeks), who subsequently underwent multidisciplinary neurodevelopmental
   assessment at 15-64 (median 24) months of adjusted age.
   The duration of initial artificial ventilation for respiratory distress
   syndrome and the grade of intraventricular hemorrhage were independent
   predictors of neurodevelopmental outcome. Mean oximetry desaturation and
   frequency of predischarge apnea correlated with mental and motor
   developmental scores. Mean oximetry desaturation during apnea was an
   independent predictor for motor score in the total population, and for
   both mental and motor scores in 50 infants with grade 3 or 4
   intraventricular hemorrhage, but not in 114 infants without grade 3 or 4
   intraventricular hemorrhage. Despite its limited predictability for
   early childhood neurodevelopment, predischarge respiratory recordings
   may be useful in predicting subsequent neurodevelopment of high-risk
   preterm infants, especially those with severe intraventricular
   hemorrhage. Pediatr Pulmonol, 1999; 27:14-20, (C) 1999 Wiley-Liss. Inc.
RI Cheung, Po-Yin/C-2804-2013
TC 18
ZB 16
Z8 2
ZS 0
Z9 20
SN 8755-6863
UT WOS:000078272500004
PM 10023786
ER

PT J
AU Biarent, D
TI New tools in ventilatory support: high frequency ventilation, nitric
   oxide, tracheal gas insufflation, non-invasive ventilation.
SO Pediatric pulmonology. Supplement
VL 18
BP 178
EP 81
PD 1999
PY 1999
AB Protection of the lungs against ventilator-induced lung injury is
   becoming one of the main concerns in pediatric and neonatal intensive
   care. High frequency ventilation using a constant distending pressure
   with small variations during respiratory cycles allows adequate
   recruitment. High frequency oscillation is the most promising HFV mode
   especially in premature neonates but clinical studies are contradictory.
   Nitric oxide, an inhaled gas with specific pulmonary vasodilating
   effects, has become a powerful tool in the treatment of pulmonary
   arterial hypertension alone or in combination with HFO, but studies have
   failed to show improvement in survival in neonates as well as in
   children with ARDS. Tracheal gas insufflation, in addition to
   conventional ventilation, by washing dead space during exhalation,
   improves gas exchange while lowering tidal volume. It is however still
   experimental. Maintenance of spontaneous ventilation during conventional
   ventilation improves gas exchange, hemodynamic functions, mobilization,
   active coughing, and avoids prolonged muscle weakness. Non invasive
   modes of ventilation like BiPAP have certain indications in pediatrics
   but need to become more familiar to the pediatric intensivist.
TC 4
ZB 2
Z8 0
ZS 1
Z9 6
SN 1054-187X
UT MEDLINE:10093136
PM 10093136
ER

PT J
AU De Jonghe, B
   Cook, D
   Sharshar, T
   Lefaucheur, J P
   Carlet, J
   Outin, H
TI Acquired neuromuscular disorders in critically ill patients: a
   systematic review. Groupe de Reflexion et d'Etude sur les
   Neuromyopathies En Reanimation.
SO Intensive care medicine
VL 24
IS 12
BP 1242
EP 50
DI 10.1007/s001340050757
PD 1998-Dec
PY 1998
AB OBJECTIVE: To summarize the prospective clinical studies of
   neuromuscular abnormalities in intensive care unit (ICU) patients. STUDY
   IDENTIFICATION AND SELECTION: Studies were identified through MEDLINE,
   EMBASE, references in primary and review articles, personal files, and
   contact with authors. Through duplicate independent review, we selected
   prospective cohort studies evaluating ICU-acquired neuromuscular
   disorders.
   DATA ABSTRACTION: In duplicate, independently, we abstracted key data
   regarding design features, the population, clinical and laboratory
   diagnostic tests, and clinical outcomes.
   RESULTS: We identified eight studies that enrolled 242 patients.
   Inception cohorts varied; some were mechanically ventilated patients for
   > or = 5 days, others were based on a diagnosis of sepsis, organ
   failure, or severe asthma while others were selected on the basis of
   exposure to muscle relaxants, or because of participation in muscle
   biochemistry studies. Weakness was systematically assessed in two of the
   eight studies, concerning patients with severe asthma, with a reported
   frequency of 36 and 70%, respectively. Electrophysiologic and histologic
   abnormalities consisted of both peripheral nerve and muscle involvement
   and were frequently reported, even in non-selected ICU patients. In a
   population of patients mechanically ventilated for more than 5 days,
   electrophysiologic abnormalities were reported in 76 % of cases. Two
   studies showed a clinically important increase (5 and 9 days,
   respectively) in duration of mechanical ventilation and a mortality
   twice as high in patients with critical illness neuromuscular
   abnormalities, compared to those without.
   CONCLUSIONS: Prospective studies of ICU-acquired neuromuscular
   abnormalities include a small number of patients with various
   electrophysiologic findings but insufficiently reported clinical
   correlations. Evaluation of risk factors for these disorders and studies
   examining their contribution to weaning difficulties and long-term
   disability are needed.
TC 74
ZB 25
Z8 0
ZS 1
Z9 76
SN 0342-4642
UT MEDLINE:9885875
PM 9885875
ER

PT J
AU Bonekat, H W
TI Noninvasive ventilation in neuromuscular disease.
SO Critical care clinics
VL 14
IS 4
BP 775
EP 97
DI 10.1016/S0749-0704(05)70030-0
PD 1998-Oct
PY 1998
AB The treatment of respiratory failure in patients who have NMD continues
   to be an evolving process. Negative-pressure ventilation, once prominent
   in the 1940s and 1950s, gave way to intermittent positive-pressure
   ventilation with tracheostomy or endotracheal tubes in the 1960s. Now
   there is a resurgence of noninvasive ventilation, brought about by
   innovative modes of positive pressure delivered through nasal and facial
   masks. Although frequently relegated to second-line choices,
   negative-pressure devices still offer a practical treatment alternative
   as patient preference still plays a role in selecting a proper mode of
   ventilation. Studies have shown that noninvasive ventilation can prevent
   or reverse respiratory failure and improve quality of life and
   longevity. Despite the seemingly widespread acceptance of noninvasive
   ventilation in the treatment of respiratory failure, physicians still
   appear reluctant to use ventilatory assistance in the neuromuscular
   arena. In 1985, a survey found that respiratory support systems were
   utilized routinely in only 33% of the 132 responding Muscular Dystrophy
   Association (MDA) clinics. Bach recently surveyed 273 MDA clinic
   directors and co-directors from 167 clinics, to evaluate their current
   use of mechanical ventilation. Ventilatory assistance was recommended
   and used electively in only 43 (26%) of the 167 clinics. Furthermore, it
   was the policy in 68 of the clinics to discourage the use of mechanical
   ventilation. Even more importantly, only 2 physicians who discouraged
   the use of mechanical ventilation were familiar with the newest
   noninvasive methods of ventilatory support. Sadly, although our
   methodologies in the treatment of respiratory failure continue to
   improve, physician practice has lagged behind. Physicians who treat
   patients who have NMD need to become cognizant of these new techniques
   and incorporate them into their present therapeutic armamentarium.
TC 6
ZB 0
Z8 0
ZS 0
Z9 6
SN 0749-0704
UT MEDLINE:9891637
PM 9891637
ER

PT J
AU Hosain, G M
   Chatterjee, N
TI Health-care utilization by disabled persons: a survey in rural
   Bangladesh.
SO Disability and rehabilitation
VL 20
IS 9
BP 337
EP 45
PD 1998-Sep
PY 1998
AB The purpose of the present study was to examine the utilization of
   health services by disabled persons in rural Bangladesh and to identify
   associated factors to inform the development of appropriate health
   services. Household surveys were conducted in two villages of Bangladesh
   by a trained primary-care specialist who lived in the study area for 4
   months. About 81% of the sample had utilized some form of health care
   with more than half consulting unqualified practitioners of modern
   medicine. Disabled persons whose families perceived they were disabled
   were 14 times more likely than others to seek treatment. Being male and
   in the economically productive age group, having an acquired disability
   and having some form of belief about disability causation were
   associated with utilization. The conclusions of the study are that
   social and cultural barriers prevent certain groups, notably women and
   demographically dependent age groups, from accessing health care. Those
   who are economically beneficial to the family usually utilize health
   services. A combination of educational and economic initiatives such as
   a disability benefits allowance would strongly promote the health of
   disabled persons and create a general awareness of disability in
   Bangladesh. A long-term programme which includes disability training for
   health-care workers and use of financial institutions and existing local
   government infrastructure for intensive rehabilitation will improve
   quality of life for disabled persons and is proposed for urgent
   implementation.
RI Hosain, GM/A-9584-2009
TC 11
ZB 0
Z8 0
ZS 0
Z9 11
SN 0963-8288
UT MEDLINE:9664192
PM 9664192
ER

PT J
AU Sheth, R D
TI Frequency of neurologic disorders in the neonatal intensive care unit.
SO Journal of child neurology
VL 13
IS 9
BP 424
EP 8
PD 1998-Sep
PY 1998
AB Neonatal intensive care unit survival rates have improved significantly
   over the past decade. This improvement primarily reflects declining
   mortality rates among preterm infants. Neurologic morbidity increases
   with prematurity and is the major predictor of long-term disability.
   Accordingly, concern has been expressed that the burden of neurologic
   dysfunction among contemporary neonatal intensive care unit survivors
   may be increasing. To define the trends of neurologic disorders in the
   contemporary neonatal intensive care unit, all 4164 admissions between
   1986 and 1995 to a tertiary neonatal intensive care unit were examined.
   Neonatal intensive care unit admissions (413 +/- 49 per year),
   proportion of births at less than 37 weeks (70 +/- 3% per year), and
   referral patterns were stable between 1986 and 1995. Over the study
   period, 773 (18%) of 4164 neonatal intensive care unit infants had a
   total of 1062 neurologic disorders. The neonatal intensive care unit
   mortality rate declined from 12% in 1986 to 4.2% in 1995 (P < .01).
   Neurologic disorders declined, from 27% of infants born in 1986 to 12%
   in 1995 (P < .001): 356 had seizures (14% in 1986 to 4% in 1995; P <
   .001), 235 had hypoxic-ischemic encephalopathy (8% in 1986 to 4% in
   1995, P < .01), and 167 had intraventricular hemorrhage (7% in 1986 to
   1.4% in 1995, P < .005). Frequency of congenital or chromosomal
   aberration affecting the nervous system was relatively constant (4.5%
   per year). Despite a three-fold improvement in neonatal intensive care
   unit survival between 1986 and 1995, the frequency of perinatally
   acquired neurologic disorders declined by more than 50%.
TC 2
ZB 1
Z8 0
ZS 0
Z9 2
SN 0883-0738
UT MEDLINE:9733287
PM 9733287
ER

PT J
AU Melillo, E M
   Sethi, J M
   Mohsenin, V
TI Guillain-Barre syndrome: rehabilitation outcome and recent developments.
SO The Yale journal of biology and medicine
VL 71
IS 5
BP 383
EP 9
PD 1998 Sep-Oct
PY 1998
AB Guillain-Barre syndrome is the most common polyneuropathy causing major
   disability and respiratory failure. Respiratory complications are the
   main cause of death. Improved respiratory care and new treatment
   strategies such as plasmaphoresis and immunoglobulin have been shown to
   improve outcome. We studied the course and outcome of 37 patients with
   Guillain-Barre syndrome who were admitted to a rehabilitation and
   respiratory care facility over a 10-year period. There were 21 males and
   16 females with a mean age of 62+/-3 years. Fourteen patients developed
   respiratory failure requiring endotracheal intubation and mechanical
   ventilation. The mean duration of mechanical ventilation was 38+/-10
   days. All patients were successfully liberated from the ventilator.
   However, 83 percent of the patients were moderately to severely disabled
   at the time of discharge. Thirteen out of 37 (35 percent) developed
   long-term disability. None of the patients died over the period of
   follow-up. These results indicate that early recognition and treatment
   of respiratory complications in Guillain-Barre syndrome could reduce the
   morbidity and mortality of this condition.
TC 3
ZB 0
Z8 0
ZS 0
Z9 3
SN 0044-0086
UT MEDLINE:10527365
PM 10527365
ER

PT J
AU Patterson, C M
TI The role of the primary care physician in maximizing cognitive and
   behavioral recovery from moderate to severe pediatric traumatic brain
   injury.
SO The Journal of the Arkansas Medical Society
VL 95
IS 3
BP 109
EP 13
PD 1998-Aug
PY 1998
AB Traumatic brain injury (TBI) is a major cause of death and the most
   common cause of acquired disability in children. Moderate to severe TBI
   typically results in cognitive deficits, and behavioral and psychosocial
   adjustment problems, sometimes compromising long term development.
   Although variable, considerable recovery can occur, especially over the
   first one to two years post-injury. Appropriate educational and
   psychological intervention is critical to positive outcome. The primary
   care physician (PCP) has a major role in monitoring progress and
   intervention, and therefore in maximizing outcome. The short term
   neurocognitive and neurobehavioral sequelae and recovery pattern for
   traumatic brain injury, and the role of the primary care physician in
   maximizing recovery based on risk factors are described. Some
   intervention resources are included.
TC 3
ZB 2
Z8 0
ZS 0
Z9 3
SN 0004-1858
UT MEDLINE:9735636
PM 9735636
ER

PT J
AU Davis, N A
   Rodgers, J E
   Gonzalez, E R
   Fowler, A A 3rd
TI Prolonged weakness after cisatracurium infusion: a case report.
SO Critical care medicine
VL 26
IS 7
BP 1290
EP 2
DI 10.1097/00003246-199807000-00038
PD 1998-Jul
PY 1998
AB OBJECTIVE: To present the first documented case report of myopathy
   persisting for >48 hrs in a patient treated with cisatracurium and
   concomitant high-dose corticosteroids.
   DESIGN: Anecdotal observations in one patient.
   SETTING: Medical-respiratory intensive care unit (ICU) at a tertiary
   care, university teaching hospital.
   PATIENT: A 45-yr-old female admitted status for post-bilateral total
   knee replacement complicated by aspiration pneumonitis and acute
   respiratory distress syndrome (ARDS).
   INTERVENTIONS: The patient required pressure control ventilation and
   sedation with midazolam and fentanyl infusions. On ICU day 2, the
   patient was placed on inverse ratio ventilation and paralyzed with
   cisatracurium. On ICU day 6, methylprednisolone 125 mg i.v. every 6 hrs
   was initiated for fibroproliferative ARDS. On ICU day 11,
   methylprednisolone was reduced to 60 mg i.v. every 6 hrs and tapered
   over several weeks. Cisatracurium infusion rates ranged from 6.3 to 10.5
   microg/kg/min, with an average of 8.0 microg/kg/min.
   MEASUREMENTS AND MAIN RESULTS: Train-of-Four was assessed before
   initiation of therapy and every 4 hrs, thereafter. Train-of-Four values
   were maintained from 1 to 4 throughout therapy and a value of 4 was
   recorded when therapy was discontinued. On day 13, neuromuscular
   blocking agent therapy was discontinued, but severe proximal and distal
   muscle weakness was observed bilaterally. Creatinine kinase
   concentrations on 3 and 13 days after discontinuation of the paralytic
   agent were 181 and 96 units/L, respectively. On day 24, the patient
   moved her fingertips. On ICU day 30, the patient was weaned from the
   mechanical ventilator. The patient was transferred to the ward on day
   33. Extensive rehabilitation with physical and occupational therapy was
   required for several months.
   CONCLUSION: Clinicians should remember that irrespective of chemical
   structural, neuromuscular blocking agents might produce prolonged
   paralysis in predisposed patients.
TC 30
ZB 10
Z8 0
ZS 0
Z9 31
SN 0090-3493
UT MEDLINE:9671384
PM 9671384
ER

PT J
AU Syabbalo, N
TI Respiratory muscle function in patients with neuromuscular disorders and
   cardiopulmonary diseases.
SO International journal of clinical practice
VL 52
IS 5
BP 319
EP 29
PD 1998 Jul-Aug
PY 1998
AB Respiratory muscle dysfunction frequently occurs in patients with
   neuromuscular disorders, cardiopulmonary diseases and in patients in
   intensive care units. Respiratory muscle weakness and/or fatigue is
   responsible for dyspnoea, reduced exercise tolerance, nocturnal
   desaturation, and prolonged weaning from mechanical ventilation. Chronic
   respiratory muscle weakness may also be associated with poor quality of
   life and increased mortality. Patients with severe respiratory muscle
   weakness are at increased risk of respiratory failure due to respiratory
   infections, electrolyte imbalance, sedation or uncontrolled inspired
   oxygen therapy. Although respiratory muscle weakness is often seen in
   clinical practice, the consequences and the precise point at which
   respiratory muscle fatigue occurs remain elusive. This article reviews
   the pathophysiology of respiratory muscle weakness and fatigue, and
   therapeutic interventions for enhancing respiratory muscle function in
   patients with neuromuscular and cardiopulmonary diseases.
TC 2
ZB 1
Z8 0
ZS 0
Z9 2
SN 1368-5031
UT MEDLINE:9796564
PM 9796564
ER

