POPULARITY
5 episodes with respir care
2 episodes with respir care
5 episodes with respir care
About our Guest: Dr. Omar Alibrahim is a professor of pediatrics at Duke University and a pediatric intensivist at Duke Children's Hospital. He completed his Pediatric Residency and Chief Residency at St. Joseph's Children's Hospital, followed by Pediatric Critical Care Fellowship at the University of Buffalo. He served as the Pediatric Critical Care Division chief, the PICU Medical Director, and the PCCM fellowship Director in Buffalo, NY, for more than 8 years, during which he worked with the pulmonology and respiratory therapy divisions to develop a negative pressure ventilation program for acute respiratory failure. In 2021 Dr. Alibrahim was recruited to Duke Children's Hospital and now serves as the PICU Medical Director and the program director for the Pediatric Critical Care Fellowship. Learning Objectives: By the end of this podcast series, listeners should be able to: Critique the physiologic rationale for negative pressure ventilation (NPV) in acute respiratory failure.Understand the experience of introducing a novel form of respiratory support in a PICU.Describe the stepwise escalation of NPV settings often used in acute respiratory failure.References:Derusso, M., Miller, A. G., Caccamise, M., & Alibrahim, O. (2024). Negative-Pressure Ventilation in the Pediatric ICU. Respiratory Care, 69(3), 354–365. https://doi.org/10.4187/RESPCARE.11193Hassinger AB, Breuer RK, Nutty K, Ma CX, Al Ibrahim OS. Negative-Pressure Ventilation in Pediatric Acute Respiratory Failure. Respir Care. 2017 Dec;62(12):1540-1549. doi: 10.4187/respcare.05531. Epub 2017 Aug 31. PMID: 28860332.Deshpande SR, Maher KO. Long term negative pressure ventilation: Rescue for the failing fontan? World J Cardiol. 2014 Aug 26;6(8):861-4. doi: 10.4330/wjc.v6.i8.861. PMID: 25228965; PMCID: PMC4163715.Questions, comments or feedback? Please send us a message at this link (leave email address if you would like us to relpy) Thanks! -Alice & ZacSupport the showHow to support PedsCrit:Please complete our Listener Feedback SurveyPlease rate and review on Spotify and Apple Podcasts!Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show. Thank you for listening to this episode of PedsCrit. Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at pedscritpodcast@gmail.com. Check out http://www.pedscrit.com for detailed show notes. And visit @critpeds on twitter and @pedscrit on instagram for real time show updates.
About our Guest: Dr. Omar Alibrahim is a professor of pediatrics at Duke University and a pediatric intensivist at Duke Children's Hospital. He completed his Pediatric Residency and Chief Residency at St. Joseph's Children's Hospital, followed by Pediatric Critical Care Fellowship at the University of Buffalo. He served as the Pediatric Critical Care Division chief, the PICU Medical Director, and the PCCM fellowship Director in Buffalo, NY, for more than 8 years, during which he worked with the pulmonology and respiratory therapy divisions to develop a negative pressure ventilation program for acute respiratory failure. In 2021 Dr. Alibrahim was recruited to Duke Children's Hospital and now serves as the PICU Medical Director and the program director for the Pediatric Critical Care Fellowship. Learning Objectives: By the end of this podcast series, listeners should be able to: Critique the physiologic rationale for negative pressure ventilation (NPV) in acute respiratory failure.Understand the experience of introducing a novel form of respiratory support in a PICU.Describe the stepwise escalation of NPV settings often used in acute respiratory failure.References:Derusso, M., Miller, A. G., Caccamise, M., & Alibrahim, O. (2024). Negative-Pressure Ventilation in the Pediatric ICU. Respiratory Care, 69(3), 354–365. https://doi.org/10.4187/RESPCARE.11193Hassinger AB, Breuer RK, Nutty K, Ma CX, Al Ibrahim OS. Negative-Pressure Ventilation in Pediatric Acute Respiratory Failure. Respir Care. 2017 Dec;62(12):1540-1549. doi: 10.4187/respcare.05531. Epub 2017 Aug 31. PMID: 28860332.Deshpande SR, Maher KO. Long term negative pressure ventilation: Rescue for the failing fontan? World J Cardiol. 2014 Aug 26;6(8):861-4. doi: 10.4330/wjc.v6.i8.861. PMID: 25228965; PMCID: PMC4163715.Questions, comments or feedback? Please send us a message at this link (leave email address if you would like us to relpy) Thanks! -Alice & ZacSupport the showHow to support PedsCrit:Please complete our Listener Feedback SurveyPlease rate and review on Spotify and Apple Podcasts!Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show. Thank you for listening to this episode of PedsCrit. Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at pedscritpodcast@gmail.com. Check out http://www.pedscrit.com for detailed show notes. And visit @critpeds on twitter and @pedscrit on instagram for real time show updates.
Listener discretion is advised (language). References: Abdo WF, Heunks LM. Oxygen-induced hypercapnia in COPD: myths and facts. Crit Care. 2012 Oct 29;16(5):323. Bonilla Arcos D, Krishnan JA, et al. High-Dose Versus Low-Dose Systemic Steroids in the Treatment of Acute Exacerbations of Chronic Obstructive Pulmonary Disease: Systematic Review. Chronic Obstr Pulm Dis. 2016 Feb 17;3(2):580-588. Fawzy A, Wise RA. Pulse Oximetry Misclassifies Need for Long-Term Oxygen Therapy in Chronic Obstructive Pulmonary Disease. Ann Am Thorac Soc. 2023 Nov;20(11):1556-1557. Goldberg P, Reissmann H, Maltais F, Ranieri M, Gottfried SB. Efficacy of noninvasive CPAP in COPD with acute respiratory failure. Eur Respir J. 1995 Nov;8(11):1894-900. Jennifer T. Thibodeau, Mark H. Drazner. The Role of the Clinical Examination in Patients With Heart Failure,JACC: Heart Failure, Volume 6, Issue 7, 2018, Pages 543-551. Kartal M, Goksu E, Eray O, et al. The value of ETCO2 measurement for COPD patients in the emergency department. Eur J Emerg Med. 2011 Feb;18(1):9-12. Ni, H., Aye, S., Naing, C. Magnesium sulfate for acute exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2022 May 26; 2022(5):CD013506. Pertzov, B., Ronen, M., Rosengarten, D. et al. Use of capnography for prediction of obstruction severity in non-intubated COPD and asthma patients. Respir Res 22, 154 (2021). Pu X, Liu L, Feng B, Wang M, Dong L, Zhang Z, Fan Q, Li Y, Wang G. Efficacy and Safety of Different Doses of Systemic Corticosteroids in COPD Exacerbation. Respir Care. 2021 Feb;66(2):316-326. Tyagi D, Govindagoudar MB, et al. Correlation of PaCO2 and ETCO2 in COPD Patients with Exacerbation on Mechanical Ventilation. Indian J Crit Care Med. 2021 Mar;25(3):305-309. van Gestel AJ, Steier J. Autonomic dysfunction in patients with chronic obstructive pulmonary disease (COPD). J Thorac Dis. 2010 Dec;2(4):215-22. doi: 10.3978/j.issn.2072-1439.2010.02.04.5.
