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Movement disorders
Published in Henry J. Woodford, Essential Geriatrics, 2022
The first step is to stop the antipsychotic (or other suspected causative) medication, ensure adequate hydration and control pyrexia. As may be expected in such a rare and sporadic condition, large-scale randomised controlled trials of treatment modalities have not been performed. Pro-dopaminergic medications bromocriptine and dantrolene have been proposed to reduce hyperthermia and rigidity but this approach is controversial. Their use is usually unnecessary when the disorder is detected early and the offending agent is discontinued. There is also some evidence that bromocriptine or dantrolene may actually worsen or prolong the duration.127 Mechanical ventilation is sometimes required for those with respiratory failure.
Eventration of the diaphragm
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Colin G. DeLong, Afif N. Kulaylat, Robert E. Cilley
Response to operation may be immediate, allowing prompt weaning and extubation. In patients who have required prolonged mechanical ventilation prior to operation, slower ventilator weaning is performed. The most common postoperative complications include pneumonia and pleural effusion. Intrapleural drainage may be used briefly after surgery and is usually discontinued within a few days.
Clinical Workflows Supported by Patient Care Device Data
Published in John R. Zaleski, Clinical Surveillance, 2020
Many CABG patients arrive from surgery with cardiovascular instabilities and co-morbidities in addition to complex acid-base disturbances which can affect the manner in which they metabolize oxygen and carbon dioxide. Patients who are able to be weaned rather directly from postoperative mechanical ventilation are normally those, as prescribed by clinical protocols and guidelines, who are free of these complicating factors. Furthermore, patients who are weaned from postoperative mechanical ventilation are those whose physiological and metabolic system parameters remain within normal ranges. Such patients are also free of acute neurological events (e.g.: coma or altered level of consciousness) and impaired autonomic nervous system activity that could otherwise disable spontaneous respiration [38].
The complex lipid, SPPCT-800, reduces lung damage, improves pulmonary function and decreases pro-inflammatory cytokines in the murine LPS-induced acute respiratory distress syndrome (ARDS) model
Published in Pharmaceutical Biology, 2022
Peter P. Sordillo, Andrea Allaire, Annie Bouchard, Dan Salvail, Sebastien M. Labbe
In this study, we have used the murine LPS-induced ARDS model, a well-established and commonly used model for studies of this disease (Bastarache and Blackwell 2009; Aeffner et al. 2015). It ‘duplicates the mechanisms and consequences of ARDS and displays major features of microvascular lung injury, including leukocyte accumulation in lung tissue, pulmonary edoema, profound lung inflammation and mortality’ (Chen et al. 2010). It has been reported that in this model, cytokines such as IL-1β, IL-2, IL-5, IL-6, IL-12, IL-17, vascular endothelial growth factor (VEGF), INF-γ monocyte chemoattract protein-1 (MCP-1, CCL2), keratinocytes-derived chemokine (KC, CXCL1), MIP-1α (macrophage inflammatory protein-1α (CCL3)], and interferon-γ induced protein 10 (IP-10, CXCL-10), were all significantly elevated after 18 h (Juskewitch et al. 2012). Further, it is known that mechanical ventilation, when necessary, will cause additional lung damage and inflammation (Ware and Matthay 2000; Henderson et al. 2017; Spadaro et al. 2019). Thus, suppression of inflammation is key to treating this disease.
Acute diquat poisoning resulting in toxic encephalopathy: a report of three cases
Published in Clinical Toxicology, 2022
Guangcai Yu, Tianzi Jian, Siqi Cui, Longke Shi, Baotian Kan, Xiangdong Jian
A 31-year-old previously healthy man ingested approximately 50 mL of diquat (20 g/100 mL), which was followed by nausea and vomiting. Gastric lavage and haemoperfusion (HA 330 × 2, Jafron) were performed and methylprednisolone (500 mg) was provided. After 16 h, he was transferred to our hospital. On admission, his physical examinations, except blood pressure (153/112 mmHg), were normal. Laboratory test results were as follows: creatinine, 209 μmol/L; urea, 7.6 mmol/L; potassium, 4.06 mmol/L; sodium, 138 mmol/L; and blood diquat concentration, 0.43 μg/mL. We performed haemoperfusion and comprehensive treatment. On day 3 after ingestion, he was oliguric and agitated and developed anuria and coma soon afterwards. His urea and creatine levels were 27.5 mmol/L and 600 μmol/L, respectively. His MRI indicated brain damage (Figure 3). Mechanical ventilation and intermittent CVVHF (8–12 h/day) were the main supportive treatments. On day 15, he regained consciousness, and the daily urine volume, creatine level, and urea level were 150 mL, 1080 μmol/L, and 50.4 mmol/L, respectively. Mechanical ventilation was weaned. On day 17, his urine volume gradually increased, but without limb movement. MRI indicated his brain damage similar to the previous. On day 27, he developed dystaxia, especially in the upper limb. His MRI indicated that the regions of brain damage had reduced. At 57 days, his symptoms were almost completely relieved, the electroencephalogram examination was normal, and brain damage improved significantly.
Redox signaling and antioxidant therapies in acute respiratory distress syndrome: a systematic review and meta-analysis
Published in Expert Review of Respiratory Medicine, 2021
Liyan Bo, Faguang Jin, Zhuang Ma, Congcong Li
To date, only some life support management methods have been shown to benefit. Mechanical ventilation is a vital treatment method, especially a ventilation strategy that could minimize ventilator-induced lung injury such as lung protective ventilation, prone positioning, lung recruitment maneuvers, and extracorporeal membrane oxygenation [6–8]. With regard to pharmacologic therapies, several potentially effective drugs aimed at the underlying pathology have been tested, such as β2 agonists, statins, granulocyte-macrophage colony stimulating factor, keratinocyte growth factor, low-dose methylprednisolone, neutrophil elastase inhibitors, and surfactants [9,10]. However, their therapeutic effect has not been confirmed by large randomized controlled trials or well-done meta-analysis [2,9,11]. Moreover, for severe phenotypes of ARDS, there were some randomized controlled trials [12,13] demonstrated a benefit of neuromuscular blockade and prone positioning.