PT J
AU Clack, Z A
   Anand, K J
   Fortenberry, J D
   Chambliss, C R
TI Bilateral vocal cord paralysis after meningitis due to Streptococcus
   pneumoniae.
SO Southern medical journal
VL 91
IS 7
BP 660
EP 2
PD 1998-Jul
PY 1998
AB We report the clinical course of a 15-month-old boy who had fever,
   decreased activity, and weakness, with severe respiratory distress
   during transport to the hospital. Laboratory evaluation confirmed the
   diagnosis of meningitis due to Streptococcus pneumoniae. He was
   intubated on arrival and required 4 days of ventilatory support. Soon
   after extubation, he had marked stridor and dyspnea that were
   unresponsive to standard therapy with nebulized racemic epinephrine and
   intravenous dexamethasone. Magnetic resonance imaging of the brain
   revealed nonspecific findings, and airway endoscopy showed bilateral
   vocal cord paralysis. Repeated endoscopy showed no improvement in vocal
   cord function and a deficient swallowing mechanism. Tracheostomy was
   done to facilitate airway management before discharge from the pediatric
   intensive care unit. We propose that the diagnosis of vocal cord
   paralysis must be considered in patients with meningitis and respiratory
   compromise.
TC 2
ZB 1
Z8 0
ZS 0
Z9 2
SN 0038-4348
UT MEDLINE:9671838
PM 9671838
ER

PT J
AU Lissoni, A
   Aliverti, A
   Tzeng, A C
   Bach, J R
TI Kinematic analysis of patients with spinal muscular atrophy during
   spontaneous breathing and mechanical ventilation.
SO American journal of physical medicine & rehabilitation / Association of
   Academic Physiatrists
VL 77
IS 3
BP 188
EP 92
DI 10.1097/00002060-199805000-00002
PD 1998 May-Jun
PY 1998
AB Patients with infantile spinal muscular atrophy develop pectus excavatum
   along with a severe restrictive syndrome as a result of failure to
   expand the upper chest wall and lungs because of intercostal muscle
   weakness. By using an automatic motion analyzer to provide
   three-dimensional computer analyses of images sampled at 25 Hz, 9 spinal
   muscular atrophy Type II patients and 13 controls underwent kinematic
   analysis of thoracoabdominal movements partitioned into the upper
   thorax, lower thorax, and abdominal volume compartments. The analyses
   were performed during spontaneous breathing for the controls and during
   spontaneous breathing and while using mechanically assisted ventilation
   for the patients. Vital capacity, maximum inspiratory pressures, and
   nocturnal oxyhemoglobin saturation and transcutaneous carbon dioxide
   tensions were also measured for the patients. The kinematic data
   demonstrated a paradoxical ventilatory pattern for the spontaneously
   breathing SMA patients with the following inspiratory volume changes:
   upper thorax, -6.4+/-9.6%; lower thorax, 7.3+/-15.8%; abdominal,
   99.1+/-21.3%. During mechanical ventilation, the compartmental volume
   changes were as follows: upper thorax, 13.5+/-6%; lower thorax,
   13.7+/-7.9%; abdominal, 72.7+/-9.3%. This kinematic pattern is
   comparable with that seen in spontaneously breathing normal subjects. We
   conclude that mechanical ventilation can normalize kinematic volume
   changes during alveolar ventilation and that this might help deter loss
   of thoracic compliance caused by the chronic hypoventilation of the
   upper thoracic compartments. Kinematic analysis may be helpful for
   choosing the ventilation parameters to optimize therapeutic benefits.
RI Andrea, Aliverti/A-3901-2015
OI Andrea, Aliverti/0000-0002-2950-0231
TC 7
ZB 5
Z8 0
ZS 2
Z9 10
SN 0894-9115
UT MEDLINE:9635553
PM 9635553
ER

PT J
AU Make, B J
   Hill, N S
   Goldberg, A I
   Bach, J R
   Criner, G J
   Dunne, P E
   Gilmartin, M E
   Heffner, J E
   Kacmarek, R
   Keens, T G
   McInturff, S
   O'Donohue, W J Jr
   Oppenheimer, E A
   Robert, D
TI Mechanical ventilation beyond the intensive care unit. Report of a
   consensus conference of the American College of Chest Physicians.
SO Chest
VL 113
IS 5 Suppl
BP 289S
EP 344S
DI 10.1378/chest.113.5_Supplement.289S
PD 1998-May
PY 1998
TC 73
ZB 19
Z8 0
ZS 1
Z9 73
SN 0012-3692
UT MEDLINE:9599593
PM 9599593
ER

PT J
AU Hughes, R A
TI Management of acute neuromuscular paralysis.
SO Journal of the Royal College of Physicians of London
VL 32
IS 3
BP 254
EP 9
PD 1998 May-Jun
PY 1998
AB The diagnosis of acute neuromuscular paralysis includes central nervous
   system disorders, peripheral neuropathy, neuromuscular conduction block
   and muscle disease. Identification of the cause is largely a clinical
   problem but neurophysiological investigations are often essential and a
   few specific tests are helpful. The commonest cause is Guillain-Barre
   syndrome. Special precautions, especially monitoring vital capacity,
   must be taken to detect respiratory failure and avoid atelectasis and
   chest infection. In acute neuropathy there is an additional danger of
   cardiac arrhythmias which requires continuous electrocardiographic
   monitoring. Prolonged artificial ventilation should be supervised by a
   specialist multidisciplinary intensive care team. Specific treatment
   depends on the diagnosis: for Guillain-Barre syndrome, intravenous
   immunoglobulin is preferred to plasma exchange on the basis of similar
   efficacy but greater convenience; steroids are not helpful; for
   myasthenia gravis, anticholinesterases and prednisolone may need to be
   supplemented with intravenous immunoglobulin or plasma exchange; for
   polymyositis, steroids are the mainstay of treatment. During
   convalescence patients require understanding and support in coping with
   residual disability.
TC 5
ZB 0
Z8 0
ZS 0
Z9 5
SN 0035-8819
UT MEDLINE:9670155
PM 9670155
ER

PT J
AU Lacomis, D
   Petrella, J T
   Giuliani, M J
TI Causes of neuromuscular weakness in the intensive care unit: a study of
   ninety-two patients.
SO Muscle & nerve
VL 21
IS 5
BP 610
EP 7
DI 10.1002/(SICI)1097-4598(199805)21:5<610::AID-MUS7>3.0.CO;2-B
PD 1998-May
PY 1998
AB The spectrum of neuromuscular disorders among intensive care unit (ICU)
   patients has shifted toward disorders acquired within the ICU and away
   from "traditional" neuromuscular disorders that lead to ICU admission.
   We sought to assess this spectrum by determining the causes and relative
   frequencies of neuromuscular disorders that led to electromyography
   (EMG) examinations in our ICU population. Ninety-two patients were
   studied over a 4 1/2-year period. Twenty-six (28%) had neuromuscular
   disorders (mainly Guillain-Barre syndrome, myopathy, and motor neuron
   disease) that led to ICU admission. Among patients who developed
   weakness in the ICU, there was a predominance of organ transplant
   patients and patients with the systemic inflammatory response syndrome
   and multiorgan dysfunction. Thirty-nine (42%) developed acute myopathy
   (consistent with critical illness myopathy in most), and 13% developed
   acute axonal sensorimotor polyneuropathy (mainly critical illness
   polyneuropathy). Patients with acute myopathy and acute axonal
   sensorimotor polyneuropathy had similar functional outcomes. We conclude
   that among patients who underwent EMG in our ICU population, acute
   myopathy is three times as common as acute axonal polyneuropathy, and
   the outcomes from acute myopathy and acute axonal polyneuropathy may be
   similar.
TC 106
ZB 44
Z8 1
ZS 0
Z9 107
SN 0148-639X
UT MEDLINE:9572240
PM 9572240
ER

PT J
AU [Anonymous]
TI The collaborative UK ECMO (Extracorporeal Membrane Oxygenation) trial:
   follow-up to 1 year of age.
SO Pediatrics
VL 101
IS 4
BP E1
EP E1
PD 1998-Apr
PY 1998
AB OBJECTIVE: To evaluate the clinical effectiveness of neonatal
   extracorporeal membrane oxygenation (ECMO), in terms of mortality and
   morbidity, in the treatment of cardiorespiratory failure in term
   infants.
   METHODS: The criteria for trial entry were: an oxygenation index of >40
   or arterial partial pressure of carbon dioxide (PaCO2) >12 kPa for at
   least 3 hours; gestational age at birth of 35 completed weeks or more; a
   birth weight of 2 kg or more; <10 days high-pressure ventilation; an age
   of <28 days; and no contraindication to ECMO such as previous cardiac
   arrest or intraventricular hemorrhage. Eligible infants were randomized
   either to be transferred to one of five ECMO centers in the United
   Kingdom or to continue conventional treatment. The principal outcome was
   death or severe disability at the age of 1 year. Severe disability was
   defined as an overall developmental quotient of <50 using the Griffiths
   Mental Development Scales, or blindness or a level of function so as to
   make assessment using the Griffiths Scales impossible. Families of
   surviving children were contacted at regular intervals during the first
   year and at the age of 1, and an assessment of the child was performed
   by one of three developmental pediatricians. This included a neurologic
   examination, assessment of hearing and vision, developmental level,
   general health, and health service use.
   RESULTS: Of 185 infants recruited into the trial, 93 infants were in the
   ECMO arm and 92 were allocated conventional treatment. The groups were
   comparable at trial entry. Thirty of 93 (32%) ECMO infants died before
   the age of 1 year and 54 of 92 (59%) of the infants in the conventional
   group died. Two infants were lost to follow-up, 1 from each arm of the
   trial. Of the remaining 99 survivors, at the age of 1 year, 2 infants (1
   in each arm) were still in the hospital, and 5 (3 in the ECMO arm and 2
   conventional) still required supplementary oxygen. Fifteen infants had
   tone changes in the limbs, 10/62 (16%) in the ECMO arm and 5/37 (13.5%)
   in the conventional arm. These signs were more common on the left side
   in both groups. One infant (in the ECMO arm) had bilateral sensorineural
   deafness and 1 infant (also in the ECMO arm) had low vision. Overall, 2
   infants were severely disabled (1 ECMO and 1 conventional), 16 others
   also had evidence of functional loss (12 vs 4), and 8 had impairment
   without functional loss (4 vs 5). There was a trend toward
   proportionately greater respiratory morbidity in the conventional group.
   Neurologic morbidity was more common in the ECMO group, reflecting the
   larger number of survivors. The lower rate of adverse primary outcome
   (death or severe disability at 1 year) was found among infants allocated
   ECMO in all the predefined stratified analyses. Disease severity at
   trial entry and type of referral center did not appear to alter the
   effects of ECMO. Only 4 of 18 infants with congenital diaphragmatic
   hernia survived and at age 1 year only 1 of the 4 survivors was
   considered normal.
   CONCLUSION: These results are in accord with the earlier preliminary
   findings that a policy of ECMO support reduces the risk of death without
   a concomitant rise in severe disability. However, 1 in 4 survivors had
   evidence of impairment with or without disability. Further follow-up is
   planned at the age of 4 and 7 years.
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
UT MEDLINE:9521968
PM 9521968
ER

PT J
AU Tobin, M J
   Laghi, F
   Jubran, A
TI Respiratory muscle dysfunction in mechanically-ventilated patients.
SO Molecular and cellular biochemistry
VL 179
IS 1-2
BP 87
EP 98
DI 10.1023/A:1006807904036
PD 1998-Feb
PY 1998
AB The interaction between a patient and a ventilator is the major
   determinant of the amount of respiratory muscle rest achieved by the
   machine. We are beginning to acquire a better understanding of the
   mechanisms that underlie this complex interaction, but this information
   has yet to be integrated into the routine clinical management of
   ventilator-supported patients. To achieve that goal, we need better
   techniques of detecting and monitoring patient-ventilation asynchrony,
   and the development of simple algorithms that can minimize its
   occurrence. Finally, research is needed to determine the occurrence and
   importance of respiratory muscle fatigue during failed weaning attempts
   so as to better guide the timing and pace of the weaning process in
   problematic patients.
TC 23
ZB 8
Z8 0
ZS 0
Z9 23
SN 0300-8177
UT MEDLINE:9543352
PM 9543352
ER

PT J
AU Benditt, J O
TI Management of pulmonary complications in neuromuscular disease.
SO Physical medicine and rehabilitation clinics of North America
VL 9
IS 1
BP 167
EP 85
PD 1998-Feb
PY 1998
AB The clinician working with patients with neuromuscular disease should be
   aware of the effects of muscle weakness on the respiratory system.
   Symptoms may present insidiously and can result in progressive loss of
   function, respiratory failure, and even death. A number of techniques,
   including several forms of mechanical ventilation as well as physical
   aids to assist airway hygiene, are available and are effective in
   improving symptoms and survival in appropriately selected patients with
   neuromuscular disease.
TC 12
ZB 5
Z8 0
ZS 0
Z9 12
SN 1047-9651
UT MEDLINE:9894139
PM 9894139
ER

PT J
AU Capdevila, X
   Perrigault, P F
   Ramonatxo, M
   Roustan, J P
   Peray, P
   d'Athis, F
   Prefaut, C
TI Changes in breathing pattern and respiratory muscle performance
   parameters during difficult weaning.
SO Critical care medicine
VL 26
IS 1
BP 79
EP 87
DI 10.1097/00003246-199801000-00020
PD 1998-Jan
PY 1998
AB OBJECTIVE: This study examined, using noninvasive means, the changes in
   breathing pattern and inspiratory muscle pressure-time indices during
   difficult progressive withdrawal of pressure-support ventilation.
   DESIGN: A prospective analysis of the temporal evolution of several
   respiratory variables in difficult-to-wean patients.
   SETTING: A university hospital intensive care unit.
   PATIENTS: A heterogeneous group of 17 patients receiving prolonged
   mechanical ventilation.
   INTERVENTIONS: Daily measurements of breathing pattern and respiratory
   muscle performance parameters in difficult-to-wean patients.
   MEASUREMENTS AND MAIN RESULTS: We examined breathing pattern variables,
   rapid shallow breathing (respiratory rate/tidal volume), tracheal
   occlusion pressure, maximal inspiratory pressure (P(I)max), and the
   tension-time index of the inspiratory muscles (TTmus = P(I)/P(I)max x
   Ti/Ttot) (where Ti/Ttot is inspiratory fraction of the cycle). All
   measurements were repeated at 24-hr intervals throughout the difficult
   weaning period. The patients were extubated on satisfying ten of 12
   classical weaning criteria. Eleven patients were successfully weaned
   from mechanical ventilation while six patients were not. Weaning failure
   was associated with the following: a) longer periods of mechanical
   ventilation before weaning; b) high values of tracheal occlusion
   pressure, respiratory rate, minute ventilation, and effective impedance
   maintained throughout the difficult weaning period; and c) persistent
   high PaCO2 and intrinsic positive end-expiratory pressure values. As the
   weaning failure patients' inspiratory muscles confronted an increasing
   inspiratory load, values of the tension-time index of the inspiratory
   muscles entered or remained in the fatigue zone. In contrast, weaning
   success patients normalized their breathing pattern and decreased their
   tracheal occlusion pressure, effective impedance, and tension-time index
   values.
   CONCLUSIONS: Breathing pattern alterations and respiratory muscle
   performance impairments lead to ventilator dependency after prolonged
   mechanical ventilation. The measurement of variables such as the
   noninvasive tracheal occlusion pressure, inspiratory power of breathing,
   and tension-time index of the inspiratory muscles facilitate the
   management of difficult-to-wean patients.
TC 36
ZB 11
Z8 2
ZS 1
Z9 40
SN 0090-3493
UT MEDLINE:9428547
PM 9428547
ER

PT J
AU Gilson, S F
TI Case management and supported employment: a good fit.
SO Journal of case management
VL 7
IS 1
BP 10
EP 7
PD 1998
PY 1998
AB Individuals with severe disabilities have often been denied the full
   range of vocational opportunities. Because of discrimination and
   oppression, and false beliefs regarding their skills, capacities,
   capabilities, and interests, individuals with disabilities have often
   been relegated to nonwork activities or sheltered work opportunities.
   Passage of legislation, such as the Developmental Disabilities
   Assistance and Bill of Rights Act of 1984 and Title VI, Part C of the
   Rehabilitation Act Amendments of 1986, in combination with systems
   change grants funded through Title III of the Rehabilitation Act,
   provided the basis for the initiation of a series of federal- and
   state-funded demonstration projects designed to provide opportunities
   and supports for individuals with severe or significant disabilities to
   work at competitive sites in the community. This model of vocational
   services, called supported employment, while initially conceived as a
   vocational program for individuals with mental retardation, has been
   modified to successfully provide services to individuals with mental
   illness, acquired brain injury, autism, cerebral palsy, physical
   disabilities, and other disabilities. A key to the success of these
   programs is the complementary working relationship between the case
   manager and the job coach. While there may be some overlap in what each
   brings to the person with a disability, each professional plays
   distinctive and critical roles in the carrying out of supported
   employment.
TC 1
ZB 0
Z8 0
ZS 0
Z9 1
SN 1061-3706
UT MEDLINE:9764021
PM 9764021
ER