Alexander Rotta, MD is a Professor of Pediatrics and the Division Chief of Pediatric Critical Care at Duke University School of Medicine. He is an accomplished intensivist, educator and physician scientist with well over 100 publications with a focus on respiratory care in critically ill children. He authored a review on high-frequency jet ventilation that served as the foundation for today's episode. Learning Objectives:By the end of this podcast, listeners should be able to discuss:The physiologic rationale supporting the use of high frequency jet ventilation (HFJV).Patient populations most likely to benefit from HFJV.Key published evidence that informs our use of HFJV in pediatric critical care.An expert approach to managing a patient with HFJV.References:Cheifetz IM, Rotta AT. High-Frequency Jet Ventilation in Pediatric Acute Respiratory Failure. Respir Care. 2021 Feb;66(2):191-198. doi: 10.4187/respcare.08241. Epub 2020 Oct 2. PMID: 33008841.Miller AG, Scott BL, Gates RM, Haynes KE, Lopez Domowicz DA, Rotta AT. High-Frequency Jet Ventilation in Infants With Congenital Heart Disease. Respir Care. 2021 Nov;66(11):1684-1690. doi: 10.4187/respcare.09186. Epub 2021 Jun 9. PMID: 34108137.Questions, comments or feedback? Please send us a message at this link (leave email address if you would like us to relpy) Thanks! -Alice & ZacSupport the Show.How to support PedsCrit:Please complete our Listener Feedback SurveyPlease rate and review on Spotify and Apple Podcasts!Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show. Thank you for listening to this episode of PedsCrit. Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at pedscritpodcast@gmail.com. Check out http://www.pedscrit.com for detailed show notes. And visit @critpeds on twitter and @pedscrit on instagram for real time show updates.
Alexander Rotta, MD is a Professor of Pediatrics and the Division Chief of Pediatric Critical Care at Duke University School of Medicine. He is an accomplished intensivist, educator and physician scientist with well over 100 publications with a focus on respiratory care in critically ill children. He authored a review on high-frequency jet ventilation that served as the foundation for today's episode. Learning Objectives:By the end of this podcast, listeners should be able to discuss:The physiologic rationale supporting the use of high frequency jet ventilation (HFJV).Patient populations most likely to benefit from HFJV.Key published evidence that informs our use of HFJV in pediatric critical care.An expert approach to managing a patient with HFJV.References:Cheifetz IM, Rotta AT. High-Frequency Jet Ventilation in Pediatric Acute Respiratory Failure. Respir Care. 2021 Feb;66(2):191-198. doi: 10.4187/respcare.08241. Epub 2020 Oct 2. PMID: 33008841.Miller AG, Scott BL, Gates RM, Haynes KE, Lopez Domowicz DA, Rotta AT. High-Frequency Jet Ventilation in Infants With Congenital Heart Disease. Respir Care. 2021 Nov;66(11):1684-1690. doi: 10.4187/respcare.09186. Epub 2021 Jun 9. PMID: 34108137.Questions, comments or feedback? Please send us a message at this link (leave email address if you would like us to relpy) Thanks! -Alice & ZacSupport the Show.How to support PedsCrit:Please complete our Listener Feedback SurveyPlease rate and review on Spotify and Apple Podcasts!Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show. Thank you for listening to this episode of PedsCrit. Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at pedscritpodcast@gmail.com. Check out http://www.pedscrit.com for detailed show notes. And visit @critpeds on twitter and @pedscrit on instagram for real time show updates.
With over 700 modes of mechanical ventilation available today, it can be overwhelming to find the best application of technology at the bedside. Focused on goal-directed mechanical ventilation, this discussion covers the taxonomy of mechanical ventilation modes and provides a framework for a rational approach at the bedside. Dr. Zanotti is joined by Dr. Eduardo Mireles-Cabodevila, Director of the Medical Intensive Care Unit and the Simulation and Advanced Skills Center at the Cleveland Clinic. In addition, Dr. Mireles-Cabodevila is the Vice-Chair of the Division of Critical Care Medicine, Department of Pulmonary and Critical Care, within the Integrated Hospital-Care Institute at the Cleveland Clinic. Additional Resources: How do I ventilate patients with ARDS: Goal-directed mode selection. E. Mireles-Cabodevila. Med Intensiva 2022: https://pubmed.ncbi.nlm.nih.gov/36220727/ A Rational Framework for Selecting Modes of Ventilation. E. Mireles-Cabodevila, et al. Respir Care 2013: https://pubmed.ncbi.nlm.nih.gov/22710796/ Closing the Gap in Patient-Ventilator Discordance Recognition. A. Liendo and E. Mireles-Cabodevila. Respir Care 2024: https://pubmed.ncbi.nlm.nih.gov/38267228/ Standardized Education for Ventilatory Assistance (SEVA) resources page; https://my.clevelandclinic.org/departments/respiratory/medical-professionals/seva#seva-resources-tab Mechanical Ventilation Mode Taxonomy App: iPhone: https://apps.apple.com/us/app/ventilator-mode-map/id1508307955 Android: https://play.google.com/store/apps/details?id=org.ccf.vmm&hl=en_US Books mentioned in this episode: Solito: A Memoir. By Javier Zamora: https://bit.ly/4b6hPG8
In this episode we discuss a case scenario of Asthma exacerbation. This can be one of the most challenging patients to manage on the ventilator. If at all possible we try not to intubate these patients, however there are times when this happens. We will discuss clinical treatment, ventilator management, and what our rolls are as transport clinicians in the transport of these patients. References: 1) National Asthma Education and Prevention Program: Expert Panel Report III: Guidelines for the diagnosis and management of asthma. Bethesda, MD. National Heart, Lung, and Blood Institute, 2007. (NIH publication no. 08-4051) www.nhlbi.nih.gov/guidelines/asthma/asthgdln.htm (Accessed on September 19, 2018).2) McFadden ER Jr, Lyons HA. Arterial-blood gas tension in asthma. N Engl J Med. 1968 May 9;278(19):1027-32. doi: 10.1056/NEJM196805092781901. PMID: 5644962.3) Global Initiative for Asthma (GINA). Global Strategy for Asthma Management and Prevention. www.ginasthma.org (Accessed on February 13, 2022)4) National Asthma Education and Prevention Program: Expert Panel Report III: Guidelines for the diagnosis and management of asthma. Bethesda, MD. National Heart, Lung, and Blood Institute, 2007. (NIH publication no. 08-4051) www.nhlbi.nih.gov/guidelines/asthma/asthgdln.htm (Accessed on September 19, 2018).5) Rowe BH, Spooner C, Ducharme FM, Bretzlaff JA, Bota GW. Early emergency department treatment of acute asthma with systemic corticosteroids. Cochrane Database Syst Rev. 2001;(1):CD002178. doi: 10.1002/14651858.CD002178. PMID: 11279756.6) Menzies-Gow A, Busse WW, Castro M, Jackson DJ. Prevention and Treatment of Asthma Exacerbations in Adults. J Allergy Clin Immunol Pract. 2021 Jul;9(7):2578-2586. doi: 10.1016/j.jaip.2021.05.016. PMID: 34246434.7) Nanchal R, Kumar G, Majumdar T, et al. Utilization of mechanical ventilation for asthma exacerbations: analysis of a national database. Respir Care 2014; 59:644.
