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Preparing the Malnourished Patient for Parenteral Nutrition (PN)
Published in Michael M. Rothkopf, Jennifer C. Johnson, Optimizing Metabolic Status for the Hospitalized Patient, 2023
Michael M. Rothkopf, Jennifer C. Johnson
Severe hypophosphatemia decreases intracellular ATP which can cause metabolic encephalopathy, paresthesia, proximal myopathy and spasm. The cardiorespiratory system may be impaired due to reduced myocardial contractility and diaphragmatic weakness. In severe cases, this can lead to respiratory failure or difficulty weaning from the ventilator. Skeletal muscle can present with proximal myopathy and even rhabdomyolysis. In the gastrointestinal (GI) tract, dysphagia and ileus can be seen. The hematologic system effects include hemolysis, impaired granulocytes and decreased platelet activation (Sharma and Castro 2019).
Social Distancing and Quarantine as COVID-19 Control Remedy
Published in Hanadi Talal Ahmedah, Muhammad Riaz, Sagheer Ahmed, Marius Alexandru Moga, The Covid-19 Pandemic, 2023
Adeel Ahmad, Muhammad Hussaan, Fatima Batool, Sahar Mumtaz, Nagina Rehman, Samina Yaqoob, Humaira Kausar
In severe illness, the person may be in ICU or even on a ventilator and takes few weeks to months to recover. Recovering from severe COVID-19 illness will take more time to regain the normal working of the pulmonary and immune system of the body. In addition, if a person is on a ventilator, the body takes some time to get its independence back, which also depends on body strength and the ratio of lung damage. It is evident that illness intensity varies from person to person either develop pneumonia or the immune system does efforts to eliminate the virus. As a result, inflammatory response produces that SARS causing lungs damage, even respiratory failure [70].
Solving the Mystery of COVID-19
Published in Srijan Goswami, Chiranjeeb Dey, COVID-19 and SARS-CoV-2, 2022
Usually, people try to manage the flu with medicines, and sometimes, there are chances for the virus to move down from the upper respiratory tract to the lower respiratory tract. As a result, breathing difficulty occurs and if checked with an oximeter, the oxygen level will be ≤ 90%. In such situations, the doctor will advise a ventilator because the lungs are full of water. What you have to do in such a situation is avoid going to the hospital because you will be put on a mechanical ventilator. You have to make your own ventilator at home. This is called prone ventilation (Guerin, 2014).
Levosimendan: mechanistic insight and its diverse future aspects in cardiac care
Published in Acta Cardiologica, 2023
Md Sayeed Akhtar, Md Quamrul Hassan, Aisha Siddiqui, Sirajudeen S. Alavudeen, Obaid Afzal, Abdulmalik S.A Altamimi, Syed Obaidur Rahman, Mallika Khurana, Mohamed Jawed Ahsan, Arun Kumar Sharma, Fauzia Tabassum
Ventilator weaning is the process of a gradual decrease in ventilator support. Evidence indicated that LEVO can be used in weaning among the patients taking either inotropes or vasoconstrictors [16,84]. LEVO not only exhibits potential effects in weaning from mechanical ventilation but also improves splanchnic mucosal oxygenation suppressed by mechanical ventilation [85]. Moreover, LEVO also demonstrated efficacy in assisting weaning in patients with LV dysfunction after CABG [55]. A retrospective cohort study was conducted among 150 patients undergoing venoarterial extracorporeal membrane oxygenation (VA-ECMO) in ICU. Data indicated its weaning advantage on these ICU patients. In another similar study among 240 patients studied LEVO for VA-ECMO therapy after cardiovascular surgery and data support its use to improve short- and long-term survival in these patients [86]. In an RCT, LEVO has been shown to improve both peak VO2 and Ventilation/VCO2 slope as well as myocardial crunch indicated by reduced plasma NT-proBNP level [87]. Moreover, study conducted in paediatric patients with anomalies to left coronary artery from pulmonary artery concurrent to impaired LV function showed strong potential of LEVO among patients who had undergone surgical repair [88]. On contrary, Mehta et al reported less benefits of LEVO in weaning from mechanical ventilation and possesses greater risk of supraventricular tachyarrhythmia (SVT) [89]. LEVO-CTS trial also indicated that LEVO with Heart-Lung Machine has been shown to be inefficient in improving the patient outcome [90].
Is surgical rib fixation in patients aged more than 65 years old associated with worse outcomes compared to younger patients? A retrospective single-center study
Published in Acta Chirurgica Belgica, 2022
Apostolos C. Agrafiotis, Lucie Bourlon, Harry Etienne, Marielle Le Roux, Lucia Mazzoni, Mihaela Giol, Denis Debrosse, Jalal Assouad
The complete data of two patients could not been retrieved and therefore these patients were not included in the analysis. There were complete data for 87 patients, 59 male (67.8%) and 28 females (32.2%). The patient demographics of the entire cohort are demonstrated in Table 1. Mean (SD) age was 58.9 (17.3) years. Mean Injury Severity Score (ISS) was 13.1 (6.6). The mean number of rib fractures was 5.5 (2.1), [Range: 1–12] and the mean number of surgically fixed ribs was 3.2 (1.2), [Range: 1–6]. Intraoperatively, 8 patients were found to suffer diaphragmatic lacerations and 4 patients both pulmonary and diaphragmatic lacerations that needed repair. Twenty-two patients had only pulmonary lacerations. In total, 34 patients (39%) had intrathoracic lesions. Eight patients (9.2%) were intubated prior to surgery. All patients were weaned from mechanical ventilation. The mean time on ventilator support after surgery for these patients was 4.8 days [Range: 0–14]. One patient was extubated immediately after surgery and two other patients on the first postoperative day. Three patients died within 30 days after surgery (30-day mortality 3.4%) and three other patients on postoperative day 47, 49 and 50 (overall mortality 6.9%). Among them, one patient was 60 years old, one patient was 75 years old and the other four were older than 85 years. The majority of patients were discharged at home, 19 patients (21.8%) were transferred to another department (geriatric ward, orthopedic ward, ICU of another hospital etc) and 18 patients (20.7%) were admitted to a rehabilitation centre.
Care of children with home mechanical ventilation in the healthcare continuum
Published in Hospital Practice, 2021
Benjamin Kalm, Khanh Lai, Natalie Darro
There is limited evidence to inform the in-hospital care of children with new tracheostomies who require long-term mechanical ventilation. HMV is usually initiated in the hospital in consultation with pulmonary and otolaryngology teams. Discussion on optimal home ventilator, modes, and settings is beyond the scope of this article and varies based on local clinicians’ experience, preference, and availability of various equipment brands for both home health companies and hospitals. Home ventilators work in various modes including pressure or volume-controlled modes. Monitoring of ventilator parameters includes assessment of peak inspiratory pressure, positive end expiratory pressure, exhaled tidal volumes, respiratory rate, minute ventilation and leak. Home ventilators are set to alarm if there are high or low respiratory rates, minute ventilation, or pressure, as well if there is a circuit disconnect. At our institution patients utilize Trilogy ventilators as their home ventilator (either Trilogy 100 or Trilogy EVO). While modes of ventilation at other institutions may vary, children with HMV at our institution are preferentially placed on pressure control-synchronized intermittent mandatory ventilation (PC-SIMV), primarily for a standardized and consistent approach across providers. Newer ventilator modes such as pressure regulated volume control (PRVC) are not supported by our home ventilators.