PT J
AU Panadero, E
   Lopez-Herce, J
   Caro, L
   Sanchez, A
   Cueto, E
   Bustinza, A
   Moral, R
   Carrillo, A
   Sancho, L
TI Transpyloric enteral feeding in critically ill children.
SO Journal of pediatric gastroenterology and nutrition
VL 26
IS 1
BP 43
EP 8
DI 10.1097/00005176-199801000-00008
PD 1998-Jan
PY 1998
AB BACKGROUND: Nutrition is important in childhood because the child has a
   lower energy reserve than the adult and a higher demand for calories
   because of ongoing growth. In this study, the utility of transpyloric
   enteral feeding (TEF) in critically ill children was evaluated.
   METHODS: A prospective, descriptive study was made in a pediatric
   intensive care unit of a tertiary pediatric center of 41 critically ill
   children, 30 after surgical procedures and 11 with nonsurgical illness,
   aged 8 days to 12 years, who received transpyloric enteral feeding with
   8- or 10-Fr weighted feeding tubes. Analysis was made of tolerance and
   complications (vomiting, abdominal distension, excessive gastric
   residual, diarrhea, and pulmonary aspiration) of TEF.
   RESULTS: The mean duration of TEF was 19.5 +/- 26.8 days (range, 1-120
   days). The administration of sedative agents or inotropic drugs did not
   alter toleration of TEF. Eight of 12 patients treated with continuous
   infusion of vecuronium tolerated TEF without complications. Eleven
   gastrointestinal complications occurred in 10 patients, abdominal
   distension and excessive gastric residual in 7 (17%), and diarrhea in 4
   (9.7%). In 7 patients gastrointestinal complications improved, with
   decreasing use or transitory interruption of TEF, but in 4 patients
   (9.7%), TEF had to be withdrawn. Gastrointestinal complications were
   more frequent in postsurgical than in nonsurgical patients (p < 0.001).
   No patients suffered from pulmonary aspiration, and the incidence of
   pulmonary infection and hepatic dysfunction diminished during TEF.
   CONCLUSIONS: Transpyloric enteral feeding is a good method of
   nutritional support in critically ill children and can be used in
   patients treated with neuromuscular blocking agents. The frequency and
   severity of complications and the risks of pulmonary infection and
   hepatic dysfunction related to TEF are low.
TC 13
ZB 4
Z8 0
ZS 0
Z9 13
SN 0277-2116
UT MEDLINE:9443119
PM 9443119
ER

PT J
AU Schonhofer, B
   Geibel, M
   Sonneborn, M
   Haidl, P
   Kohler, D
TI Daytime mechanical ventilation in chronic respiratory insufficiency.
SO The European respiratory journal
VL 10
IS 12
BP 2840
EP 6
DI 10.1183/09031936.97.10122840
PD 1997-Dec
PY 1997
AB Chronic respiratory insufficiency (CRI) is associated with nocturnal
   hypoventilation. Treatment with noninvasive mechanical ventilation
   (NIMV) performed overnight relieves symptoms of hypoventilation and
   improves daytime blood gases in CRI. In order to test whether the
   efficacy of NIMV depends on it being applied during sleep, we conducted
   a prospective case-controlled study comparing daytime mechanical
   ventilation (dMV) in awake patients with nocturnal mechanical
   ventilation (nMV) given in equal quantities. We enrolled 34 clinically
   stable patients (age 56.1+/-12.1 yrs, 20 females, 14 males) with CRI due
   to restrictive lung and chest wall disorders and neuromuscular disease.
   Using a prospective case-control design, matched subjects were allocated
   alternately to dMV and nMV. After 1 month of NIMV there was considerable
   symptomatic improvement in both dMV and nMV patients. There were no
   significant differences between groups in the improvement in daytime
   arterial carbon dioxide tension (Pa,CO2) (dMV from 7.5+/-0.6 to
   5.7+/-0.6 kPa; nMV from 7.2+/-0.5 to 5.8+/-0.5 kPa, p<0.0001) and during
   the unassisted spontaneous night-time ventilation in terms of
   transcutaneous Pa,CO2 (dMV from 8.4+/-1.2 to 6.6+/-0.7 kPa; nMV from
   8.2+/-1.2 to 6.8+/-0.5 kPa, p<0.0001). We conclude that in many
   respects, when compared to nocturnal mechanical ventilation, daytime
   mechanical ventilation in awake patients is equally effective at
   reversing chronic respiratory insufficiency. Since long-term safety
   issues were not addressed in this study, we recommend that nocturnal
   mechanical ventilation should remain the modality of choice for
   noninvasive mechanical ventilation.
TC 44
ZB 17
Z8 0
ZS 0
Z9 44
SN 0903-1936
UT MEDLINE:9493671
PM 9493671
ER

PT J
AU Fish, D N
   Singletary, T J
TI Cross-resistance to both atracurium- and vecuronium-induced
   neuromuscular blockade in a critically ill patient.
SO Pharmacotherapy
VL 17
IS 6
BP 1322
EP 7
PD 1997 Nov-Dec
PY 1997
AB A previously healthy 33-year-old woman received neuromuscular blocking
   agents during treatment of severe adult respiratory distress syndrome
   secondary to pneumococcal pneumonia and septic shock. Atracurium
   infusion rates were progressively increased, preceded by repeated
   loading doses up to a maximum of 3.57 mg/kg/hour, but produced
   inadequate neuromuscular blockade as assessed by clinical and
   ventilatory parameters as well as train-of-four (TOF) monitoring.
   Atracurium was discontinued and vecuronium infusions of 2.3 mg/kg/hour
   finally produced adequate paralysis for 7 days. Increasing vecuronium
   requirements then prompted discontinuation of neuromuscular blockade.
   Atracurium was reinstituted 2 days later because of worsening pulmonary
   function. Infusion rates of 3.04 mg/kg/hour were again required,
   together with high-dose midazolam and fentanyl, to achieve adequate
   oxygenation with acceptable airway pressures; however, TOF monitoring
   showed an unacceptable level of paralysis. Cross-resistance among
   chemically dissimilar neuromuscular blocking agents poses a difficult
   patient management problem and supports a pharmacodynamic basis of
   resistance to these agents.
TC 9
ZB 4
Z8 0
ZS 0
Z9 10
SN 0277-0008
UT MEDLINE:9399619
PM 9399619
ER

PT J
AU Nates, J L
   Cooper, D J
   Day, B
   Tuxen, D V
TI Acute weakness syndromes in critically ill patients--a reappraisal.
SO Anaesthesia and intensive care
VL 25
IS 5
BP 502
EP 13
PD 1997-Oct
PY 1997
AB Over the last twenty years, increasing numbers of critically ill,
   mechanically ventilated patients who develop acute profound muscle
   weakness have been described. These acute weakness syndromes have not
   been well understood and they have been given many names including:
   acute steroid myopathy, acute quadriplegic myopathy, the floppy person
   syndrome, critical illness polyneuropathy, critical illness
   polyneuromyopathy, and prolonged neurogenic weakness. Many of these
   "syndromes" either overlap or represent the same disease process in
   different patients. Many have been incompletely diagnosed. During this
   review it became evident that the acute weakness syndromes currently
   recognized in critically ill patients could be categorized into four
   major groups: myopathy, neuromuscular junction abnormalities, neuropathy
   and polyneuromyopathy. Each had different possible aetiologies.
   "Myopathy" includes acute necrotizing myopathy and disuse atrophy.
   Neuromuscular junction abnormalities are subdivided into myasthenia-like
   syndromes and prolonged neuromuscular blockade. Neuropathies are divided
   into critical illness polyneuropathy and acute motor neuropathy. The
   anterior horn cell injury in Hopkins syndrome should also be considered
   in this group. Polyneuromyopathies include various combinations of
   neuropathy and myopathy in the same patients.
RI Cooper, D. James/G-7961-2013
OI Cooper, D. James/0000-0002-5872-9051
TC 32
ZB 14
Z8 0
ZS 2
Z9 34
SN 0310-057X
UT MEDLINE:9352763
PM 9352763
ER

PT J
AU Berkahn, J M
   Sleigh, J W
TI Hyperkalaemic cardiac arrest following succinylcholine in a longterm
   intensive care patient.
SO Anaesthesia and intensive care
VL 25
IS 5
BP 588
EP 9
PD 1997-Oct
PY 1997
TC 13
ZB 7
Z8 0
ZS 0
Z9 13
SN 0310-057X
UT MEDLINE:9352784
PM 9352784
ER

PT J
AU Hayden, M F
   Heller, T
TI Support, problem-solving/coping ability, and personal burden of younger
   and older caregivers of adults with mental retardation.
SO Mental retardation
VL 35
IS 5
BP 364
EP 72
DI 10.1352/0047-6765(1997)035<0364:SPAAPB>2.0.CO;2
PD 1997-Oct
PY 1997
AB Relations between service and support utilization,
   problem-solving/coping strategies, level of personal burden experienced
   by younger and older caregivers were examined. Overall, there were no
   differences in the number of support services received. However, younger
   caregivers reported significantly more unmet service needs and rated
   significantly more of them as a critical or an emergency need. Both
   groups had highly developed effective problem-solving skills. However,
   older caregivers were more likely to seek spiritual support and the
   younger caregivers more apt to mobilize their families to acquire and
   accept help. Older caregivers experienced significantly less personal
   burden. Results suggest that younger caregivers are more predisposed
   toward seeking outside help and have higher expectations of the service
   system.
TC 23
ZB 2
Z8 0
ZS 0
Z9 23
SN 0047-6765
UT MEDLINE:9339065
PM 9339065
ER

PT J
AU Magarey, J M
TI Sedation of adult critically ill ventilated patients in intensive care
   units: a national survey.
SO Australian critical care : official journal of the Confederation of
   Australian Critical Care Nurses
VL 10
IS 3
BP 90
EP 3
DI 10.1016/S1036-7314(97)70406-5
PD 1997-Sep
PY 1997
AB The aim of this survey was to review the practice of sedation for adult
   artificially ventilated patients in Australian intensive care units. In
   particular, the survey sought to investigate the drugs used, how they
   were administered, who was responsible for the administration, how
   sedation was assessed, and if, in the opinion of charge nurses,
   complications were occurring as a result of their practice.
   Questionnaires were sent by post to the clinical nurse consultants
   (CNCs) in charge of 72 units containing five or more beds, as identified
   in the Hospital Health Services Yearbook. By June 1996, 65
   questionnaires had been returned (a 90 per cent response rate). Results
   showed that the most common form of sedation is a combination of
   benzodiazepines and narcotics (88 per cent); in particular, morphia (92
   per cent) and midazolam (94 per cent). In 79 per cent of units, these
   drugs are administered by continuous infusion. Neuromuscular blocking
   agents are no longer commonly used in conjunction with sedation, with
   the majority of units (88 per cent) indicating occasional use only. Also
   in the majority of units (94 per cent), nurses are responsible for
   titrating and administering sedation. The experience of these nurses
   varied; in 61 per cent of units it ranged from first year
   post-graduation to the holding of a critical care certificate. In most
   units (63 per cent), the aim is to lightly sedate patients. Methods of
   assessing sedation vary, with few units using sedation scales (17 per
   cent). Twenty six CNCs (40 per cent) reported that, in their opinion,
   there were no complications related to their practice of sedation. The
   most common complication reported (by 21 CNCs or 32 per cent) was
   over-sedation. It appears that there is no consistent method of
   assessing the level of sedation in critically ill ventilated patients
   and that over-sedation is common. Therefore, it is recommended that
   clinicians investigate the possibility of introducing sedation scales in
   their units. However, the efficacy of such scales in ensuring a more
   appropriate level of sedation needs to be researched.
TC 26
ZB 6
Z8 1
ZS 0
Z9 27
SN 1036-7314
UT MEDLINE:9362609
PM 9362609
ER

PT J
AU Chittaro, L
   Dojat, M
TI Using a general theory of time and change in patient monitoring:
   experiment and evaluation.
SO Computers in biology and medicine
VL 27
IS 5
BP 435
EP 52
DI 10.1016/S0010-4825(97)00014-0
PD 1997-Sep
PY 1997
AB In this paper, we propose to use one of the well-known general theories
   of time and change, namely the Event Calculus (Kowalski and Sergot, New
   Generation Computing 4, 67-95, 1986), to represent temporal aspects in
   intelligent medical monitoring systems. In particular, we explore the
   application of CEC (Chittaro and Montanari, Computational Intelligence
   12, 359-382, 1996) (an efficient implementation of the Event Calculus)
   to the management of mechanical ventilation. First, we present the
   prototype we have built, which has been extensively tested on patient's
   data from real clinical cases. Then, we provide a thorough evaluation of
   the obtained results, pointing out both strengths and weaknesses of the
   approach, and identifying a number of extensions which can be extremely
   useful to scale up the medical application of the approach.
RI Dojat, Michel/G-7758-2011
OI Dojat, Michel/0000-0003-2747-6845
TC 18
ZB 1
Z8 0
ZS 0
Z9 18
SN 0010-4825
UT MEDLINE:9397343
PM 9397343
ER

PT J
AU Qin, F
   Xu, H
   Chen, Y
TI [Intermediate syndrome after acute organophosphorus pesticides
   poisoning: clinical analysis of 10 cases].
SO Zhonghua nei ke za zhi
VL 36
IS 9
BP 613
EP 6
PD 1997-Sep
PY 1997
AB Ten patients with intermediate syndrome (IMS) after acute
   organophosphorus (OP) pesticides poisoning were observed. The occurrence
   rate of IMS was 5.4% among total inpatients of acute OP poisoning in the
   same period. The majority of IMS cases were of severe oral OP poisoning.
   Seven to 68 hours after poisoning there were initial signs including
   motor weakness of muscles innervated by the 9th and 10th cranial nerves
   (e.g. dysphagia, hoarse voice). The neck flexor muscles and proximal
   limb muscles were also involved. Patients with respiratory muscle
   paralysis usually required urgent tracheal intubation and mechanical
   ventilation. The IMS in this group persisted for 6-30 days (mean 13
   days) with no fatality. The relevant kinds of pesticide, the development
   and regression of IMS, and the treatment and possible mechanism of IMS
   were discussed.
TC 1
ZB 1
Z8 0
ZS 0
Z9 1
SN 0578-1426
UT MEDLINE:10436973
PM 10436973
ER

PT J
AU Imanaka, H
   Taenaka, N
   Nakamura, J
   Aoyama, K
   Hosotani, H
TI Ocular surface disorders in the critically ill.
SO Anesthesia and analgesia
VL 85
IS 2
BP 343
EP 6
DI 10.1097/00000539-199708000-00018
PD 1997-Aug
PY 1997
AB Abnormalities of the cornea and conjunctiva occur in association with
   neurological diseases, nocturnal lagophthalmos, coma, infection, and
   mechanical ventilation. We investigated the incidence and causes of
   ocular surface disorders in critically ill patients. In a retrospective
   study, the presence of conjunctivitis and corneal erosion was determined
   by reviewing the medical charts of 143 mechanically ventilated patients
   (intensive care unit [ICU] stay > or =7 days). In the subsequent
   prospective study, 15 patients who had sedatives or muscle relaxants
   administered continuously for more than 48 h in the ICU were
   investigated. Corneal erosion was examined using a slit lamp once a day.
   Ocular surface disorder was found in 28 of the 143 patients (20%) whose
   ICU stay exceeded 7 days. The incidence increased with continuous
   sedation (35% vs 15%). The incidence also increased with continuous
   neuromuscular blockade (39% vs 11%). In the prospective study, nine
   patients (60%) developed corneal erosion. A patient's inability to fully
   close his or her eyes increased the incidence (P < 0.01) of corneal
   erosion. Protective eyelid taping was effective in preventing and
   treating the corneal erosion. In conclusion, the critically ill often
   develop ocular surface disorders, especially when sedated and
   immobilized. A close relationship was observed between these conditions
   and the inability to close one's eyes.
TC 27
ZB 4
Z8 0
ZS 1
Z9 27
SN 0003-2999
UT MEDLINE:9249111
PM 9249111
ER