In this week's episode, Martin talks to Dr Michael Klompas, Infectious Disease physician, Hospital Epidemiologist, and Professor of Population Medicine at Harvard Medical School and Brigham and Women's Hospital, Boston, USA. We discuss the complexities of undertaking surveillance of Ventilator-associated pneumonia (VAP) and the USA approach to looking at the wider issue of Ventilator-associated Events (VAE) that removes subjectivity from the surveillance of these important complications. We also discuss the recent SHEA/IDSA/APIC/AMA prevention strategies paper that is the latest state of the art guidance on VAP/VAE prevention. Useful reading here: 1. Klompas M, et al. Strategies to prevent ventilator-associated pneumonia, ventilator-associated events, and nonventilator hospital-acquired pneumonia in acute-care hospitals: 2022 Update. Infect Control Hosp Epidemiol. 2022;43(6):687-713. https://doi.org/10.1017/ice.2022.88 2. Weinberger JF, et al. Changes in the epidemiology of ventilator-associated events over the course of the coronavirus disease 2019 (COVID-19) pandemic. Infect Control Hosp Epidemiol. 2021:1-3. https://doi.org/10.1017/ice.2021.459 3. Klompas M. Ventilator-Associated Events: What They Are and What They Are Not. Respir Care. 2019;64(8):953-961. https://doi.org/10.4187/respcare.07059 4. Klompas M. Ventilator-associated conditions versus ventilator-associated pneumonia: different by design. Curr Infect Dis Rep. 2014;16(10):430. https://doi.org/10.1007/s11908-014-0430-0 5. Klompas M, et al. Risk of misleading ventilator-associated pneumonia rates with use of standard clinical and microbiological criteria. Clin Infect Dis. 2008;46(9):1443-1446. https://doi.org/10.1086/587103
In this week's episode, Martin talks to Dr Michael Klompas, Infectious Disease physician, Hospital Epidemiologist, and Professor of Population Medicine at Harvard Medical School and Brigham and Women's Hospital, Boston, USA. We discuss the complexities of undertaking surveillance of Ventilator-associated pneumonia (VAP) and the USA approach to looking at the wider issue of Ventilator-associated Events (VAE) that removes subjectivity from the surveillance of these important complications. We also discuss the recent SHEA/IDSA/APIC/AMA prevention strategies paper that is the latest state of the art guidance on VAP/VAE prevention. Useful reading here: 1. Klompas M, et al. Strategies to prevent ventilator-associated pneumonia, ventilator-associated events, and nonventilator hospital-acquired pneumonia in acute-care hospitals: 2022 Update. Infect Control Hosp Epidemiol. 2022;43(6):687-713. https://doi.org/10.1017/ice.2022.88 2. Weinberger JF, et al. Changes in the epidemiology of ventilator-associated events over the course of the coronavirus disease 2019 (COVID-19) pandemic. Infect Control Hosp Epidemiol. 2021:1-3. https://doi.org/10.1017/ice.2021.459 3. Klompas M. Ventilator-Associated Events: What They Are and What They Are Not. Respir Care. 2019;64(8):953-961. https://doi.org/10.4187/respcare.07059 4. Klompas M. Ventilator-associated conditions versus ventilator-associated pneumonia: different by design. Curr Infect Dis Rep. 2014;16(10):430. https://doi.org/10.1007/s11908-014-0430-0 5. Klompas M, et al. Risk of misleading ventilator-associated pneumonia rates with use of standard clinical and microbiological criteria. Clin Infect Dis. 2008;46(9):1443-1446. https://doi.org/10.1086/587103
Extubation Readiness with Alyssa Stoner and Gina Patel--Part 3: Cardiovascular and Gastrointestinal Considerations + Practical Tips for ExtubationAbout our guests:Dr. Alyssa Stoner is an Assistant Professor of Pediatrics, University of Missouri-Kansas City School of Medicine and practicing pediatric intensivist at Children's Mercy Kansas City.Dr. Gina Patel is a fellow in pediatric critical care at Children's Mercy Kansas City.How to support PedsCrit?Please share, like, rate and review on Apple Podcasts or Spotify!Donations appreciated @PedsCrit on Venmo or support us by becoming a Patreon. 100% of all funds will go to supporting the show to keep this project going. Objectives for this episode:The participant will be able to describe 3 factors that influence a patient's readiness to extubate. The participant will be able determine the appropriate level of respiratory support to extubate to based on the patient's clinical picture. The participant will be able to develop and execute a patient's extubation References: Best KM, Boullata JI, Curley MA. Risk factors associated with iatrogenic opioid and benzodiazepine withdrawal in critically ill pediatric patients: a systematic review and conceptual model. Pediatr Crit Care Med. 2015;16(2):175-183. doi:10.1097/PCC.0000000000000306Wratney AT, Benjamin DK Jr, Slonim AD, He J, Hamel DS, Cheifetz IM. The endotracheal tube air leak test does not predict extubation outcome in critically ill pediatric patients. Pediatr Crit Care Med. 2008 Sep;9(5):490-6. doi: 10.1097/PCC.0b013e3181849901. PMID: 18679147; PMCID: PMC2782931.Newth CJ, Hotz JC, Khemani RG. Ventilator Liberation in the Pediatric ICU. Respir Care. 2020;65(10):1601-1610. doi:10.4187/respcare.07810Newth CJ, Venkataraman S, Willson DF, et al. Weaning and extubation readiness in pediatric patients. Pediatr Crit Care Med. 2009;10(1):1-11. doi:10.1097/PCC.0b013e318193724dVeldhoen, Esther S et al. “Post-extubation stridor in Respiratory Syncytial Virus bronchiolitis: Is there a role for prophylactic dexamethasone?.” PloS one vol. 12,2 e0172096. 16 Feb. 2017, doi:10.1371/journal.pone.0172096Thank you for listening to this episode of PedsCrit. Please remember that all content during this episode is intended for informational and educational purposes only. It should not be used as a replacement for medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at pedscritpodcast@gmail.com. Check out pedscrit.com for detailed show notes. And visit @critpeds on twitter and @pedscrit on instagram for real time show updatesSupport the show
