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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.
Thoracic Trauma
Published in Ian Greaves, Keith Porter, Jeff Garner, Trauma Care Manual, 2021
Ian Greaves, Keith Porter, Jeff Garner
Pain reduces the patient’s tidal volume, leading to inadequate ventilation of the basal segments, resulting in atelectasis. Pain also inhibits coughing, allowing secretions to obstruct bronchi and cause acute respiratory failure. Effective pain relief is therefore essential and may include the application of intercostal nerve or paravertebral blockade (see later), although these techniques are most appropriately performed in a hospital setting. Even a small flail may be a devastating injury in the frail elderly patient. Splinting is not an effective management as this will reduce respiratory movement and exacerbate the ventilatory compromise. Operative fixation of rib fractures is occasionally indicated, but its place in management has not been definitively established. In severe cases the patient will require intubation and mechanical ventilation. The use of non-invasive ventilation may also be considered.
Anaesthetic Records
Published in T.M. Craft, P.M. Upton, Key Topics In Anaesthesia, 2021
Anaesthesia. Airway: airway type, size, cuff and shape used. Breathing system used. Ventilation —type and mode. Use of humidifier, filter, throat pack. Difficulties encountered. Intravenous cannula used — type, size and site. Drugs and fluids used together with doses, route of administration and time given.
Neutrophil Extracellular Traps (NET) and SARS-CoV-2
Published in Immunopharmacology and Immunotoxicology, 2023
Several case series report that the use of anakinra may be beneficial in the control of COVID-19 with a reduction in mortality and the need of mechanical ventilation [12]. Regarding the use of anti-IL-6 in COVID-19, a meta-analysis showed a favorable effect on mortality at 28 days after randomization. Indeed, 1407 out of 6449 people died in the tocilizumab group versus 1158 out of 4481 in the placebo group. This represents an absolute mortality risk of 22% for the anti-IL-6 group and 25% for the placebo group. Beneficial effects on the use of assisted ventilation were also demonstrated [13]. The JAK inhibitors baricitinib, ruxolitinib and tofacitinib have been shown to be well tolerated in patients [14]. A study of patients hospitalized with COVID-19 pneumonia showed that there was a reduction in 30-days mortality when treated with baricitinib. This study showed an absolute risk reduction of 18.5% in the population aged over 70 years. These results would be in agreement with the unpublished results of the COV-BARRIER study, where a 38% reduction in 28- days mortality has been observed [15].
Effect of combined use of ivermectin and colchicine in COVID-19 patients
Published in Egyptian Journal of Anaesthesia, 2022
Rania Gamal El Sayed, Amr Fouad Hafez, Adham Magdy Ahmed Mohammed Haggag, Mohamed A. Alhadidy
The primary endpoint was: 28-day mortality rate.The secondary endpoints wereThe length of oxygen requirement.Clinical deterioration by the WHO clinical progression scale (marked by increase oxygen requirements >8 liters/min to maintain SPO2 > 92%).The need for ICU admission.The need for mechanical ventilation.The length of stay in ICU.Complications observed from study drugs.
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.