PT J
AU Colt, H G
   Harrell, J H
TI Therapeutic rigid bronchoscopy allows level of care changes in patients
   with acute respiratory failure from central airways obstruction.
SO Chest
VL 112
IS 1
BP 202
EP 6
DI 10.1378/chest.112.1.202
PD 1997-Jul
PY 1997
AB OBJECTIVE: To determine whether emergency rigid bronchoscopic
   intervention, including Nd-YAG laser resection or stenting, immediately
   affected the need for continued mechanical ventilation or intensive care
   level of support in critically ill patients with acute respiratory
   failure from malignant or benign central airways obstruction.
   DESIGN: Retrospective review of medical records of all patients with
   acute respiratory failure and malignant or benign tracheobronchial
   obstruction necessitating intubation, mechanical ventilation, or
   hospitalization in the ICU prior to referral for therapeutic
   bronchoscopy.
   SETTING: University of California San Diego, a tertiary care institution
   specialized in airway management.
   PATIENTS: Medical records of 32 patients with malignant or benign
   central airways obstruction requiring admission to the ICU prior to
   rigid bronchoscopic intervention between January 1994 and April 1996.
   INTERVENTIONS: Emergent rigid bronchoscopy with dilatation, Nd-YAG laser
   resection, or silicone stent insertion performed in the operating room
   under general anesthesia.
   RESULTS: Thirty-two patients with central airways obstruction requiring
   emergent hospitalization in the ICU were referred for therapeutic rigid
   bronchoscopy. Airway strictures were caused by benign disease in 18
   patients, and by primary bronchogenic lung cancer in 14. Of the 19
   patients who were mechanically ventilated, bronchoscopic intervention
   allowed immediate discontinuation of mechanical ventilation in 10
   (52.6%). Twenty-five patients had indwelling artificial airways (12
   endotracheal tubes, 13 tracheotomy tubes). Two, however, were considered
   tracheotomy-dependent because of neuromuscular disease. Of the remaining
   23 patients, immediate extubation or decannulation was possible in seven
   (30.4%). Of seven patients with no indwelling airway, five (71.4%) were
   immediately transferred to a lower level of care after intervention. Of
   the 32 total patients, 20 (62.5%) were immediately transferred to a
   lower level of care immediately after intervention.
   CONCLUSIONS: Emergency laser resection or stent insertion can favorably
   affect health-care utilization in patients with acute respiratory
   distress from central airways obstruction. Treatment may be lifesaving
   and allows successful withdrawal from mechanical ventilation,
   hospitalization in a lower level of care environment, relief of
   symptoms, and extended survival in critically ill patients. In patients
   with regionally advanced cancer, the palliative nature of this procedure
   postpones death by respiratory distress and may prompt consideration for
   institution of conservative comfort measures to reduce patient
   suffering.
TC 62
ZB 14
Z8 6
ZS 1
Z9 69
SN 0012-3692
UT MEDLINE:9228377
PM 9228377
ER

PT J
AU Prielipp, R C
   Robinson, J C
   Wilson, J A
   MacGregor, D A
   Scuderi, P E
TI Dose response, recovery, and cost of doxacurium as a continuous infusion
   in neurosurgical intensive care unit patients.
SO Critical care medicine
VL 25
IS 7
BP 1236
EP 41
DI 10.1097/00003246-199707000-00028
PD 1997-Jul
PY 1997
AB OBJECTIVES: To determine the optimal dosing of doxacurium as a
   continuous infusion in neurosurgical patients with traumatic brain
   injury; to determine the effects of bolus administration of doxacurium
   on heart rate (HR), blood pressure (BP), and intracranial pressure
   (ICP); to monitor neuromuscular recovery after discontinuation of
   prolonged doxacurium infusion; and to compare the cost of doxacurium
   with other current neuromuscular blocking drugs.
   DESIGN: Prospective, open-label study.
   SETTING: Neurosurgical intensive care unit (ICU) of a
   university-affiliated teaching hospital.
   PATIENTS: Eight critically ill, mechanically ventilated patients with
   traumatic head injury and normal renal and hepatic function. Patients
   had ICP monitoring.
   INTERVENTIONS: A bolus injection of doxacurium (0.05 mg/kg) followed by
   a continuous infusion (0.015 mg/kg/hr), adjusted to maintain one twitch
   during Train-of-Four nerve stimulation of the adductor pollicis muscle.
   MEASUREMENTS AND MAIN RESULTS: Bolus injections of doxacurium did not
   alter the HR, BP, or ICP. Patients were paralyzed 66 +/- 12 (SEM) hrs,
   with recovery of the fourth twitch occurring 118 +/- 19 mins after
   infusion of the doxacurium was discontined. There were no incidences of
   prolonged weakness, myopathy, or other adverse events.
   CONCLUSIONS: Continuous infusion of doxacurium provides stable
   neuromuscular blockade for neurosurgical patients with traumatic brain
   injury. Doxacurium is devoid of clinically important interactions with
   HR, BP, or ICP and is less costly than other neuromuscular blockers used
   in the ICU.
TC 10
ZB 3
Z8 0
ZS 0
Z9 11
SN 0090-3493
UT MEDLINE:9233753
PM 9233753
ER

PT J
AU Leung, P
   Jubran, A
   Tobin, M J
TI Comparison of assisted ventilator modes on triggering, patient effort,
   and dyspnea.
SO American journal of respiratory and critical care medicine
VL 155
IS 6
BP 1940
EP 8
PD 1997-Jun
PY 1997
AB In 11 ventilator-dependent patients, we undertook a head-to-head
   comparison of patient-ventilator interaction during four ventilator
   modes: assist-control ventilation (ACV), intermittent mandatory
   ventilation (IMV), pressure support (PS), and a combination of IMV and
   PS. Progressive increases in IMV rate and PS level each decreased
   inspiratory pressure-time product (PTP) (p < 0.0001). These reductions
   in PTP were greater with PS than with IMV at lower but proportional
   levels of maximal assistance (p < 0.005). When PS 10 cm H2O was added to
   a given level of IMV, greater reductions in PTP were achieved not only
   during intervening (PS) breaths (p < 0.001), but also during mandatory
   (volume-assisted) breaths (p < 0.0005); this additional unloading during
   mandatory breaths was proportional to the decrease in respiratory drive
   (dP/dt) during intervening breaths (r = 0.67, p < 0.0001). Maximal
   unloading occurred with ACV, achieving more than a fivefold decrease in
   PTP compared with unassisted breathing. Decreases in PTP were confined
   to the post-trigger phase, and PTP of the post-trigger phase correlated
   with dP/dt (r = 0.78, p < 0.0001). Effort during the trigger phase
   remained constant despite marked changes in drive and intrinsic positive
   end-expiratory pressure (PEEPi). Ineffective triggering occurred with
   all modes, and wasted PTP increased with increasing levels of assistance
   as a result of the accompanying decrease in drive and increase in
   volume. Breaths preceding nontriggering efforts had shorter respiratory
   cycle times (p < 0.0005) and expiratory times (p < 0.0001) and higher
   PEEPi (p < 0.0001), indicating that neural-mechanical asynchrony
   resulted from inspiratory activity commencing prematurely before elastic
   recoil pressure had fallen to a level that could be overcome by a
   patient's muscular effort. Thus, increases in the level of ventilator
   assistance produced progressive decreases in inspiratory muscle effort
   and dyspnea,which were accompanied by increases in the rate of
   ineffective triggering.
TC 167
ZB 53
Z8 2
ZS 0
Z9 170
SN 1073-449X
UT MEDLINE:9196100
PM 9196100
ER

PT J
AU Leon, F
   Badui, E
   Campos, A
   Enciso, R
   Fakih, T
   Guadarrama, M
   Valdespino, A
   Murillo, H
   Calleja, C
TI Cholera and myocarditis--a case report.
SO Angiology
VL 48
IS 6
BP 545
EP 9
DI 10.1177/000331979704800610
PD 1997-Jun
PY 1997
AB The authors describe the case of a fifty-nine-year-old white man,
   previously in good health, who initiated his present illness with acute
   episode of enterocolitis characterized by mild fever and, in the next
   eight hours, twenty-four episodes of watery diarrhea, nausea and
   vomiting, as well as generalized sweating and severe weakness secondary
   to hypovolemia and electrolyte disorder. These complications were
   corrected in seventy-two hours in the intensive care unit. Two days
   later, when the patient was stable hemodynamically, under cardiac
   monitoring and with normal laboratory studies including serum
   electrolytes, he developed electrocardiographic changes characterized by
   trifascicular block (prolonged P-R interval, complete right bundle
   branch block [CRBBB] and left posterior hemiblock [LPH]) with a cardiac
   rate of thirty beats per minute, for which a temporary pacemaker was
   inserted. Endomyocardial biopsy showed histopathologic signs of
   myocarditis and the immunologic study of the cardiac tissue revealed
   positive polymerize chain reaction (PCR+) with the presence of
   antitoxine choleric antibodies (AcTCA). After three weeks, the same
   conduction disturbances remained, for which a permanent pacemaker was
   inserted. On top of intravenous fluid replacement and electrolyte
   supplements, the patient was managed with tetracycline 2 g a day for one
   week and sulfamethoxazole-trimethoprim 800/160 mg a day for two weeks.
   The purpose of this study is to present a rare and very well-documented
   myocarditis by cholera in a patient with enteric disease, in whom
   several cardiac complications occurred.
TC 1
ZB 0
Z8 0
ZS 0
Z9 1
SN 0003-3197
UT MEDLINE:9194541
PM 9194541
ER

PT J
AU Tejeda, M
   Boix, J H
   Alvarez, F
   Balanza, R
   Morales, M
TI Comparison of pressure support ventilation and assist-control
   ventilation in the treatment of respiratory failure.
SO Chest
VL 111
IS 5
BP 1322
EP 5
DI 10.1378/chest.111.5.1322
PD 1997-May
PY 1997
AB STUDY OBJECTIVE: To assess whether pressure support ventilation (PSV)
   could be used as an alternative ventilatory mode to assist-control (A/C)
   ventilation in the treatment of respiratory failure.
   DESIGN: A short-term (4-h) prospective study in which the beneficial
   effect of PSV on respiratory mechanics, gas exchange, arterial
   oxygenation, cardiovascular hemodynamics, and oxygen consumption was
   compared with A/C ventilation.
   SETTING: ICU of a community hospital.
   PATIENTS: Forty-five patients (mean age, 62.8 [11.8] years) with
   respiratory failure secondary to COPD, restrictive disorders, or
   neuromuscular disease requiring mechanical ventilatory support in the
   ICU were selected for study.
   INTERVENTIONS: The mean duration of mechanical ventilation before the
   study was 7.16 (8.64) days. Patients were switched to the PSV mode of
   the mechanical ventilator for a period of 4 h after which conventional
   A/C ventilation was resumed.
   RESULTS: Patients supported with PSV compared with A/C ventilation
   showed significantly higher tidal volume, minute ventilation, and
   inspiratory time in association with significantly lower pressure in the
   airway and I:E ratio. With regard to gas exchange data, an increase in
   dead space/tidal volume ratio (VD/VT), decrease in PaO2, and
   statistically but not clinically significant alteration of arterial
   oxygenation indexes were noted. However, when patients with COPD,
   restrictive disorders, and neuromuscular disease were compared,
   significant changes in arterial oxygenation parameters were found only
   in patients with restrictive disorders. There were significant decreases
   in heart rate, systolic pulmonary artery pressure, and pulmonary
   capillary wedge pressure when PSV was applied. Oxygen transport and
   oxygen consumption were unchanged.
   CONCLUSIONS: PSV could be a possible alternative to A/C ventilation in
   patients with respiratory failure. PSV caused an increase in VD/VT in
   association with a significantly lower pressure in the airway and I:E
   ratio. Randomized studies are needed to define the long-term benefits of
   both respiratory modes and the conditions in which PSV may be a valuable
   alternative to A/C ventilation.
TC 20
ZB 6
Z8 0
ZS 0
Z9 20
SN 0012-3692
UT MEDLINE:9149589
PM 9149589
ER

PT J
AU Cohn, S M
TI Pulmonary contusion: review of the clinical entity.
SO The Journal of trauma
VL 42
IS 5
BP 973
EP 9
DI 10.1097/00005373-199705000-00033
PD 1997-May
PY 1997
AB Pulmonary contusion is a common lesion occurring in patients sustaining
   severe blunt chest trauma. Alveolar hemorrhage and parenchymal
   destruction are maximal during the first 24 hours after injury and then
   usually resolve within 7 days. The diagnosis of traumatic lung injury is
   usually made clinically with confirmation by chest x-ray films. The
   chest computed tomography scan is highly sensitive in identifying
   pulmonary contusion and may help predict the need for mechanical
   ventilation. Respiratory distress is common after lung trauma, with
   hypoxemia and hypercarbia greatest at about 72 hours. Although
   management of patients with pulmonary contusion is supportive, pneumonia
   and adult respiratory distress syndrome with long-term disability occur
   frequently.
TC 127
ZB 51
Z8 4
ZS 0
Z9 132
SN 0022-5282
UT MEDLINE:9191684
PM 9191684
ER

PT J
AU Braghiroli, A
   Zaccaria, S
   Ioli, F
   Erbetta, M
   Donner, C F
TI Pulmonary failure as a cause of death in COPD.
SO Monaldi archives for chest disease = Archivio Monaldi per le malattie
   del torace / Fondazione clinica del lavoro, IRCCS [and] Istituto di
   clinica tisiologica e malattie apparato respiratorio, Universita di
   Napoli, Secondo ateneo
VL 52
IS 2
BP 170
EP 5
PD 1997-Apr
PY 1997
AB Data on the outcome of patients with chronic obstructive pulmonary
   disease (COPD) are limited. We know that the prognosis is poor when
   respiratory insufficiency develops, but we have little information on
   the actual cause of death. Epidemiological studies are suitable for the
   assessment of the prevalence of the disease, but give no details on the
   actual cause of death. Age and forced expiratory volume in one second
   (FEV1) have been recognized as the best predictors of mortality in
   studies designed to quantify survival of COPD patients, particularly
   when the post-brochodilator value is used, as this provides a better
   estimate of airway and parenchymal damage. Data from Intensive Care
   Units on acute respiratory failure have several significant limitations.
   Firstly, it is probable that some patients elect not to undergo
   intensive treatment for a terminal bout of respiratory failure,
   particularly if it is not first episode. Secondly, the actual cause of
   death is often not described in adequate detail. Hypoxaemia and
   acidaemia are the main risk factors in acute exacerbation of the disease
   and the presence of pulmonary infiltrates on chest radiographs worsens
   the prognosis. A single bout of respiratory failure appears to have no
   effect on the prognosis of COPD patients after recovery, but there is a
   consistent increase in mortality after the second episode. It seems
   possible to manage the majority of episodes of acute respiratory failure
   with mechanical ventilation administered with noninvasive techniques.
   When endotracheal intubation is necessary, the prognosis is usually poor
   and the survival after 1 yr is usually lower than 40%. The role of
   long-term home mechanical ventilation is still unclear. Results from
   pivotal studies have been encouraging, although survival is far less
   impressive than in neuromuscular disorders. In patients with end-stage
   lung disease, lung transplantation can be considered the only
   possibility of increasing pulmonary functional capacity. However the
   technique is reserved only for a highly selected group of patients and
   data on the long-term outcome are awaited.
TC 2
ZB 0
Z8 0
ZS 0
Z9 2
SN 1122-0643
UT MEDLINE:9203816
PM 9203816
ER

PT J
AU Hund, E
   Genzwurker, H
   Bohrer, H
   Jakob, H
   Thiele, R
   Hacke, W
TI Predominant involvement of motor fibres in patients with critical
   illness polyneuropathy.
SO British journal of anaesthesia
VL 78
IS 3
BP 274
EP 8
PD 1997-Mar
PY 1997
AB Critical illness polyneuropathy (CIP) is a recognized cause of muscle
   weakness and failure of weaning from a ventilator. In order to
   characterize the features of CIP, we have examined 28 consecutive
   surgical patients with severe sepsis using bedside electrophysiology. Of
   the 28 patients (median APACHE II score 31), 20 developed moderate to
   severe CIP, as shown by the presence of moderate to severe denervation
   activity on resting EMG. The median nerve compound muscle action
   potential (CMAP) amplitudes were reduced to 3.24 (SEM 0.48) mV, while
   sensory nerve action potential (SNAP) amplitudes obtained from the same
   nerve were normal (13.1 (1.9) microV). In approximately 50% of these
   patients, the reduction in CMAP exceeded 50% of the lower limit of
   normal. Similar results were obtained from stimulation of the ulnar
   nerve. We conclude that CIP is a major complication in patients with
   severe sepsis and prolonged artificial ventilation. It predominantly
   involves motor fibres and thus markedly interferes with weaning from the
   ventilator.
TC 49
ZB 18
Z8 1
ZS 0
Z9 50
SN 0007-0912
UT MEDLINE:9135304
PM 9135304
ER