Extubation Readiness with Alyssa Stoner and Gina Patel--Part 2: Upper Airway and Pulmonary ConsiderationsAbout our guests:Dr. Alyssa Stoner is an Assistant Professor of Pediatrics, University of Missouri-Kansas City School of Medicine and practicing pediatric intensivist at Children's Mercy Kansas City.Dr. Gina Patel is a fellow in pediatric critical care at Children's Mercy Kansas City.How to support PedsCrit?Please share, like, rate and review on Apple Podcasts or Spotify!Donations appreciated @PedsCrit on Venmo or support us by becoming a Patreon. 100% of all funds will go to supporting the show to keep this project going. Objectives for this episode:The participant will be able to describe 3 factors that influence a patient's readiness to extubate. The participant will be able determine the appropriate level of respiratory support to extubate to based on the patient's clinical picture. The participant will be able to develop and execute a patient's extubation References: Best KM, Boullata JI, Curley MA. Risk factors associated with iatrogenic opioid and benzodiazepine withdrawal in critically ill pediatric patients: a systematic review and conceptual model. Pediatr Crit Care Med. 2015;16(2):175-183. doi:10.1097/PCC.0000000000000306Wratney AT, Benjamin DK Jr, Slonim AD, He J, Hamel DS, Cheifetz IM. The endotracheal tube air leak test does not predict extubation outcome in critically ill pediatric patients. Pediatr Crit Care Med. 2008 Sep;9(5):490-6. doi: 10.1097/PCC.0b013e3181849901. PMID: 18679147; PMCID: PMC2782931.Newth CJ, Hotz JC, Khemani RG. Ventilator Liberation in the Pediatric ICU. Respir Care. 2020;65(10):1601-1610. doi:10.4187/respcare.07810Newth CJ, Venkataraman S, Willson DF, et al. Weaning and extubation readiness in pediatric patients. Pediatr Crit Care Med. 2009;10(1):1-11. doi:10.1097/PCC.0b013e318193724dVeldhoen, Esther S et al. “Post-extubation stridor in Respiratory Syncytial Virus bronchiolitis: Is there a role for prophylactic dexamethasone?.” PloS one vol. 12,2 e0172096. 16 Feb. 2017, doi:10.1371/journal.pone.0172096Thank you for listening to this episode of PedsCrit. Please remember that all content during this episode is intended for informational and educational purposes only. It should not be used as a replacement for medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at pedscritpodcast@gmail.com. Check out pedscrit.com for detailed show notes. And visit @critpeds on twitter and @pedscrit on instagram for real time show updatesSupport the show
Extubation Readiness with Alyssa Stoner and Gina Patel--Part 1: Introduction and Sedation ManagementAbout our guests:Dr. Alyssa Stoner is an Assistant Professor of Pediatrics, University of Missouri-Kansas City School of Medicine and practicing pediatric intensivist at Children's Mercy Kansas City.Dr. Gina Patel is a fellow in pediatric critical care at Children's Mercy Kansas City.How to support PedsCrit?Please share, like, rate and review on Apple Podcasts or Spotify!Donations appreciated @PedsCrit on Venmo or support us by becoming a Patreon. 100% of all funds will go to supporting the show to keep this project going. Objectives for this episode:The participant will be able to describe 3 factors that influence a patient's readiness to extubate. The participant will be able determine the appropriate level of respiratory support to extubate to based on the patient's clinical picture. The participant will be able to develop and execute a patient's extubation References: Best KM, Boullata JI, Curley MA. Risk factors associated with iatrogenic opioid and benzodiazepine withdrawal in critically ill pediatric patients: a systematic review and conceptual model. Pediatr Crit Care Med. 2015;16(2):175-183. doi:10.1097/PCC.0000000000000306Wratney AT, Benjamin DK Jr, Slonim AD, He J, Hamel DS, Cheifetz IM. The endotracheal tube air leak test does not predict extubation outcome in critically ill pediatric patients. Pediatr Crit Care Med. 2008 Sep;9(5):490-6. doi: 10.1097/PCC.0b013e3181849901. PMID: 18679147; PMCID: PMC2782931.Newth CJ, Hotz JC, Khemani RG. Ventilator Liberation in the Pediatric ICU. Respir Care. 2020;65(10):1601-1610. doi:10.4187/respcare.07810Newth CJ, Venkataraman S, Willson DF, et al. Weaning and extubation readiness in pediatric patients. Pediatr Crit Care Med. 2009;10(1):1-11. doi:10.1097/PCC.0b013e318193724dVeldhoen, Esther S et al. “Post-extubation stridor in Respiratory Syncytial Virus bronchiolitis: Is there a role for prophylactic dexamethasone?.” PloS one vol. 12,2 e0172096. 16 Feb. 2017, doi:10.1371/journal.pone.0172096Thank you for listening to this episode of PedsCrit. Please remember that all content during this episode is intended for informational and educational purposes only. It should not be used as a replacement for medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at pedscritpodcast@gmail.com. Check out pedscrit.com for detailed show notes. And visit @critpeds on twitter and @pedscrit on instagram for real time show updatesSupport the show
Contributor: Nick Hatch, MD Educational Pearls: High flow nasal cannula (HFNC) or “heated high flow” can deliver higher oxygen levels than nasal cannula It typically is used as an “intermediate” between oxygen via nasal cannula and other non-invasive positive pressure devices, such as BiPAP Can modify both the FiO2 and flow rate Maximum flow rate is typically 60 liters per minute (compare that to a typical breath that is 30-40 L/min) Humidification of HFNC is important due to risk of epistaxis from drying out the nasal mucosa Large energy expenditure to humidify airflow by a patient in respiratory distress, so humidified oxygen may help decrease this metabolic demand References Nishimura M. High-Flow Nasal Cannula Oxygen Therapy in Adults: Physiological Benefits, Indication, Clinical Benefits, and Adverse Effects. Respir Care. 2016;61(4):529-541. doi:10.4187/respcare.04577 Hacquin A, Perret M, Manckoundia P, et al. High-Flow Nasal Cannula Oxygenation in Older Patients with SARS-CoV-2-Related Acute Respiratory Failure. J Clin Med. 2021;10(16):3515. Published 2021 Aug 10. doi:10.3390/jcm10163515 Summarized by John Spartz, MS4 | Edited by Erik Verzemnieks, MD The Emergency Medical Minute is excited to announce that we are now offering AMA PRA Category 1 credits™ via online course modules. To access these and for more information, visit our website at https://emergencymedicalminute.org/cme-courses/ and create an account. Donate to EMM today!