PT J
AU Bradley, S F
TI Methicillin-resistant Staphylococcus aureus in nursing homes.
   Epidemiology, prevention and management.
SO Drugs & aging
VL 10
IS 3
BP 185
EP 98
DI 10.2165/00002512-199710030-00003
PD 1997-Mar
PY 1997
AB Infections caused by Staphylococcus aureus are a significant cause of
   morbidity and mortality in elderly persons in the community, hospitals
   and chronic care facilities. Methicillin-resistant S. aureus (MRSA) has
   become an important cause of severe infection in acutely ill patients in
   hospitals from diverse geographic areas. Whether MRSA has the same
   potential to spread and cause infection in nursing homes has only
   recently been explored. In the facilities studied, asymptomatic MRSA
   carriage has been common, but patients do not appear to have the same
   risk of acquiring the organism. The risk of MRSA colonisation appears to
   be associated with increasing debility, the presence of invasive devices
   or wounds, and increased overall mortality. Most nursing home residents
   acquire MRSA during a hospital stay, not in the nursing home.
   Transmission of MRSA between nursing home residents may be less
   efficient than that seen among hospitalised patients. Once residents
   acquire MRSA, they remain persistently colonised for months to years.
   Many different MRSA strains circulate within nursing homes, probably
   reflecting the strains found in referring hospitals. Fortunately,
   although MRSA colonisation is relatively common, rates of MRSA infection
   and attributable mortality appear to be low. However, the presence of
   MRSA in a facility might lead to fewer treatment options when infections
   do occur, with more adverse effects and increased costs. The routine use
   of surveillance cultures and antibacterials in an attempt to permanently
   eradicate MRSA from nursing home residents has not been successful, and
   resistance has quickly emerged. More importantly, nursing homes should
   utilise infection control practices that disrupt transmission by direct
   contact, thus preventing the potential spread of MRSA. Simple,
   inexpensive precautions, which emphasise handwashing and the use of
   gloves and gowns when soiling by patient body fluids is likely, are
   generally effective. Knowledge of the patient's MRSA colonisation status
   is not necessary when these universal barrier precautions are applied to
   the care of all patients. If an increase in the rate of MRSA infections
   is documented, more intensive infection control measures should be
   implemented.
TC 48
ZB 27
Z8 0
ZS 0
Z9 48
SN 1170-229X
UT MEDLINE:9108892
PM 9108892
ER

PT J
AU Leijten, F S
   Poortvliet, D C
   de Weerd, A W
TI The neurological examination in the assessment of polyneuropathy in
   mechanically ventilated patients.
SO European journal of neurology : the official journal of the European
   Federation of Neurological Societies
VL 4
IS 2
BP 124
EP 9
DI 10.1111/j.1468-1331.1997.tb00317.x
PD 1997-Mar
PY 1997
AB Polyneuropathy has been implicated in critical illness as a cause of
   difficult weaning from artificial ventilation and of rehabilitation
   problems. We wanted to see which clinical parameters can be used to
   identify patients with polyneuropathy in the intensive care. In a
   prospective study during 18 months, mechanically ventilated patients
   underwent serial neurological and EMG investigations in the general
   intensive care unit of a large community hospital. Fifty patients under
   75 years old were studied who were on the respirator for more than 7
   days. Using simple criteria, both a provisional clinical and an EMG
   diagnosis were made with regard to polyneuropathy during the second and
   fourth week and the second month of mechanical ventilation. After the
   intensive care period, 34 surviving patients were also given a final
   clinical diagnosis which was compared to earlier EMG conclusions. Even
   with crude criteria, such as the presence of either paresis or
   areflexia, maximal sensitivity of the provisional clinical judgement was
   only 60% as compared to concurrent EMG diagnosed polyneuropathy. EMG
   investigations in the intensive care, however, did not identify two out
   of 10 patients with a final clinical diagnosis of polyneuropathy. Thus,
   neurological examination is an insufficient screening method for
   polyneuropathy in intensive care. EMG has a fair diagnostic yield but
   one should realize that it is not an infallible gold standard. 
TC 5
ZB 3
Z8 0
ZS 0
Z9 5
SN 1351-5101
UT MEDLINE:24283904
PM 24283904
ER

PT J
AU Shikora, S A
   Benotti, P N
TI Nutritional support of the mechanically ventilated patient.
SO Respiratory care clinics of North America
VL 3
IS 1
BP 69
EP 90
PD 1997-Mar
PY 1997
AB As with all critically ill patients, those requiring mechanical
   ventilation are susceptible to the wasting of illness and cannot survive
   without prompt nutritional support. It may be fair to say that the
   proper provision of nutrients, and in particular the avoidance of
   overfeeding, are even more crucial for this subset of critically ill
   patients. To maximize the overall benefits of feeding, it is crucial to
   provide the nutritional support early and enterally whenever possible.
   Therefore, the best strategy for early removal of the mechanical
   ventilatory support must include the timely and careful administration
   of nutrients, micronutrients, minerals, vitamins, and fluid, in
   conjunction with standard intensive care therapeutics and the
   appropriate respiratory muscle-strengthening program.
TC 5
ZB 2
Z8 0
ZS 0
Z9 5
SN 1078-5337
UT MEDLINE:9390903
PM 9390903
ER

PT J
AU Zheng, H
   Lin, Y
   Chen, S
TI [Application of atracurium to critical care patients in ICU].
SO Zhonghua wai ke za zhi [Chinese journal of surgery]
VL 35
IS 2
BP 125
EP 6
PD 1997-Feb
PY 1997
AB Fifty-two patients entered ICU after heart operation with
   cardiopulmonary bypass. These patients with ventilation atracurium (ATC)
   were given 3 micrograms-6 micrograms/kg/min for 5-48 hours. No
   complications happened. After ATC was used, the patients could open
   eyes, and cooperate with the doctor when they regain consciousness. The
   circulation index was normal. The limbs of these patients relaxed. In
   the 52 cases, 30 did't use sedatives, and 22 used senall dose of
   sedatives for sleep at night. We conclude that ATC does not require
   hepatic or renal function for termination of effect and action is
   terminated by the "Hoffman elimination" the ester hydrolysis. The time
   of effect is short and there is no cumulation effect. There is no vagal
   or ganglionic blocking activity, so ATC does not influence circulation
   and myocardial function. Maintenance relaxation keeps ventilation steady
   and oxygen supply normal.
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 0529-5815
UT MEDLINE:10374495
PM 10374495
ER

PT J
AU Tobias, J D
TI Increased cis-atracurium requirements during prolonged administration to
   a child.
SO Canadian journal of anaesthesia = Journal canadien d'anesthesie
VL 44
IS 1
BP 82
EP 4
PD 1997-Jan
PY 1997
AB PURPOSE: To report increase infusion requirements of cis-atracurium
   during prolonged infusion (six weeks) to provide neuromuscular blockade
   in a child during prolonged mechanical ventilation. Despite a previous
   study in adult patients which demonstrated no increase in infusion
   requirements over five days, we noted a considerable increase over six
   weeks.
   CLINICAL FEATURES: A seven month old infant required prolonged
   mechanical ventilation and neuromuscular blockade following an episode
   of multi-system organ failure from pseudomembranous colitis. The
   infusion of cis-atracurium was adjusted according to the train-of-four
   response obtained with a peripheral nerve stimulator using standard
   train-of-four monitoring. Initial infusion requirements which were 2.8
   micrograms.kg-1 min-1 on day #1 increased to 22.3 micrograms.kg-1 min-1
   on day #40.
   CONCLUSION: Increased infusion requirements were necessary during the
   prolonged administration of cis-atracurium to a critically ill infant.
   Titration of the dose based on monitoring with a peripheral nerve
   stimulator is recommended.
TC 3
ZB 1
Z8 0
ZS 0
Z9 3
SN 0832-610X
UT MEDLINE:8988829
PM 8988829
ER

PT J
AU Blitz, R K
   Wachtel, R C
   Blackmon, L
   Berenson-Howard, J
TI Neurodevelopmental outcome of extremely low birth weight infants in
   Maryland.
SO Maryland medical journal (Baltimore, Md. : 1985)
VL 46
IS 1
BP 18
EP 24
PD 1997-Jan
PY 1997
AB The survival rate of extremely low birth weight (ELBW; i.e. < 1001
   grams) infants has significantly improved in the past 10 years secondary
   to the numerous advances in neonatology. There have been many favorable
   reports of the neurodevelopmental outcomes of survivors, but the studies
   often span several years to collect sufficient number of subjects. This
   study assesses the outcome of 100 ELBW infants born in Maryland in 1990
   and analyzes factors that may have contributed to their outcomes at one
   year corrected age. Of this group, 72% had no evidence of severe
   disability (e.g., cerebral palsy (CP) or mental retardation (MR);
   however, 51% of the children had abnormal or suspect neurological
   examinations, and 24% had CP. Eighteen percent of the children were more
   than one standard deviation below the mean cognitively; 30% were below
   normal for motor abilities, and 33% were below normal for language
   abilities. Prior to this study, many of these children were not
   recognized by their primary physician as having any developmental
   problems. Many of these children were not followed in neonatal intensive
   care unit (NICU) follow-up programs, and most were not receiving
   appropriate early intervention services (EIS). Previous studies have
   associated different neonatal events with the risk of developmental
   delay. Bronchopulmonary dysplasia (BPD) and periventricular leukomalacia
   (PVL) accounted for most of the variance of this sample's developmental
   outcome. Of these 100 ELBW infants, 56 received surfactant. Analysis
   demonstrated no significant differences in developmental outcomes
   between those who received surfactant and those who did not. However,
   those who received rescue surfactant were more likely to acquire a
   diagnosis of BPD. As demonstrated by this study, ELBW infants are at
   risk for significant developmental problems. This supports the need for
   targeted outreach, developmental monitoring, early intervention
   services, and parent support and education.
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 0886-0572
UT MEDLINE:9001122
PM 9001122
ER

PT J
AU Bach, J R
   Tilton, M
TI Pulmonary dysfunction and its management in post-polio patients.
SO NeuroRehabilitation
VL 8
IS 2
BP 139
EP 53
DI 10.3233/NRE-1997-8207
PD 1997
PY 1997
AB Respiratory dysfunction is extremely common and entails considerable
   risk of morbidity and mortality for individuals with past poliomyelitis.
   Although it is usually primarily due to respiratory muscle weakness,
   post- poliomyelitis individuals also have a high incidence of scoliosis,
   obesity, sleep disordered breathing, and bulbar muscle dysfunction.
   Although these factors can result in chronic alveolar hypoventilation
   (CAH) and frequent pulmonary complications and hospitalizations, CAH is
   usually not recognized until acute respiratory failure complicates an
   otherwise benign upper respiratory tract infection. The use of
   non-invasive inspiratory and expiratory muscle aids, however, can
   decrease the risk of acute respiratory failure, hospitalizations for
   respiratory complications, and need to resort to tracheal intubation.
   Timely introduction of non-invasive intermittent positive pressure
   ventilation (IPPV), manually assisted coughing, and mechanical
   insufflation-exsufflation (MI-E) and non-invasive blood gas monitoring
   which can most often be performed in the home setting, are the principle
   interventions for avoiding complications and maintaining optimal quality
   of life. 
TC 8
ZB 1
Z8 0
ZS 1
Z9 8
SN 1053-8135
UT MEDLINE:24525983
PM 24525983
ER

PT J
AU Evans, O B
   Vedanarayanan, V
TI Guillain-Barre syndrome.
SO Pediatrics in review / American Academy of Pediatrics
VL 18
IS 1
BP 10
EP 6
DI 10.1542/pir.18-1-10
PD 1997-Jan
PY 1997
AB GBS is an acquired, monophasic illness of the peripheral nervous system
   that usually presents with a gait disturbance and clinical features of
   pain, weakness, and areflexia. The etiology of the disease is
   immune-mediated and directed against the peripheral nervous system
   myelin, axon, or both. A careful history, physical examination, and
   routine laboratory tests are necessary to make a clinical diagnosis and
   to exclude other disorders that cause acute weakness. Laboratory tests
   that support the diagnosis, such as an increased CSF protein and
   abnormal electrodiagnostic studies, may be normal early in the illness.
   The most serious complications during the acute phase of the disease are
   respiratory failure and autonomic disturbances. Plasma exchange or IVIG
   shortens the duration and severity of the disease significantly. The
   prognosis for children who have GBS generally is excellent for full and
   functional recovery, using modern intensive care for respiratory support
   and the management of other complications.
TC 14
ZB 8
Z8 0
ZS 1
Z9 15
SN 0191-9601
UT MEDLINE:8993064
PM 8993064
ER

PT J
AU Pfeiffer, G
   Winkler, G
   Neunzig, P
   Wolf, W
   Thayssen, G
   Kunze, K
TI Long-term management of acute respiratory failure in metabolic myopathy.
SO Intensive care medicine
VL 22
IS 12
BP 1406
EP 9
DI 10.1007/BF01709559
PD 1996-Dec
PY 1996
AB OBJECTIVE: To describe how patients cope with the proposal of treatment
   with intermittent artificial ventilation after acute respiratory failure
   due to progressive respiratory muscle weakness.
   DESIGN: Case series, follow-up study.
   SETTING: Neurological intensive care unit (ICU).
   PATIENTS: 7 consecutive patients with metabolic myopathy treated for
   acute respiratory failure between 1983 and 1992.
   INTERVENTIONS: Intermittent positive pressure ventilation (IPPV) via
   tracheostomy.
   MEASUREMENTS AND RESULTS: Symptoms of chronic hypoventilation preceded
   acute respiratory failure for months. With one exception, patients were
   mainly disabled from respiratory muscle weakness and sleep-related
   breathing disorders. IPPV was recommended to prevent recurrent
   respiratory failure. Two of three patients who accepted home IPPV
   returned to full-time jobs. One patient, who decided against IPPV, died
   from CO2 narcosis several months after discharge. All patients adhered
   to the respiratory regimen once instituted.
   CONCLUSIONS: Acute respiratory failure in chronic myopathy is heralded
   by daytime drowsiness. IPPV, or at least regular monitoring of waking
   and sleeping partial pressure of carbon dioxide, is highly recommended
   even if weaning is successful. IPPV improved quality of life. The
   treatment strategy at discharge from the ICU should be optimal, as
   patients are reluctant to modify regimens.
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 0342-4642
UT MEDLINE:8986494
PM 8986494
ER

PT J
AU McBeth, C
   Watkins, T G
TI Isoflurane for sedation in a case of congenital myasthenia gravis.
SO British journal of anaesthesia
VL 77
IS 5
BP 672
EP 4
PD 1996-Nov
PY 1996
AB We describe the use of isoflurane for the management of a 3-yr-old boy
   with congenital myasthenia gravis who required ventilation for
   pneumonia. While in the intensive care unit he was sedated with
   isoflurane for 5 days (81 MAC-h). This provided a safe, easily
   controllable method of sedation which avoided the use of neuromuscular
   blocking agents and appeared to have no significant side effects during
   use. However, after it was stopped the patient developed a fine,
   self-limiting tremor which lasted for 2 days. Previous reports of
   paediatric patients sedated with isoflurane suggest that prolonged
   exposure may result in temporary dose-dependent neurological
   dysfunction, including hallucinations, ataxia and non-purposeful
   movements.
TC 11
ZB 5
Z8 0
ZS 0
Z9 11
SN 0007-0912
UT MEDLINE:8957991
PM 8957991
ER

PT J
AU Zifko, U
   Chen, R
TI The respiratory system.
SO Bailliere's clinical neurology
VL 5
IS 3
BP 477
EP 95
PD 1996-Oct
PY 1996
AB Neurological disorders frequently contribute to respiratory failure in
   critically ill patients. They may be the primary reason for the
   initiation of mechanical ventilation, or may develop later as a
   secondary complication. Disorders of the central nervous system leading
   to respiratory failure include metabolic encephalopathies, acute stroke,
   lesions of the motor cortex and brain-stem respiratory centres, and
   their descending pathways. Guillan-Barre syndrome, critical illness
   polyneuropathy and acute quadriplegic myopathy are the more common
   neuromuscular causes of respiratory failure. Clinical observations and
   pulmonary function tests are important in monitoring respiratory
   function. Respiratory electrophysiological studies are useful in the
   investigation and monitoring of respiratory failure. Transcortical and
   cervical magnetic stimulation can assess the central respiratory drive,
   and may be useful in determining the prognosis in ventilated patients,
   with cervical cord dysfunction. It is also helpful in the assessment of
   failure to wean, which is often caused by a combination of central and
   peripheral nervous system disorders. Phrenic nerve conduction studies
   and needle electromyography of the diaphragm and chest wall muscles are
   useful to characterize neuropathies and myopathies affecting the
   diaphragm. Repetitive phrenic nerve stimulation can assess neuromuscular
   transmission defects. It is important to identify patients at risk of
   respiratory failure. They should be carefully monitored and mechanical
   ventilation should be initiated before the development of severe
   hypoxaemia.
TC 7
ZB 5
Z8 0
ZS 0
Z9 7
SN 0961-0421
UT MEDLINE:9117072
PM 9117072
ER

PT J
AU Wilkinson, I
   Bear, J
   Smith, J
   Gill, A
   Challinor, C
   Jones, W
   Shahidullah, M
   Wooderson, S
TI Neurological outcome of severe cystic periventricular leukomalacia.
SO Journal of paediatrics and child health
VL 32
IS 5
BP 445
EP 9
DI 10.1111/j.1440-1754.1996.tb00947.x
PD 1996-Oct
PY 1996
AB OBJECTIVE: To determine the neurological outcome of a cohort of
   premature babies having ultrasound diagnoses of severe cystic
   periventricular leukomalacia.
   METHODOLOGY: All neonatal intensive care unit admissions born at less
   than 35 weeks gestation or weighing less than 1500 g underwent serial
   cranial ultrasounds. Those developing severe bilateral cystic
   periventricular leukomalacia (12 patients) were then followed clinically
   to a mean age of 27.3 months.
   RESULTS: Ten of the 12 patients fulfilling strict ultrasound criteria
   survived. All had a major neurological handicap, all having spastic
   quadriparesis and visual impairments, with most suffering global
   developmental delay and epilepsy.
   CONCLUSIONS: Severe bilateral cystic periventricular leukomalacia
   results in major permanent handicap. It is currently impossible to
   identify most patients with this condition while they are being
   ventilated. Non-ultrasound techniques are needed to diagnose the
   condition earlier, and to give guidance to management.
TC 5
ZB 3
Z8 0
ZS 0
Z9 5
SN 1034-4810
UT MEDLINE:8933408
PM 8933408
ER

PT J
AU Shneerson, J M
TI Home mechanical ventilation in children: techniques, outcomes and
   ethics.
SO Monaldi archives for chest disease = Archivio Monaldi per le malattie
   del torace / Fondazione clinica del lavoro, IRCCS [and] Istituto di
   clinica tisiologica e malattie apparato respiratorio, Universita di
   Napoli, Secondo ateneo
VL 51
IS 5
BP 426
EP 30
PD 1996-Oct
PY 1996
AB Various neuromuscular and pulmonary disorders can cause ventilatory
   failure in children. Tracheostomy ventilation in the home is especially
   valuable in younger children who require ventilatory support for most of
   the day and who have bulbar dysfunction but newer noninvasive techniques
   especially nasal mask ventilation are often preferable. It is important
   to select the type of ventilator and to choose the interface with the
   patient carefully in order to maximise the child's quality of life.
TC 2
ZB 0
Z8 0
ZS 0
Z9 2
SN 1122-0643
UT MEDLINE:9009634
PM 9009634
ER

PT J
AU Blosser, S A
   Stauffer, J L
TI Intubation of critically ill patients.
SO Clinics in chest medicine
VL 17
IS 3
BP 355
EP 78
DI 10.1016/S0272-5231(05)70321-X
PD 1996-Sep
PY 1996
AB Airway management of critically ill patients has been enhanced by the
   recent introduction of several new types of artificial airways and
   laryngoscopes. New drugs for sedation and neuromuscular blockade have
   been developed to facilitate care of the intubated patient. Guidelines
   for management of the difficult airway have been introduced. Several new
   prospective studies have improved our understanding of complications of
   intubation and how to avoid these sometimes tragic events. A consensus
   is evolving that TLI and tracheotomy each have clear advantages and
   disadvantages in prolonged airway maintenance and that multiple factors,
   not simply the duration of TLI, must be considered in the optimal timing
   of tracheotomy for each patient. Complex medicolegal and ethical issues
   directly impact intubation, perhaps more so than any other practice in
   critical care medicine. Physicians who care for critically ill patients
   should be familiar with these recent developments and concepts in airway
   management.
TC 8
ZB 5
Z8 1
ZS 0
Z9 9
SN 0272-5231
UT MEDLINE:8875001
PM 8875001
ER

PT J
AU Leijten, F S
   De Weerd, A W
   Poortvliet, D C
   De Ridder, V A
   Ulrich, C
   Harink-De Weerd, J E
TI Critical illness polyneuropathy in multiple organ dysfunction syndrome
   and weaning from the ventilator.
SO Intensive care medicine
VL 22
IS 9
BP 856
EP 61
PD 1996-Sep
PY 1996
AB BACKGROUND: Acute axonal polyneuropathy has been found in patients with
   multiple organ dysfunction syndrome. This 'critical illness
   polyneuropathy' (CIP) has been associated with difficult weaning from
   the ventilator in retrospective studies.
   OBJECTIVE: To test the hypothesis that CIP is related to the degree and
   number of organ dysfunctions, and to weaning problems.
   DESIGN: Prospective study of 18 months.
   SETTING: A multidisciplinary intensive care unit in a general hospital
   SUBJECTS: Thirty-eight patients under 75 years of age who had been
   mechanically ventilated for more than 7 days, without previous signs of
   or risk factors for polyneuropathy.
   MEASURES: Organ dysfunctions were quantified using a dynamic scoring
   system (0-12 points). Electromyography studies were performed during
   mechanical ventilation to identify patients with and without CIP.
   RESULTS: CIP was present in 18 out of 38 patients and associated with an
   increased organ dysfunction score (5.3 +/- 1.8 vs. 3.6 +/- 1.5; p =
   0.003) and number of organs involved [median (range): 4 (3-5) vs. 2
   (1-4); p = 0.009], in particular cardiovascular (p = 0.003), renal (p =
   0.04), and hematopoietic failure (p = 0.04). Patients with
   polyneuropathy were ventilated longer, but this was not clearly due to
   more difficult weaning [median: 16.5 (1-48) vs. 9.5 (1-38) days; p =
   0.26]. Polyneuropathy was present in 2 of 4 patients with normal
   weaning.
   CONCLUSIONS: Axonal polyneuropathy is related to the severity of
   multiple-organ-dysfunction syndrome. Its presence does not necessarily
   implicate difficult weaning from artificial ventilation.
TC 93
ZB 32
Z8 3
ZS 0
Z9 96
SN 0342-4642
UT MEDLINE:8905417
PM 8905417
ER

PT J
AU el-Ad, B
   Bornstein, N M
   Fuchs, P
   Korczyn, A D
TI Mechanical ventilation in stroke patients--is it worthwhile?
SO Neurology
VL 47
IS 3
BP 657
EP 9
PD 1996-Sep
PY 1996
AB We assessed the therapeutic efficacy and outcome of mechanical
   ventilation (MV) in patients with acute respiratory failure (ARF)
   following ischemic stroke (IS) or intracerebral hemorrhage (ICH),
   retrospectively graded by patients with IS (n = 881) and ICH (n = 108)
   admitted to our service during 11 years, according to the severity of
   their clinical state and to whether we employed MV. Outcome was recorded
   in terms of survival and duration of MV and compared with patients with
   neuromuscular (NM) diseases. We found a very high in-hospital mortality
   in stroke patients who were treated with ventilation (90.5% for IS and
   87.5% for ICH) compared with NM patients (29%). We conclude that MV in
   stroke patients with ARF is not life-saving, and its use should be
   considered only after considering other potentially important factors.
TC 30
ZB 7
Z8 0
ZS 0
Z9 30
SN 0028-3878
UT MEDLINE:8797459
PM 8797459
ER

PT J
AU Wiles, C M
TI Neurological complications of severe illness and prolonged mechanical
   ventilation.
SO Thorax
VL 51 Suppl 2
BP S40
EP 4
DI 10.1136/thx.51.Suppl_2.S40
PD 1996-Aug
PY 1996
TC 4
ZB 2
Z8 1
ZS 0
Z9 4
SN 0040-6376
UT MEDLINE:8869351
PM 8869351
ER

PT J
AU Davies, R H
TI Home ventilation of a child with motor and sensory neuropathy.
SO BMJ (Clinical research ed.)
VL 313
IS 7050
BP 153
EP 4; discussion 154-5
PD 1996-Jul-20
PY 1996
TC 11
ZB 3
Z8 0
ZS 0
Z9 11
SN 0959-8138
UT MEDLINE:8688778
PM 8688778
ER

PT J
AU Dematteis, J A
TI Guillain-Barre syndrome: a team approach to diagnosis and treatment.
SO American family physician
VL 54
IS 1
BP 197
EP 200
PD 1996-Jul
PY 1996
AB Guillain-Barre syndrome is the most frequently acquired demyelinating
   peripheral polyneuropathy. In approximately two-thirds of cases,
   Guillain-Barre syndrome is preceded by a viral respiratory or
   gastrointestinal infection. The mechanism of injury is unclear but is
   believed to be immunologic. The cardinal clinical feature is symmetric
   and rapidly progressive weakness. Aspiration and respiratory failure are
   the major concerns. Sensory symptoms, such as paresthesias, are common.
   The most severe stage of the disease is reached two to four weeks after
   onset. Dysautonomia has replaced respiratory failure as the most common
   cause of death. Recovery is variable: 50 percent of patients recover
   completely, about 35 percent experience permanent neurologic sequelae,
   and 15 percent are significantly and permanently damaged. About 10
   percent relapse before complete recovery, and 2 to 5 percent experience
   recurrence after full recovery. Laboratory confirmation of
   Guillain-Barre syndrome includes the typical cerebrospinal fluid
   cytoalbumin dissociation (elevated protein without white blood cells).
   Treatment is primarily symptomatic and preventive. Convalescent patients
   require intensive inpatient physical and occupational therapy to improve
   strength and prevent disabling contractures.
TC 3
ZB 2
Z8 0
ZS 0
Z9 3
SN 0002-838X
UT MEDLINE:8677835
PM 8677835
ER

PT J
AU Hardy, K A
   Anderson, B D
TI Noninvasive clearance of airway secretions.
SO Respiratory care clinics of North America
VL 2
IS 2
BP 323
EP 45
PD 1996-Jun
PY 1996
AB Airway clearance techniques are indicated for specific diseases that
   have known clearance abnormalities (Table 2). Murray and others have
   commented that such techniques are required only for patients with a
   daily sputum production of greater than 30 mL. The authors have observed
   that patients with diseases known to cause clearance abnormalities can
   have sputum clearance with some techniques, such as positive expiratory
   pressure, autogenic drainage, and active cycle of breathing techniques,
   when PDPV has not been effective. Hasani et al has shown that use of the
   forced exhalatory technique in patients with nonproductive cough still
   resulted in movement of secretions proximally from all regions of the
   lung in patients with airway obstruction. It is therefore reasonable to
   consider airway clearance techniques for any patient who has a disease
   known to alter mucous clearance, including CF, dyskinetic cilia
   syndromes, and bronchiectasis from any cause. Patients with atelectasis
   from mucous plugs and hypersecretory states, such as asthma and chronic
   bronchitis, patients with pain secondary to surgical procedures, and
   patients with neuromuscular disease, weak cough, and abnormal patency of
   the airway may also benefit from the application of airway clearance
   techniques. Infants and children up to 3 years of age with airway
   clearance problems need to be treated with PDPV. Manual percussion with
   hands alone or a flexible face mask or cup and small mechanical
   vibrator/percussors, such as the ultrasonic devices, can be used. The
   intrapulmonary percussive ventilator shows growing promise in this area.
   The high-frequency oscillator is not supplied with vests of appropriate
   sizes for tiny babies and has not been studied in this group. Young
   patients with neuromuscular disease may require assisted ventilation and
   airway oscillations can be applied. CPAP alone has been shown to improve
   achievable flow rates that will increase air-liquid interactions for
   patients with these diseases or airway malacia. Use of positive pressure
   to maintain airway patency in these children allows cephalad clearance
   of secretions. Patients with segmental atelectasis, particularly related
   to asthma, may benefit from intrapulmonary percussive ventilator,
   positive expiratory pressure, or PDPV. Prevention of postoperative
   atelectasis is particularly well suited to positive expiratory pressure,
   which is not as painful as techniques using oscillations. Neurologically
   abnormal patients who are unable to cooperate with any active method are
   also treated using intrapulmonary percussive ventilator, PDPV, and
   suctioning, if necessary. Musculoskeletal abnormalities, muscular
   dystrophies, myasthenia gravis, poliomyelitis, or other similar diseases
   require stabilization of bellows function. Optimizing ventilation in
   patients with such abnormalities may require positive pressure
   ventilation either during sleep or continuously. Externally applied
   pressure, such as with the In-Exsufflator or the cyclically inflated
   pneumatic belt, can augment the patient's own efforts and is sometimes
   helpful. Normalizing the vital capacity and functional residual capacity
   typically helps to improve the ability to cough and clear secretions.
   Assisted cough devices or maneuvers are described in other papers by
   Bach and Hill. Not all patients who have weak muscles require nocturnal
   or continuous support, and may benefit from positive expiratory pressure
   mask treatments. Further studies are sorely needed for this population.
   Long-term controlled trials are urgently needed to help establish the
   best types of treatment for patients with CF and bronchiectasis. Such
   studies will become more complicated by the introduction of new
   treatments, such as DNase and other therapies that alter secretions, and
   may begin to change mucociliary or cough clearance. The selection of
   appropriate outcome measures is central to studying these questions, and
   it is unclear which are the most important. (ABSTRACT TRUNCATED)
TC 20
ZB 7
Z8 2
ZS 1
Z9 23
SN 1078-5337
UT MEDLINE:9390886
PM 9390886
ER

PT J
AU Frankel, H
   Jeng, J
   Tilly, E
   St Andre, A
   Champion, H
TI The impact of implementation of neuromuscular blockade monitoring
   standards in a surgical intensive care unit.
SO The American surgeon
VL 62
IS 6
BP 503
EP 6
PD 1996-Jun
PY 1996
AB The purpose was to determine whether implementation of standards for
   peripheral nerve monitoring could decrease the incidence of
   neuromuscular dysfunction related to the administration of paralytic
   agents. Over a 2-year period, consecutive patients admitted to a
   surgical intensive care unit who received continuously-infused or >6
   daily doses of neuromuscular blocking agents were subjected to
   train-of-four (TOF) monitoring of the adductor pollicis. Therapy was
   titrated to the maintenance of one to two twitches at all times. The
   incidence of prolonged (>12 h) paralysis after drug discontinuation was
   documented in these patients and compared to that in patients treated in
   the previous 12 months. The presence of electrolyte abnormalities, organ
   dysfunction, and concomitant medications was also recorded. Chi-square
   analysis with Yates correction was employed. Before implementation of
   routine TOF monitoring, there were five instances of
   paralytic-associated neuromuscular dysfunction (5/43). After
   implementation of the TOF protocol, no instances of paralytic-associated
   neuromuscular dysfunction occurred (0/90), despite the same incidence of
   risk factors (100%) (P < 0.05). A protocol for neuromuscular blockade
   monitoring is efficacious in preventing paralytic-associated
   neuromuscular dysfunction. This can be a cost-effective measure,
   minimizing the prolonged mechanical ventilation and intensive
   rehabilitation required secondary to unmonitored use of neuromuscular
   blocking agents.
TC 19
ZB 3
Z8 0
ZS 0
Z9 19
SN 0003-1348
UT MEDLINE:8651538
PM 8651538
ER

PT J
AU Leatherman, J W
   Fluegel, W L
   David, W S
   Davies, S F
   Iber, C
TI Muscle weakness in mechanically ventilated patients with severe asthma.
SO American journal of respiratory and critical care medicine
VL 153
IS 5
BP 1686
EP 90
PD 1996-May
PY 1996
AB Patients who undergo mechanical ventilation for severe asthma are at
   risk of developing diffuse muscle weakness because of acute myopathy.
   The relative importance of corticosteroids and neuromuscular paralysis
   in causing the myopathy is controversial, and it is uncertain whether
   the chemical structure of the drug used to induce paralysis influences
   the risk of myopathy. Using a retrospective cohort study design, we
   evaluated 107 consecutive episodes of mechanical ventilation for severe
   asthma to assess (1) the incidence of clinically significant weakness in
   patients treated with corticosteroids alone versus corticosteroids with
   neuromuscular paralysis, (2) the influence of the duration of paralysis
   on the incidence of muscle weakness, and (3) the relative risk of
   weakness in patients paralyzed with the nonsteroidal drug atracurium
   versus an aminosteroid paralytic agent (pancuronium, vecuronium). The
   use of corticosteroids and a neuromuscular blocking agent was associated
   with a much higher incidence of muscle weakness as compared with the use
   of corticosteroids alone (20 of 69 versus O of 38, p < 0.001). The 20
   weak patients were paralyzed significantly longer than the 49 patients
   who received a neuromuscular blocking agent without subsequent weakness
   (3.4 +/- 2.4 versus 0.6 +/- 0.7 d, p < 0.001). Eighteen of the 20 weak
   patients had been paralyzed for more than 24 h. The incidence of
   weakness was not reduced when paralysis was achieved with atracurium as
   opposed to an aminosteroid neuromuscular blocking agent. In conclusion,
   corticosteroid-treated patients with severe asthma who undergo prolonged
   neuromuscular paralysis are at significant risk for the development of
   muscle weakness, and the risk of weakness is not reduced by use of
   atracurium.
TC 117
ZB 41
Z8 1
ZS 0
Z9 118
SN 1073-449X
UT MEDLINE:8630621
PM 8630621
ER