REFERÊNCIAS1.Pontone G, Scafuri S, Mancini ME, Agalbato C, Guglielmo M, Baggiano A, et al. Role of computed tomography in COVID-19. J Cardiovasc Comput Tomogr. 2021;15(1):27-36.2.Cereser L, Da Re J, Zuiani C, Girometti R. Chest high-resolution computed tomography is associated to short-time progression to severe disease in patients with COVID-19 pneumonia. Clin Imaging. 2021;70:61-6.3.Hochhegger B, Mandelli NS, Stuker G, Meirelles GSP, Zanon M, Mohammed TL, et al. Coronavirus Disease 2019 (COVID-19) Pneumonia Presentations in Chest Computed Tomography: A Pictorial Review. Curr Probl Diagn Radiol. 2021;50(3):436-42.4.Besutti G, Ottone M, Fasano T, Pattacini P, Iotti V, Spaggiari L, et al. The value of computed tomography in assessing the risk of death in COVID-19 patients presenting to the emergency room. Eur Radiol. 2021.5.Mogami R, Lopes AJ, Araujo Filho RC, de Almeida FCS, Messeder A, Koifman ACB, et al. Chest computed tomography in COVID-19 pneumonia: a retrospective study of 155 patients at a university hospital in Rio de Janeiro, Brazil. Radiol Bras. 2021;54(1):1-8.6.Cau R, Falaschi Z, Pasche A, Danna P, Arioli R, Arru CD, et al. CT findings of COVID-19 pneumonia in ICU-patients. J Public Health Res. 2021.7.Kanne JP, Bai H, Bernheim A, Chung M, Haramati LB, Kallmes DF, et al. COVID-19 Imaging: What We Know Now and What Remains Unknown. Radiology. 2021;299(3):E262-E79.8.Pourhoseingholi MA, Jafari R, Jafari NJ, Rahimi-Bashar F, Nourbakhsh M, Vahedian-Azimi A, et al. Predicting 1-year post-COVID-19 mortality based on chest computed tomography scan. J Med Virol. 2021;93(10):5694-6.9.Kato S, Ishiwata Y, Aoki R, Iwasawa T, Hagiwara E, Ogura T, et al. Imaging of COVID-19: An update of current evidences. Diagn Interv Imaging. 2021;102(9):493-500.10.Ozer H, Kilincer A, Uysal E, Yormaz B, Cebeci H, Durmaz MS, et al. Diagnostic performance of Radiological Society of North America structured reporting language for chest computed tomography findings in patients with COVID-19. Jpn J Radiol. 2021;39(9):877-88.11.Ramanan RV, Joshi AR, Venkataramanan A, Nambi SP, Badhe R. Incidental chest computed tomography findings in asymptomatic Covid-19 patients. A multicentre Indian perspective. Indian J Radiol Imaging. 2021;31(Suppl 1):S45-S52.12.Axiaq A, Almohtadi A, Massias SA, Ngemoh D, Harky A. The role of computed tomography scan in the diagnosis of COVID-19 pneumonia. Curr Opin Pulm Med. 2021;27(3):163-8.13.Ishfaq A, Yousaf Farooq SM, Goraya A, Yousaf M, Gilani SA, Kiran A, et al. Role of High Resolution Computed Tomography chest in the diagnosis and evaluation of COVID -19 patients -A systematic review and meta-analysis. Eur J Radiol Open. 2021;8:100350.14.Razek A, Fouda N, Fahmy D, Tanatawy MS, Sultan A, Bilal M, et al. Computed tomography of the chest in patients with COVID-19: what do radiologists want to know? Pol J Radiol. 2021;86:e122-e35.15.Revel MP, Boussouar S, de Margerie-Mellon C, Saab I, Lapotre T, Mompoint D, et al. Study of Thoracic CT in COVID-19: The STOIC Project. Radiology. 2021;301(1):E361-E70.16.Au-Yong I, Higashi Y, Giannotti E, Fogarty A, Morling JR, Grainge M, et al. Chest Radiograph Scoring Alone or Combined with Other Risk Scores for Predicting Outcomes in COVID-19. Radiology. 2021:210986.17.Little BP. Disease Severity Scoring for COVID-19: A Welcome (Semi)Quantitative Role for Chest Radiography. Radiology. 2021:212212.18.Prokop M, van Everdingen W, van Rees Vellinga T, Quarles van Ufford H, Stoger L, Beenen L, et al. CO-RADS: A Categorical CT Assessment Scheme for Patients Suspected of Having COVID-19-Definition and Evaluation. Radiology. 2020;296(2):E97-E104.19.Ozel M, Aslan A, Arac S. Use of the COVID-19 Reporting and Data System (CO-RADS) classification and chest computed tomography involvement score (CT-IS) in COVID-19 pneumonia. Radiol Med. 2021;126(5):679-87.20.Byrne D, Neill SBO, Muller NL, Muller CIS, Walsh JP, Jalal S, et al. RSNA Expert Consensus Statement on Reporting Chest CT Findings Related to COVID-19: Interobserver Agreement Between Chest Radiologists. Can Assoc Radiol J. 2021;72(1):159-66.21.Fonseca E, Loureiro BMC, Strabelli DG, Farias LPG, Garcia JVR, Gama VAA, et al. Evaluation of the RSNA and CORADS classifications for COVID-19 on chest computed tomography in the Brazilian population. Clinics (Sao Paulo). 2021;76:e2476.22.Barisione E, Grillo F, Ball L, Bianchi R, Grosso M, Morbini P, et al. Fibrotic progression and radiologic correlation in matched lung samples from COVID-19 post-mortems. Virchows Arch. 2021;478(3):471-85.23.Kianzad A, Meijboom LJ, Nossent EJ, Roos E, Schurink B, Bonta PI, et al. COVID-19: Histopathological correlates of imaging patterns on chest computed tomography. Respirology. 2021;26(9):869-77.24.Aesif SW, Bribriesco AC, Yadav R, Nugent SL, Zubkus D, Tan CD, et al. Pulmonary Pathology of COVID-19 Following 8 Weeks to 4 Months of Severe Disease: A Report of Three Cases, Including One With Bilateral Lung Transplantation. Am J Clin Pathol. 2021;155(4):506-14.25.De Cobelli F, Palumbo D, Ciceri F, Landoni G, Ruggeri A, Rovere-Querini P, et al. Pulmonary Vascular Thrombosis in COVID-19 Pneumonia. J Cardiothorac Vasc Anesth. 2021.26.Vlachou M, Drebes A, Candilio L, Weeraman D, Mir N, Murch N, et al. Pulmonary thrombosis in Covid-19: before, during and after hospital admission. J Thromb Thrombolysis. 2021;51(4):978-84.27.Caruso D, Guido G, Zerunian M, Polidori T, Lucertini E, Pucciarelli F, et al. Postacute Sequelae of COVID-19 Pneumonia: 6-month Chest CT Follow-up. Radiology. 2021:210834.28.Han X, Fan Y, Alwalid O, Li N, Jia X, Yuan M, et al. Six-month Follow-up Chest CT Findings after Severe COVID-19 Pneumonia. Radiology. 2021;299(1):E177-E86.29.Solomon JJ, Heyman B, Ko JP, Condos R, Lynch DA. CT of Post-Acute Lung Complications of COVID-19. Radiology. 2021:211396.30.Wells AU, Devaraj A, Desai SR. Interstitial Lung Disease after COVID-19 Infection: A Catalog of Uncertainties. Radiology. 2021;299(1):E216-E8.31.Han X, Fan Y, Alwalid O, Zhang X, Jia X, Zheng Y, et al. Fibrotic Interstitial Lung Abnormalities at 1-year Follow-up CT after Severe COVID-19. Radiology. 2021:210972.32.Lindahl A, Reijula J, Malmberg LP, Aro M, Vasankari T, Makela MJ. Small airway function in Finnish COVID-19 survivors. Respir Res. 2021;22(1):237.33.Small Airways Disease is a Post-Acute Sequelae of SARS-CoV-2 Infection [Internet]. 2021.34.Lopes AJ, Mafort TT, da Cal MS, Monnerat LB, Litrento PF, Ramos I, et al. Impulse Oscillometry Findings and Their Associations With Lung Ultrasound Signs in COVID-19 Survivors. Respir Care. 2021.35.Wells AU, Devaraj A. Residual Lung Disease at 6-month Follow-up CT after COVID-19: Clinical Significance Is a Key Issue. Radiology. 2021:211284.