PT J
AU Schindler, M B
   Bohn, D J
   Bryan, A C
TI The effect of single-dose and continuous skeletal muscle paralysis on
   respiratory system compliance in paediatric intensive care patients.
SO Intensive care medicine
VL 22
IS 5
BP 486
EP 91
DI 10.1007/BF01712173
PD 1996-May
PY 1996
AB OBJECTIVE: To investigate the effect of single dose and continuous
   skeletal muscle paralysis on respiratory system compliance in 53
   paediatric intensive care patients.
   DESIGN: Prospective clinical study.
   SETTING: Multidisciplinary paediatric intensive care unit.
   PATIENTS: Twenty-three children ventilated for acute pulmonary
   pathology, and 30 ventilated for isolated intracranial pathology, who
   initially had normal lungs.
   INTERVENTIONS: The 23 patients with acute pulmonary pathology received a
   single dose of muscle relaxant to facilitate diagnostic procedures.
   Fifteen patients with isolated intracranial pathology received
   continuous skeletal muscle paralysis for longer than 24 h, and the other
   15 received no paralysis.
   MEASUREMENTS AND RESULTS: Respiratory system compliance deteriorated by
   14% from 0.519 +/- 0.2 to 0.445 +/- 0.18 ml cmH2O-1 kg-1 (p < 0.001)
   following a single dose of muscle relaxant in the 23 patients with acute
   pulmonary pathology. In the 15 with isolated intracranial pathology who
   received continuous skeletal muscle paralysis there was a progressive
   deterioration in compliance, which reached 50% of the initial compliance
   by day 4 of paralysis (p < 0.001) and improved back to normal following
   discontinuation of paralysis. There were no changes in compliance in the
   15 patients with isolated intracranial pathology who were ventilated but
   not paralysed. The paralysed patients required mechanical ventilation
   longer than the non-paralysed patients (p < 0.001), and 26% of these
   patients developed nosocomial pneumonia (p = 0.03), a complication that
   was not seen in the non-paralysed patients.
   CONCLUSIONS: Skeletal muscle paralysis results in immediate and
   progressive deterioration of respiratory system compliance and increased
   incidence of nosocomial pneumonia. The benefits of paralysis should be
   balanced against the risks of deteriorating pulmonary function.
TC 7
ZB 4
Z8 0
ZS 0
Z9 7
SN 0342-4642
UT MEDLINE:8796408
PM 8796408
ER

PT J
AU Mazur, D J
   Merz, J F
TI Patients' willingness to accept life-sustaining treatment when the
   expected outcome is a diminished mental health state: an exploratory
   study.
SO Journal of the American Geriatrics Society
VL 44
IS 5
BP 565
EP 8
PD 1996-May
PY 1996
AB OBJECTIVE: To assess patients' willingness to accept life-sustaining
   treatment when the expected outcome is a diminished mental health state.
   DESIGN: Structured interviews with a consecutive series of patients.
   SETTING: A university-based Department of Veterans Affairs Medical
   Center.
   PATIENTS: One hundred four male patients (mean age = 65.4 years; range
   37-82) seen consecutively in a general medicine clinic.
   MEASUREMENTS: We assessed the acceptability of temporary ventilatory
   support of a hypothetical case of severe pneumonia. Patients were asked
   to consider mental health states involving minor cognitive deficits that
   varied only in their expected frequency and duration.
   RESULTS: All patients except one were willing to accept temporary life
   support in the management of severe pneumonia. Of these 103 patients, 76
   patients specified the number of days they would allow themselves to be
   continued on intubation and ventilatory support. The length of time
   varied from 1 day to 2 years and was longer when patients reported
   having had a stroke of reported being in fair of poor health. Fifty
   patients were willing to accept all diminished mental health states,
   including the most severe state (F). Patients who reported having been
   in a medical intensive care unit were more likely to accept intubation
   in the most severe state (F).
   CONCLUSIONS: In the case of "severe pneumonia", about half of our older
   male veterans reported a willingness to accept intubation and
   ventilatory support even if it resulted in persistent cognitive
   disability. These results suggest that experience in a medical intensive
   care unit with the ventilators and experience with strokes may make
   patients more tolerant of treatments that may result in impaired
   cognitive function.
TC 8
ZB 3
Z8 0
ZS 0
Z9 8
SN 0002-8614
UT MEDLINE:8617906
PM 8617906
ER

PT J
AU Chen, R
   Grand'Maison, F
   Strong, M J
   Ramsay, D A
   Bolton, C F
TI Motor neuron disease presenting as acute respiratory failure: a clinical
   and pathological study.
SO Journal of neurology, neurosurgery, and psychiatry
VL 60
IS 4
BP 455
EP 8
DI 10.1136/jnnp.60.4.455
PD 1996-Apr
PY 1996
AB Respiratory failure is rarely a presenting symptom of motor neuron
   disease. Seven patients with motor neuron disease who presented with
   acute respiratory failure of unknown cause and required mechanical
   ventilation were studied. They all had symptoms and signs suggestive of
   diaphragmatic weakness. Respiratory involvement seemed
   disproportionately severe, as six were ambulatory and only three noted
   limb weakness. Only one had tongue weakness and none had swallowing
   difficulty. Electrophysiological studies showed widespread denervation
   and, in particular, diaphragmatic involvement to explain the severe
   respiratory failure. Weaning from the ventilator was unsuccessful in all
   cases. The four patients examined at necropsy showed severe loss of
   anterior horns cells in the cervical cord, with only minimal upper motor
   neuron involvement. Motor neuron disease should be recognised as a cause
   of acute respiratory failure, secondary to diaphragmatic paralysis from
   involvement of phrenic motor neurons.
RI Chen, Robert/B-3899-2009; Strong, Michael/H-9689-2012
OI Chen, Robert/0000-0002-8371-8629; 
TC 45
ZB 23
Z8 1
ZS 0
Z9 46
SN 0022-3050
UT MEDLINE:8774419
PM 8774419
ER

PT J
AU Chailleux, E
   Fauroux, B
   Binet, F
   Dautzenberg, B
   Polu, J M
TI Predictors of survival in patients receiving domiciliary oxygen therapy
   or mechanical ventilation. A 10-year analysis of ANTADIR Observatory.
SO Chest
VL 109
IS 3
BP 741
EP 9
DI 10.1378/chest.109.3.741
PD 1996-Mar
PY 1996
AB STUDY OBJECTIVE: To analyze predictors of survival for patients
   receiving home long-term oxygen therapy (LTOT) or prolonged mechanical
   ventilation (PMV) according to the cause of chronic respiratory
   insufficiency (CRI) and the patients physiologic data.
   DESIGN: Analysis of a nationwide database (ANTADIR Observatory).
   SETTING: The national nonprofit network for home treatment of patients
   with CRI Association Nationale pour le Traitement a Domicile de
   lInsuffisance Respiratoire Chronique (ANTADIR); founded in France in the
   1980s.
   PATIENTS: There were 26,140 patients receiving LTOT or PMV (noninvasive
   or via tracheostomy) between January 1, 1984 and January 1, 1993
   (chronic bronchitis, 12,043; asthma, 1,755; bronchiectasis, 1,556;
   emphysema, 551; tuberculosis sequelae, 4,147; kyphoscoliosis, 1,574;
   neuromuscular diseases, 1,097; pneumoconiosis, 919; and fibrosis, 2,498.
   MEASUREMENTS AND RESULTS: Survival analysis was performed using the
   actuarial and the Cox's semiparametric model. The mean survival for
   patients with chronic bronchitis is 3 years. Survival is slightly better
   for patients with bronchiectasis and asthma and worse for those with
   emphysema. Patients with kyphoscoliosis and a neuromuscular disease have
   the longest survival (8 and 6.5 years, respectively). Patients with CRI
   due to tuberculosis sequelae experience the same survival as COPD
   patients (3 years). Prognosis is the worst in patients with
   pneumoconiosis or fibrosis: 50% of these patients die during the year
   following the beginning of home treatment. The association of an
   obstructive lung disease worsens the prognosis of patients with
   kyphoscoliosis or neuromuscular disease and tends to bring the survival
   rate of the patients with pneumoconiosis or fibrosis closer to that of
   COPD patients. In COPD, male sex, older age, lower body mass index
   (BMI),FEV1 percent predicted,PaO2,and PaCO2 are independent negative
   prognostic factors. For tuberculous sequelae and kyphoscoliosis, female
   sex, younger age, a high BMI, PaO2 and PaCO2 (and for kyphoscoliosis a
   higher FEV1/vital capacity [VC] ratio) are all independent favorable
   prognostic factors. In pulmonary fibrosis, a lower PaO2 and PaCO2
   values, a lower VC percent predicted, and a higher FEV1/VC ratio are
   negative prognostic factors.
   CONCLUSIONS: The ANTADIR Observatory allows a unique opportunity to
   analyze long-term survival of a large population with CRI treated at
   home.
TC 137
ZB 49
Z8 1
ZS 0
Z9 138
SN 0012-3692
UT MEDLINE:8617085
PM 8617085
ER

PT J
AU Hodges, U M
TI Vecuronium infusion requirements in paediatric patients in intensive
   care units: the use of acceleromyography.
SO British journal of anaesthesia
VL 76
IS 1
BP 23
EP 8
PD 1996-Jan
PY 1996
AB Neuromuscular blocking drugs in intensive care units (ICU) may cause
   complications, including prolonged neuromuscular block as a result of
   overdosage and post-ventilation muscle weakness. These may be increased
   by using inappropriately high infusion rates for infants, in whom
   published studies are scarce, and by failure to monitor neuromuscular
   block. There is little ICU experience of acceleromyography, which may
   permit more reliable monitoring. To determine appropriate vecuronium
   infusion rates, 12 neonates/infants (median age 4 (interquartile range
   (IQR) 2-5) months) and 18 children (median age 3.07 (2-10 yr) were
   studied. The vecuronium infusion rate was adjusted to maintain
   train-of-four (TOF) at 1 response using the TOF guard accelerometer.
   Recovery time was measured from cessation of infusion until spontaneous
   TOF ratio recovery of 0.7. Neonates and infants required 45% less
   vecuronium (mean infusion rate 54.7 (SEM 4.23) micrograms kg-1 h-1) than
   older children (98.7 (7.07) micrograms kg-1 h-1) and had faster recovery
   to 70% T4/T1 (45 (IQR 20-51) min vs 65 (55-103) min), with no evidence
   of prolonged weakness. Routine monitoring of neuromuscular block in ICU
   is essential; acceleromyography is convenient and reliable.
TC 8
ZB 5
Z8 0
ZS 0
Z9 8
SN 0007-0912
UT MEDLINE:8672374
PM 8672374
ER

PT J
AU Tolep, K
   Getch, C L
   Criner, G J
TI Swallowing dysfunction in patients receiving prolonged mechanical
   ventilation.
SO Chest
VL 109
IS 1
BP 167
EP 72
DI 10.1378/chest.109.1.167
PD 1996-Jan
PY 1996
AB Several studies have suggested that swallowing dysfunction and pulmonary
   aspiration occur in patients receiving prolonged ventilation. However,
   the incidence of swallowing dysfunction, its rate of resolution, and the
   sensitivity of tests used to characterize swallowing abnormalities are
   not well defined. The goals of our study were to evaluate swallowing
   function in this group of patients by (1) defining the specific
   swallowing abnormalities that occur in this patient population, (2)
   comparing the sensitivity of bedside evaluations to modified barium
   swallow with videofluoroscopy (MBS/VF), (3) performing endoscopic
   evaluation of the upper airway to characterize glottic function during
   swallowing, (4) evaluating the relationship between swallowing
   dysfunction and neuromuscular disorders, and (5) studying the temporal
   resolution of swallowing abnormalities. Swallowing function was
   evaluated in 35 patients receiving prolonged ventilation (ie, > or = 3
   weeks) admitted to a specialized rehabilitation unit dedicated to the
   care of patients requiring prolonged ventilation. The average age of the
   35 patients was 61 +/- 15 years. The total duration of intubation at the
   time of the initial swallowing evaluation was 29 +/- 34 days via a
   cuffed tracheostomy tube and 15 +/- 9 days via an endotracheal tube.
   Neuromuscular disorders were present in 16 patients (45%). Thirty-four
   percent of the patients had at least one swallowing abnormality detected
   by bedside examination. Results of bedside swallowing examination were
   abnormal in 31% of patients with a neuromuscular disorder and 37% of
   patients without a neuromuscular disorder. MBS/VF was abnormal in 83% of
   patients (85% in patients with and 80% in patients without a
   neuromuscular disorder). Results of early (< 1 month) repeated MBS/VF
   examinations usually remained unchanged; however, in a small group of
   patients, later studies (> or = 1 month) revealed significant
   improvement. In 50% of patients who underwent direct laryngoscopy,
   important abnormalities were found that contributed to swallowing
   dysfunction. Our data show that patients requiring prolonged mechanical
   ventilation have a high incidence of swallowing abnormalities,
   regardless of the presence or absence of neuromuscular disorders. MBS/VF
   and direct laryngoscopy can provide useful information about laryngeal
   action and swallowing dysfunction, and can facilitate the implementation
   of corrective actions to prevent respiratory complications.
TC 91
ZB 32
Z8 2
ZS 5
Z9 97
SN 0012-3692
UT MEDLINE:8549181
PM 8549181
ER

PT J
AU Safar, P
   Xiao, F
   Radovsky, A
   Tanigawa, K
   Ebmeyer, U
   Bircher, N
   Alexander, H
   Stezoski, S W
TI Improved cerebral resuscitation from cardiac arrest in dogs with mild
   hypothermia plus blood flow promotion.
SO Stroke; a journal of cerebral circulation
VL 27
IS 1
BP 105
EP 13
PD 1996-Jan
PY 1996
AB BACKGROUND AND PURPOSE: In past studies, cerebral outcome after
   normothermic cardiac arrest of 10 or 12.5 minutes in dogs was improved
   but not normalized by resuscitative (postarrest) treatment with either
   mild hypothermia or hypertension plus hemodilution. We hypothesized that
   a multifaceted combination treatment would achieve complete cerebral
   recovery.
   METHODS: With our established dog outcome model, normothermic
   ventricular fibrillation of 11 minutes (without blood flow) was followed
   by controlled reperfusion (with brief normothermic cardiopulmonary
   bypass simulating low flow and low PaO2 of external cardiopulmonary
   resuscitation) and defibrillation at < 2 minutes. Controlled ventilation
   was provided to 20 hours and intensive care to 96 hours. Control group 1
   (n = 8) was kept normothermic (37.5 degrees C), normotensive, and
   hypocapnic throughout. Experimental group 2 (n = 8) received mild
   resuscitative hypothermia (34 degrees C) from about 10 minutes to 12
   hours (by external and peritoneal cooling) plus cerebral blood flow
   promotion with induced moderate hypertension, mild hemodilution, and
   normocapnia.
   RESULTS: All 16 dogs in the protocol survived. At 96 hours, all 8 dogs
   in control group 1 achieved overall performance categories 3 (severe
   disability) or 4 (coma). In group 2, 6 of 8 dogs achieved overall
   performance category 1 (normal); 1 dog achieved category 2 (moderate
   disability), and 1 dog achieved category 3 (P < .001). Final
   neurological deficit scores (0% [normal] to 100% [brain death]) at 96
   hours were 38 +/- 10% (22% to 45%) in group 1 versus 8 +/- 9% (0% to
   27%) in group 2 (P < .001). Total brain histopathologic damage scores
   were 138 +/- 22 (110 to 176) in group 1 versus 43 +/- 9 (32 to 56) in
   group 2 (P < .001). Regional scores showed similar group differences.
   CONCLUSIONS: After normothermic cardiac arrest of 11 minutes in dogs,
   resuscitative mild hypothermia plus cerebral blood flow promotion can
   achieve functional recovery with the least histological brain damage yet
   observed with the same model and comparable insults.
TC 197
ZB 69
Z8 11
ZS 0
Z9 206
SN 0039-2499
UT MEDLINE:8553385
PM 8553385
ER

PT J
AU Goldstein, R S
   Psek, J A
   Gort, E H
TI Home mechanical ventilation. Demographics and user perspectives.
SO Chest
VL 108
IS 6
BP 1581
EP 6
DI 10.1378/chest.108.6.1581
PD 1995-Dec
PY 1995
AB Although the number of users of home mechanical ventilation (HMV) is
   increasing, information regarding the users' perceptions of the impact
   of HMV on their lives is incomplete. We administered an open-ended
   questionnaire to 98 (48 male, 50 female) HMV users aged (mean +/- SD)
   47.4 +/- 19.5 years with COPD (9%), thoracic restrictive disease (43%),
   and neuromuscular disease (48%). At the time of survey, subjects had
   received HMV for 59.5 +/- 58.3 months. Fifty-three percent were
   ventilated electively. Ventilator use was continuous (18%), at night
   only (37%), or at night with occasional daytime use (45%). Twenty-seven
   (28%) individuals identified themselves as being totally independent
   while 32 (33%) rated themselves as partially dependent on caregiver
   assistance for daily activities. Only 37 (38%) considered that they had
   made an informed choice when first starting HMV whereas 54 (55%) did
   not. The impact of using a mechanical ventilator was believed to be
   overwhelmingly positive (87%). Positive comments regarding the impact of
   the ventilator on lifestyle were grouped in the following categories:
   life sustaining, facilitating mobility, and improving physical symptoms.
   Negative comments were grouped in the following categories: limiting
   mobility, equipment issues, and social implications. HMV users with a
   tracheostomy volunteered significantly fewer positive statements than
   those ventilated noninvasively (p < 0.05). Whereas 52 (53%) of users
   indicated that they had experienced initial difficulties in coping with
   the ventilator, only 11 (11%) identified difficulties at the time of the
   survey.
TC 20
ZB 6
Z8 0
ZS 0
Z9 20
SN 0012-3692
UT MEDLINE:7497765
PM 7497765
ER

PT J
AU Zakynthinos, S G
   Vassilakopoulos, T
   Roussos, C
TI The load of inspiratory muscles in patients needing mechanical
   ventilation.
SO American journal of respiratory and critical care medicine
VL 152
IS 4 Pt 1
BP 1248
EP 55
PD 1995-Oct
PY 1995
AB We studied 31 consecutive mechanically ventilated patients with acute
   respiratory failure in two stages: (1) During spontaneous breathing
   through the respirator, switching from full mechanical assistance to
   continuous positive airway pressure mode with 0 cm H2O pressure. We
   measured maximum inspiratory pressure and continuously monitored the
   pattern of breathing. After 8 to 25 min, none of the patients were able
   to sustain spontaneous breathing and mechanical ventilation was required
   to resume. (2) Subsequently, during mechanical ventilation, by
   manipulating the variables of the ventilator we simulated the pattern of
   spontaneous breathing the patients had just before the re-institution of
   mechanical ventilation. We assessed the respiratory mechanics by the
   constant flow end-inspiratory and end-expiratory occlusion method.
   Intrinsic positive end-expiratory pressure was present in 29 patients.
   The ratio of the mean inspiratory pressure per breath over the maximum
   inspiratory pressure (Pi/pimax), as well as Ppeak/pimax, had excessively
   high mean values, equal to 0.42 +/- 0.11 and 0.56 +/- 0.10,
   respectively. Pressure-time index was 0.14 +/- 0.04. When we plotted the
   Pi/Pimax and Ppeak/Pimax against the dynamic increase in FRC, we found
   that the Pi/Pimax of 13 patients (42%) and the Ppeak/Pimax of 25 of 31
   patients (81%) were placed above a hypothetical critical line,
   representing the critical inspiratory pressures above which fatigue may
   occur. In addition, almost all patients were gathered around the
   critical line. We conclude that during discontinuation from mechanical
   ventilation (MV) almost all patients breathe against a high inspiratory
   load and their inspiratory muscles perform work that may lead to
   fatigue.
TC 42
ZB 21
Z8 1
ZS 0
Z9 43
SN 1073-449X
UT MEDLINE:7551378
PM 7551378
ER

PT J
AU Lyager, S
   Steffensen, B
   Juhl, B
TI Indicators of need for mechanical ventilation in Duchenne muscular
   dystrophy and spinal muscular atrophy.
SO Chest
VL 108
IS 3
BP 779
EP 85
DI 10.1378/chest.108.3.779
PD 1995-Sep
PY 1995
AB STUDY OBJECTIVES: The purpose was to investigate a possible relationship
   between different parameters of physical function, spirometric
   measurements, and the approaching need for mechanical ventilation.
   DESIGN: A nonrandomized, prospective, descriptive study of 11 patients
   with spinal muscular atrophy type II (SMA-II) and 14 patients with
   Duchenne muscular dystrophy (DMD). At a home visit, the anthropometric
   indices of age, height, and weight were recorded, the degree of
   disability was scored, and measurement of the strength of eight muscle
   groups and spirometry was performed. The interdependence of the
   variables was analyzed and the intergroup differences evaluated.
   Eighteen months later, it was found that one of the authors (B.J.), who
   was blind to the results of the first examination had instituted home
   mechanical ventilation on seven of the patients. The data were analyzed
   retrospectively for their predictive value as indicators of approaching
   ventilator dependency.
   RESULTS: The seven patients who needed mechanical ventilation were the
   patients with DMD with the highest disability score (Egen Klassifikation
   [EK] sum > 20) and the smallest values for FVC < 1.2 L (FVC% < 30). We
   found a significant correlation (p = 0.002) between FVC% and the EK sum
   at the first examination and between the FVC% and the time until
   treatment with mechanical ventilation was instituted (p = 0.023).
   Although 7 of the 11 patients with SMA type II had FVC below 1.2 L and
   some of them had an EK sum score higher (indicating more disability)
   than some patients with DMD who needed mechanical ventilation, none of
   them required mechanical ventilation.
   CONCLUSION: In this investigation, a combination of EK sum and FVC%
   provided a better indication of the approaching need for mechanical
   ventilation in the patients with DMD than the variables separately.
TC 26
ZB 12
Z8 0
ZS 1
Z9 27
SN 0012-3692
UT MEDLINE:7656633
PM 7656633
ER

PT J
AU Tobin, M J
   Jubran, A
   Laghi, F
   Dhand, R
TI Using physiologic end points to assess innovations in mechanical
   ventilation.
SO Respiratory care
VL 40
IS 9
BP 971
EP 4
PD 1995-Sep
PY 1995
AB It is our view that new ventilatory methods should be withheld from
   clinical practice until there has been adequate evaluation of their
   effect on physiologic variables and the link to long-term outcomes has
   been established. In the past, premature and over-enthusiastic
   acceptance of ventilatory strategies may have resulted in patient
   discomfort and even harm, and this can be minimized by a more careful
   evaluation of the physiologic effects of such innovations before their
   acceptance into clinical practice.
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 0020-1324
UT MEDLINE:10152242
PM 10152242
ER

PT J
AU Rieder, P
   Louis, M
   Jolliet, P
   Chevrolet, J C
TI The repeated measurement of vital capacity is a poor predictor of the
   need for mechanical ventilation in myasthenia gravis.
SO Intensive care medicine
VL 21
IS 8
BP 663
EP 8
DI 10.1007/BF01711545
PD 1995-Aug
PY 1995
AB OBJECTIVE: Testing the hypothesis that, in myasthenia gravis (MG),
   repeated measurements of vital capacity (VC) and various parameters
   derived from this measurement [median or lowest value of measured VCs
   during hospitalization, VC values < 20 ml/kg body weight (BW) or < 13
   ml/kg BW, or an index assessing the variability of VC values during the
   whole ICU stay] could predict the need for intubation and mechanical
   ventilation (MV), as has been shown in other neuromuscular diseases with
   respiratory failure.
   DESIGN: Retrospective study with medical chart revision of all the
   patients with MG and respiratory failure admitted to our intensive care
   unit between 1985 and 1993.
   SETTING: Medical intensive care unit (15 beds) of a university hospital.
   PATIENTS AND METHODS: Five patients suffering from ten episodes of acute
   respiratory failure due to their decompensated MG. Repeated measurements
   of arterial blood gases and VC by trained respiratory therapists, at
   least every 4 h.
   RESULTS: There was no difference in any of these parameters between
   patients eventually requiring MV (four episodes) and those in whom
   mechanical ventilation was not necessary (six episodes).
   CONCLUSIONS: VC repeated measurements is a poor predictor of the need
   for further MV in MG patients. This can probably be ascribed to the
   erratic nature of MG, a disease whose course is largely influenced by
   many parameters (infection, treatment modifications, initiation of
   corticosteroid therapy, stress, psychological factors, etc.). Early
   admissions to the ICU of MG patients with respiratory dysfunction is
   thus recommended.
TC 30
ZB 5
Z8 0
ZS 0
Z9 30
SN 0342-4642
UT MEDLINE:8522671
PM 8522671
ER

PT J
AU Borel, C O
   Guy, J
TI Ventilatory management in critical neurologic illness.
SO Neurologic clinics
VL 13
IS 3
BP 627
EP 44
PD 1995-Aug
PY 1995
AB Evolution and refinement of airway and ventilatory management has taken
   place in neurologic critical care. Applications for ventilatory
   management have been extended to virtually all acute life-threatening
   illnesses found in neurologic critical care units today. This article
   focuses on the airway and ventilatory management of patients with acute
   raised intracranial pressure, cervical spine injuries, and neuromuscular
   ventilatory failure.
TC 14
ZB 7
Z8 2
ZS 0
Z9 16
SN 0733-8619
UT MEDLINE:7476821
PM 7476821
ER

PT J
AU Madagame, E T
   Havens, P L
   Bresnahan, J M
   Babel, K L
   Splaingard, M L
TI Survival and functional outcome of children requiring mechanical
   ventilation during therapy for acute bacterial meningitis.
SO Critical care medicine
VL 23
IS 7
BP 1279
EP 83
DI 10.1097/00003246-199507000-00019
PD 1995-Jul
PY 1995
AB OBJECTIVE: To determine predictors of survival and functional outcome of
   pediatric patients requiring mechanical ventilation during therapy for
   acute bacterial meningitis.
   DESIGN: Retrospective case series.
   SETTING: Pediatric intensive care unit (ICU) at a midwestern tertiary
   care children's hospital.
   PATIENTS: Consecutive sample of 32 patients (median age 9.8 months;
   range 9 days to 12 yrs) from 1985 to 1990 with acute bacterial
   meningitis severe enough to require mechanical ventilation during
   therapy. Of these patients, 59% were female and 59% were white.
   INTERVENTIONS: None.
   MEASUREMENTS AND MAIN RESULTS: Data were analyzed to identify predictors
   of survival and functional status after hospital discharge. Variables
   included were vital signs, Pediatric Risk of Mortality (PRISM) score
   within the first 24 hrs of hospitalization, Glasgow Coma Score, and
   course of illness. Functional status was assessed at hospital discharge
   and at follow-up (median follow-up: 41.5 months, range 7 to 77) in the
   areas of locomotion, self-care, and communication. There were ten
   inhospital deaths. The 22 survivors formed three groups. At hospital
   discharge, seven children showed no functional disability. Seven
   patients were dependent in all three areas of function at discharge,
   with six still dependent at follow-up evaluation. Eight patients showed
   mild to moderate impairment in at least one area of function at hospital
   discharge. At follow-up, four of these eight patients demonstrated no
   functional disability, one had improved status, two were unchanged, and
   one was lost to follow-up. The best predictor of death and functional
   status at follow-up was the admission PRISM score. Hypotension and
   tachycardia within the first 24 hrs after pediatric ICU admission were
   strongly associated with poor outcome.
   CONCLUSIONS: After bacterial meningitis in children whose care included
   mechanical ventilation, half of the patients died or survived with
   severe functional deficits. Patients with mild or moderate functional
   deficits at hospital discharge improved with time.
RI Splaingard, Mark/D-9206-2012
TC 17
ZB 7
Z8 0
ZS 0
Z9 17
SN 0090-3493
UT MEDLINE:7600838
PM 7600838
ER

PT J
AU Neri, M
   Donner, C F
   Grandi, M
   Robert, D
TI Timing of tracheostomy in neuromuscular patients with chronic
   respiratory failure.
SO Monaldi archives for chest disease = Archivio Monaldi per le malattie
   del torace / Fondazione clinica del lavoro, IRCCS [and] Istituto di
   clinica tisiologica e malattie apparato respiratorio, Universita di
   Napoli, Secondo ateneo
VL 50
IS 3
BP 220
EP 2
PD 1995-May
PY 1995
AB Noninvasive and invasive mechanical ventilation play a fundamental role
   in the treatment of neuromuscular patients with respiratory failure. At
   present no guidelines concerning timing of tracheostomy in neuromuscular
   patients are available. The authors summarize the factors to be
   considered in the decision-making process, as illustrated during an
   international meeting (Tradate, Italy; March 1994) held with the
   participation of a group of authorities on respiratory care of
   neuromuscular patients.
TC 4
ZB 0
Z8 0
ZS 0
Z9 4
SN 1122-0643
UT MEDLINE:7663494
PM 7663494
ER

PT J
AU Soudon, P
TI Tracheal versus noninvasive mechanical ventilation in neuromuscular
   patients: experience and evaluation.
SO Monaldi archives for chest disease = Archivio Monaldi per le malattie
   del torace / Fondazione clinica del lavoro, IRCCS [and] Istituto di
   clinica tisiologica e malattie apparato respiratorio, Universita di
   Napoli, Secondo ateneo
VL 50
IS 3
BP 228
EP 31
PD 1995-May
PY 1995
AB From the experience of following 86 long-term ventilated neuromuscular
   patients, some aspects of the mode of ventilation are discussed:
   tolerance and problems, switching from one ventilation technique to
   another. As a general rule, the noninvasive methods are to be preferred.
   Tracheostomy may continue to be indicated in the event of an
   insufficient cultural level, recurrent aspirations, or low pulmonary
   compliance.
TC 6
ZB 1
Z8 0
ZS 0
Z9 6
SN 1122-0643
UT MEDLINE:7663496
PM 7663496
ER

PT J
AU Lissoni, A
TI Tracheostomy and mechanical ventilation in ventilatory failure of
   patients with neuromuscular disease.
SO Monaldi archives for chest disease = Archivio Monaldi per le malattie
   del torace / Fondazione clinica del lavoro, IRCCS [and] Istituto di
   clinica tisiologica e malattie apparato respiratorio, Universita di
   Napoli, Secondo ateneo
VL 50
IS 3
BP 232
EP 4
PD 1995-May
PY 1995
AB Decision-making about tracheostomy as a treatment of ventilatory failure
   in patients with neuromuscular disease is complicated by problems of
   several kinds (medical, surgical, psychological, ethical and social).
   From an experience of 90 home mechanically-ventilated neuromuscular
   patients (18 of whom were tracheostomized), the author reports the
   clinical, organizational and social aspects of the topic. Indications
   and contraindications, advantages and disadvantages of tracheostomy in
   this kind of patient are specified. The opinion of the quality of life
   in tracheostomized patients with neuromuscular disease is better among
   the patients themselves and their relations than among other people less
   heavily involved. Consequently, there is a need for more direct
   information to the potential users of mechanical ventilation and
   tracheostomy, concerning the possibilities and the limitations of this
   method of treatment in order to offer the patients a chance to take part
   in the decision concerning their future life.
TC 2
ZB 0
Z8 0
ZS 0
Z9 2
SN 1122-0643
UT MEDLINE:7663497
PM 7663497
ER

PT J
AU Tousignant, C P
   Bevan, D R
   Eisen, A A
   Fenwick, J C
   Tweedale, M G
TI Acute quadriparesis in an asthmatic treated with atracurium.
SO Canadian journal of anaesthesia = Journal canadien d'anesthesie
VL 42
IS 3
BP 224
EP 7
PD 1995-Mar
PY 1995
AB An 18-yr-old male asthmatic was paralyzed with atracurium for a period
   of seven days to facilitate mechanical pulmonary ventilation. After
   withdrawal of the muscle relaxant, train-of-four neuromuscular
   monitoring demonstrated rapid recovery of normal function. Three days
   later he developed acute quadriparesis without respiratory compromise.
   Electrophysiological studies showed normal conduction velocities, low
   compound muscle action potential amplitudes and evidence of denervation.
   Most cases of post-ventilatory weakness in the ICU involve the use of
   vecuronium and pancuronium. It has been suggested that the steroid
   nucleus in these muscle relaxants may be responsible. Our patient
   developed generalised weakness after treatment with atracurium, a
   benzylisoquinolinium muscle relaxant. Thus, it appears that the steroid
   nucleus of vecuronium and pancuronium is not essential in causing
   post-ventilatory weakness.
TC 12
ZB 2
Z8 0
ZS 0
Z9 12
SN 0832-610X
UT MEDLINE:7743575
PM 7743575
ER

PT J
AU Pourmand, R
TI Acquired respiratory failure in critically ill patients.
SO Indiana medicine : the journal of the Indiana State Medical Association
VL 88
IS 1
BP 68
EP 70
PD 1995 Jan-Feb
PY 1995
AB With increasing survival rates from acute medical or surgical
   emergencies a new form of peripheral neuropathy, CIP, has been
   recognized. CIP can be seen only in patients who are considered to be
   critically ill; therefore, it invariably occurs in the ICU. Typically,
   initial symptoms begin with transient (hours to a few days) septic
   encephalopathy followed by generalized weakness, manifested in weaning
   failure, limb weakness and hyporeflexia. Diagnosis is confirmed by an
   EMG. CIP should be considered in any elderly patient with sepsis and
   prolonged respiratory muscle weakness. Prognosis is poor in severe
   cases, in which the EMG also shows severe axonal degeneration. In milder
   forms, fair to good recovery is expected within weeks. Management
   includes treatment of sepsis, normalization of failing organ function,
   physical therapy and proper nutrition.
TC 1
ZB 1
Z8 0
ZS 0
Z9 1
SN 0746-8288
UT MEDLINE:7860977
PM 7860977
ER

PT J
AU Jacobs, Susan
TI AIDS in correctional facilities: current status of legal issues critical
   to policy development.
SO Journal of criminal justice
VL 23
IS 3
BP 209
EP 21
DI 10.1016/0047-2352(95)00011-E
PD 1995
PY 1995
TC 5
ZB 0
Z8 0
ZS 0
Z9 5
SN 0047-2352
UT MEDLINE:11658149
PM 11658149
ER

PT J
AU Teitelbaum, J S
   Borel, C O
TI Respiratory dysfunction in Guillain-Barre syndrome.
SO Clinics in chest medicine
VL 15
IS 4
BP 705
EP 14
PD 1994-Dec
PY 1994
AB Guillain-Barre syndrome (GBS) is the most common cause of acute
   paralysis and neuromuscular ventilatory failure. Although treatment with
   plasma exchange and immune globulins has decreased the duration of
   mechanical ventilation by half, 10% to 30% of patients require
   mechanical ventilation, 5% to 10% remain seriously disabled, and 3% to
   8% die as a result of largely avoidable complications. Good clinical
   outcome depends to a large extent on the anticipation and management of
   ventilatory failure and its complications.
TC 27
ZB 16
Z8 0
ZS 1
Z9 30
SN 0272-5231
UT MEDLINE:7867285
PM 7867285
ER

EF