REFERÊNCIAS1.Pontone G, Scafuri S, Mancini ME, Agalbato C, Guglielmo M, Baggiano A, et al. Role of computed tomography in COVID-19. J Cardiovasc Comput Tomogr. 2021;15(1):27-36.2.Cereser L, Da Re J, Zuiani C, Girometti R. Chest high-resolution computed tomography is associated to short-time progression to severe disease in patients with COVID-19 pneumonia. Clin Imaging. 2021;70:61-6.3.Hochhegger B, Mandelli NS, Stuker G, Meirelles GSP, Zanon M, Mohammed TL, et al. Coronavirus Disease 2019 (COVID-19) Pneumonia Presentations in Chest Computed Tomography: A Pictorial Review. Curr Probl Diagn Radiol. 2021;50(3):436-42.4.Besutti G, Ottone M, Fasano T, Pattacini P, Iotti V, Spaggiari L, et al. The value of computed tomography in assessing the risk of death in COVID-19 patients presenting to the emergency room. Eur Radiol. 2021.5.Mogami R, Lopes AJ, Araujo Filho RC, de Almeida FCS, Messeder A, Koifman ACB, et al. Chest computed tomography in COVID-19 pneumonia: a retrospective study of 155 patients at a university hospital in Rio de Janeiro, Brazil. Radiol Bras. 2021;54(1):1-8.6.Cau R, Falaschi Z, Pasche A, Danna P, Arioli R, Arru CD, et al. CT findings of COVID-19 pneumonia in ICU-patients. J Public Health Res. 2021.7.Kanne JP, Bai H, Bernheim A, Chung M, Haramati LB, Kallmes DF, et al. COVID-19 Imaging: What We Know Now and What Remains Unknown. Radiology. 2021;299(3):E262-E79.8.Pourhoseingholi MA, Jafari R, Jafari NJ, Rahimi-Bashar F, Nourbakhsh M, Vahedian-Azimi A, et al. Predicting 1-year post-COVID-19 mortality based on chest computed tomography scan. J Med Virol. 2021;93(10):5694-6.9.Kato S, Ishiwata Y, Aoki R, Iwasawa T, Hagiwara E, Ogura T, et al. Imaging of COVID-19: An update of current evidences. Diagn Interv Imaging. 2021;102(9):493-500.10.Ozer H, Kilincer A, Uysal E, Yormaz B, Cebeci H, Durmaz MS, et al. Diagnostic performance of Radiological Society of North America structured reporting language for chest computed tomography findings in patients with COVID-19. Jpn J Radiol. 2021;39(9):877-88.11.Ramanan RV, Joshi AR, Venkataramanan A, Nambi SP, Badhe R. Incidental chest computed tomography findings in asymptomatic Covid-19 patients. A multicentre Indian perspective. Indian J Radiol Imaging. 2021;31(Suppl 1):S45-S52.12.Axiaq A, Almohtadi A, Massias SA, Ngemoh D, Harky A. The role of computed tomography scan in the diagnosis of COVID-19 pneumonia. Curr Opin Pulm Med. 2021;27(3):163-8.13.Ishfaq A, Yousaf Farooq SM, Goraya A, Yousaf M, Gilani SA, Kiran A, et al. Role of High Resolution Computed Tomography chest in the diagnosis and evaluation of COVID -19 patients -A systematic review and meta-analysis. Eur J Radiol Open. 2021;8:100350.14.Razek A, Fouda N, Fahmy D, Tanatawy MS, Sultan A, Bilal M, et al. Computed tomography of the chest in patients with COVID-19: what do radiologists want to know? Pol J Radiol. 2021;86:e122-e35.15.Revel MP, Boussouar S, de Margerie-Mellon C, Saab I, Lapotre T, Mompoint D, et al. Study of Thoracic CT in COVID-19: The STOIC Project. Radiology. 2021;301(1):E361-E70.16.Au-Yong I, Higashi Y, Giannotti E, Fogarty A, Morling JR, Grainge M, et al. Chest Radiograph Scoring Alone or Combined with Other Risk Scores for Predicting Outcomes in COVID-19. Radiology. 2021:210986.17.Little BP. Disease Severity Scoring for COVID-19: A Welcome (Semi)Quantitative Role for Chest Radiography. Radiology. 2021:212212.18.Prokop M, van Everdingen W, van Rees Vellinga T, Quarles van Ufford H, Stoger L, Beenen L, et al. CO-RADS: A Categorical CT Assessment Scheme for Patients Suspected of Having COVID-19-Definition and Evaluation. Radiology. 2020;296(2):E97-E104.19.Ozel M, Aslan A, Arac S. Use of the COVID-19 Reporting and Data System (CO-RADS) classification and chest computed tomography involvement score (CT-IS) in COVID-19 pneumonia. Radiol Med. 2021;126(5):679-87.20.Byrne D, Neill SBO, Muller NL, Muller CIS, Walsh JP, Jalal S, et al. RSNA Expert Consensus Statement on Reporting Chest CT Findings Related to COVID-19: Interobserver Agreement Between Chest Radiologists. Can Assoc Radiol J. 2021;72(1):159-66.21.Fonseca E, Loureiro BMC, Strabelli DG, Farias LPG, Garcia JVR, Gama VAA, et al. Evaluation of the RSNA and CORADS classifications for COVID-19 on chest computed tomography in the Brazilian population. Clinics (Sao Paulo). 2021;76:e2476.22.Barisione E, Grillo F, Ball L, Bianchi R, Grosso M, Morbini P, et al. Fibrotic progression and radiologic correlation in matched lung samples from COVID-19 post-mortems. Virchows Arch. 2021;478(3):471-85.23.Kianzad A, Meijboom LJ, Nossent EJ, Roos E, Schurink B, Bonta PI, et al. COVID-19: Histopathological correlates of imaging patterns on chest computed tomography. Respirology. 2021;26(9):869-77.24.Aesif SW, Bribriesco AC, Yadav R, Nugent SL, Zubkus D, Tan CD, et al. Pulmonary Pathology of COVID-19 Following 8 Weeks to 4 Months of Severe Disease: A Report of Three Cases, Including One With Bilateral Lung Transplantation. Am J Clin Pathol. 2021;155(4):506-14.25.De Cobelli F, Palumbo D, Ciceri F, Landoni G, Ruggeri A, Rovere-Querini P, et al. Pulmonary Vascular Thrombosis in COVID-19 Pneumonia. J Cardiothorac Vasc Anesth. 2021.26.Vlachou M, Drebes A, Candilio L, Weeraman D, Mir N, Murch N, et al. Pulmonary thrombosis in Covid-19: before, during and after hospital admission. J Thromb Thrombolysis. 2021;51(4):978-84.27.Caruso D, Guido G, Zerunian M, Polidori T, Lucertini E, Pucciarelli F, et al. Postacute Sequelae of COVID-19 Pneumonia: 6-month Chest CT Follow-up. Radiology. 2021:210834.28.Han X, Fan Y, Alwalid O, Li N, Jia X, Yuan M, et al. Six-month Follow-up Chest CT Findings after Severe COVID-19 Pneumonia. Radiology. 2021;299(1):E177-E86.29.Solomon JJ, Heyman B, Ko JP, Condos R, Lynch DA. CT of Post-Acute Lung Complications of COVID-19. Radiology. 2021:211396.30.Wells AU, Devaraj A, Desai SR. Interstitial Lung Disease after COVID-19 Infection: A Catalog of Uncertainties. Radiology. 2021;299(1):E216-E8.31.Han X, Fan Y, Alwalid O, Zhang X, Jia X, Zheng Y, et al. Fibrotic Interstitial Lung Abnormalities at 1-year Follow-up CT after Severe COVID-19. Radiology. 2021:210972.32.Lindahl A, Reijula J, Malmberg LP, Aro M, Vasankari T, Makela MJ. Small airway function in Finnish COVID-19 survivors. Respir Res. 2021;22(1):237.33.Small Airways Disease is a Post-Acute Sequelae of SARS-CoV-2 Infection [Internet]. 2021.34.Lopes AJ, Mafort TT, da Cal MS, Monnerat LB, Litrento PF, Ramos I, et al. Impulse Oscillometry Findings and Their Associations With Lung Ultrasound Signs in COVID-19 Survivors. Respir Care. 2021.35.Wells AU, Devaraj A. Residual Lung Disease at 6-month Follow-up CT after COVID-19: Clinical Significance Is a Key Issue. Radiology. 2021:211284.
REFERÊNCIAS1.Pontone G, Scafuri S, Mancini ME, Agalbato C, Guglielmo M, Baggiano A, et al. Role of computed tomography in COVID-19. J Cardiovasc Comput Tomogr. 2021;15(1):27-36.2.Cereser L, Da Re J, Zuiani C, Girometti R. Chest high-resolution computed tomography is associated to short-time progression to severe disease in patients with COVID-19 pneumonia. Clin Imaging. 2021;70:61-6.3.Hochhegger B, Mandelli NS, Stuker G, Meirelles GSP, Zanon M, Mohammed TL, et al. Coronavirus Disease 2019 (COVID-19) Pneumonia Presentations in Chest Computed Tomography: A Pictorial Review. Curr Probl Diagn Radiol. 2021;50(3):436-42.4.Besutti G, Ottone M, Fasano T, Pattacini P, Iotti V, Spaggiari L, et al. The value of computed tomography in assessing the risk of death in COVID-19 patients presenting to the emergency room. Eur Radiol. 2021.5.Mogami R, Lopes AJ, Araujo Filho RC, de Almeida FCS, Messeder A, Koifman ACB, et al. Chest computed tomography in COVID-19 pneumonia: a retrospective study of 155 patients at a university hospital in Rio de Janeiro, Brazil. Radiol Bras. 2021;54(1):1-8.6.Cau R, Falaschi Z, Pasche A, Danna P, Arioli R, Arru CD, et al. CT findings of COVID-19 pneumonia in ICU-patients. J Public Health Res. 2021.7.Kanne JP, Bai H, Bernheim A, Chung M, Haramati LB, Kallmes DF, et al. COVID-19 Imaging: What We Know Now and What Remains Unknown. Radiology. 2021;299(3):E262-E79.8.Pourhoseingholi MA, Jafari R, Jafari NJ, Rahimi-Bashar F, Nourbakhsh M, Vahedian-Azimi A, et al. Predicting 1-year post-COVID-19 mortality based on chest computed tomography scan. J Med Virol. 2021;93(10):5694-6.9.Kato S, Ishiwata Y, Aoki R, Iwasawa T, Hagiwara E, Ogura T, et al. Imaging of COVID-19: An update of current evidences. Diagn Interv Imaging. 2021;102(9):493-500.10.Ozer H, Kilincer A, Uysal E, Yormaz B, Cebeci H, Durmaz MS, et al. Diagnostic performance of Radiological Society of North America structured reporting language for chest computed tomography findings in patients with COVID-19. Jpn J Radiol. 2021;39(9):877-88.11.Ramanan RV, Joshi AR, Venkataramanan A, Nambi SP, Badhe R. Incidental chest computed tomography findings in asymptomatic Covid-19 patients. A multicentre Indian perspective. Indian J Radiol Imaging. 2021;31(Suppl 1):S45-S52.12.Axiaq A, Almohtadi A, Massias SA, Ngemoh D, Harky A. The role of computed tomography scan in the diagnosis of COVID-19 pneumonia. Curr Opin Pulm Med. 2021;27(3):163-8.13.Ishfaq A, Yousaf Farooq SM, Goraya A, Yousaf M, Gilani SA, Kiran A, et al. Role of High Resolution Computed Tomography chest in the diagnosis and evaluation of COVID -19 patients -A systematic review and meta-analysis. Eur J Radiol Open. 2021;8:100350.14.Razek A, Fouda N, Fahmy D, Tanatawy MS, Sultan A, Bilal M, et al. Computed tomography of the chest in patients with COVID-19: what do radiologists want to know? Pol J Radiol. 2021;86:e122-e35.15.Revel MP, Boussouar S, de Margerie-Mellon C, Saab I, Lapotre T, Mompoint D, et al. Study of Thoracic CT in COVID-19: The STOIC Project. Radiology. 2021;301(1):E361-E70.16.Au-Yong I, Higashi Y, Giannotti E, Fogarty A, Morling JR, Grainge M, et al. Chest Radiograph Scoring Alone or Combined with Other Risk Scores for Predicting Outcomes in COVID-19. Radiology. 2021:210986.17.Little BP. Disease Severity Scoring for COVID-19: A Welcome (Semi)Quantitative Role for Chest Radiography. Radiology. 2021:212212.18.Prokop M, van Everdingen W, van Rees Vellinga T, Quarles van Ufford H, Stoger L, Beenen L, et al. CO-RADS: A Categorical CT Assessment Scheme for Patients Suspected of Having COVID-19-Definition and Evaluation. Radiology. 2020;296(2):E97-E104.19.Ozel M, Aslan A, Arac S. Use of the COVID-19 Reporting and Data System (CO-RADS) classification and chest computed tomography involvement score (CT-IS) in COVID-19 pneumonia. Radiol Med. 2021;126(5):679-87.20.Byrne D, Neill SBO, Muller NL, Muller CIS, Walsh JP, Jalal S, et al. RSNA Expert Consensus Statement on Reporting Chest CT Findings Related to COVID-19: Interobserver Agreement Between Chest Radiologists. Can Assoc Radiol J. 2021;72(1):159-66.21.Fonseca E, Loureiro BMC, Strabelli DG, Farias LPG, Garcia JVR, Gama VAA, et al. Evaluation of the RSNA and CORADS classifications for COVID-19 on chest computed tomography in the Brazilian population. Clinics (Sao Paulo). 2021;76:e2476.22.Barisione E, Grillo F, Ball L, Bianchi R, Grosso M, Morbini P, et al. Fibrotic progression and radiologic correlation in matched lung samples from COVID-19 post-mortems. Virchows Arch. 2021;478(3):471-85.23.Kianzad A, Meijboom LJ, Nossent EJ, Roos E, Schurink B, Bonta PI, et al. COVID-19: Histopathological correlates of imaging patterns on chest computed tomography. Respirology. 2021;26(9):869-77.24.Aesif SW, Bribriesco AC, Yadav R, Nugent SL, Zubkus D, Tan CD, et al. Pulmonary Pathology of COVID-19 Following 8 Weeks to 4 Months of Severe Disease: A Report of Three Cases, Including One With Bilateral Lung Transplantation. Am J Clin Pathol. 2021;155(4):506-14.25.De Cobelli F, Palumbo D, Ciceri F, Landoni G, Ruggeri A, Rovere-Querini P, et al. Pulmonary Vascular Thrombosis in COVID-19 Pneumonia. J Cardiothorac Vasc Anesth. 2021.26.Vlachou M, Drebes A, Candilio L, Weeraman D, Mir N, Murch N, et al. Pulmonary thrombosis in Covid-19: before, during and after hospital admission. J Thromb Thrombolysis. 2021;51(4):978-84.27.Caruso D, Guido G, Zerunian M, Polidori T, Lucertini E, Pucciarelli F, et al. Postacute Sequelae of COVID-19 Pneumonia: 6-month Chest CT Follow-up. Radiology. 2021:210834.28.Han X, Fan Y, Alwalid O, Li N, Jia X, Yuan M, et al. Six-month Follow-up Chest CT Findings after Severe COVID-19 Pneumonia. Radiology. 2021;299(1):E177-E86.29.Solomon JJ, Heyman B, Ko JP, Condos R, Lynch DA. CT of Post-Acute Lung Complications of COVID-19. Radiology. 2021:211396.30.Wells AU, Devaraj A, Desai SR. Interstitial Lung Disease after COVID-19 Infection: A Catalog of Uncertainties. Radiology. 2021;299(1):E216-E8.31.Han X, Fan Y, Alwalid O, Zhang X, Jia X, Zheng Y, et al. Fibrotic Interstitial Lung Abnormalities at 1-year Follow-up CT after Severe COVID-19. Radiology. 2021:210972.32.Lindahl A, Reijula J, Malmberg LP, Aro M, Vasankari T, Makela MJ. Small airway function in Finnish COVID-19 survivors. Respir Res. 2021;22(1):237.33.Small Airways Disease is a Post-Acute Sequelae of SARS-CoV-2 Infection [Internet]. 2021.34.Lopes AJ, Mafort TT, da Cal MS, Monnerat LB, Litrento PF, Ramos I, et al. Impulse Oscillometry Findings and Their Associations With Lung Ultrasound Signs in COVID-19 Survivors. Respir Care. 2021.35.Wells AU, Devaraj A. Residual Lung Disease at 6-month Follow-up CT after COVID-19: Clinical Significance Is a Key Issue. Radiology. 2021:211284.
REFERÊNCIAS1.Pontone G, Scafuri S, Mancini ME, Agalbato C, Guglielmo M, Baggiano A, et al. Role of computed tomography in COVID-19. J Cardiovasc Comput Tomogr. 2021;15(1):27-36.2.Cereser L, Da Re J, Zuiani C, Girometti R. Chest high-resolution computed tomography is associated to short-time progression to severe disease in patients with COVID-19 pneumonia. Clin Imaging. 2021;70:61-6.3.Hochhegger B, Mandelli NS, Stuker G, Meirelles GSP, Zanon M, Mohammed TL, et al. Coronavirus Disease 2019 (COVID-19) Pneumonia Presentations in Chest Computed Tomography: A Pictorial Review. Curr Probl Diagn Radiol. 2021;50(3):436-42.4.Besutti G, Ottone M, Fasano T, Pattacini P, Iotti V, Spaggiari L, et al. The value of computed tomography in assessing the risk of death in COVID-19 patients presenting to the emergency room. Eur Radiol. 2021.5.Mogami R, Lopes AJ, Araujo Filho RC, de Almeida FCS, Messeder A, Koifman ACB, et al. Chest computed tomography in COVID-19 pneumonia: a retrospective study of 155 patients at a university hospital in Rio de Janeiro, Brazil. Radiol Bras. 2021;54(1):1-8.6.Cau R, Falaschi Z, Pasche A, Danna P, Arioli R, Arru CD, et al. CT findings of COVID-19 pneumonia in ICU-patients. J Public Health Res. 2021.7.Kanne JP, Bai H, Bernheim A, Chung M, Haramati LB, Kallmes DF, et al. COVID-19 Imaging: What We Know Now and What Remains Unknown. Radiology. 2021;299(3):E262-E79.8.Pourhoseingholi MA, Jafari R, Jafari NJ, Rahimi-Bashar F, Nourbakhsh M, Vahedian-Azimi A, et al. Predicting 1-year post-COVID-19 mortality based on chest computed tomography scan. J Med Virol. 2021;93(10):5694-6.9.Kato S, Ishiwata Y, Aoki R, Iwasawa T, Hagiwara E, Ogura T, et al. Imaging of COVID-19: An update of current evidences. Diagn Interv Imaging. 2021;102(9):493-500.10.Ozer H, Kilincer A, Uysal E, Yormaz B, Cebeci H, Durmaz MS, et al. Diagnostic performance of Radiological Society of North America structured reporting language for chest computed tomography findings in patients with COVID-19. Jpn J Radiol. 2021;39(9):877-88.11.Ramanan RV, Joshi AR, Venkataramanan A, Nambi SP, Badhe R. Incidental chest computed tomography findings in asymptomatic Covid-19 patients. A multicentre Indian perspective. Indian J Radiol Imaging. 2021;31(Suppl 1):S45-S52.12.Axiaq A, Almohtadi A, Massias SA, Ngemoh D, Harky A. The role of computed tomography scan in the diagnosis of COVID-19 pneumonia. Curr Opin Pulm Med. 2021;27(3):163-8.13.Ishfaq A, Yousaf Farooq SM, Goraya A, Yousaf M, Gilani SA, Kiran A, et al. Role of High Resolution Computed Tomography chest in the diagnosis and evaluation of COVID -19 patients -A systematic review and meta-analysis. Eur J Radiol Open. 2021;8:100350.14.Razek A, Fouda N, Fahmy D, Tanatawy MS, Sultan A, Bilal M, et al. Computed tomography of the chest in patients with COVID-19: what do radiologists want to know? Pol J Radiol. 2021;86:e122-e35.15.Revel MP, Boussouar S, de Margerie-Mellon C, Saab I, Lapotre T, Mompoint D, et al. Study of Thoracic CT in COVID-19: The STOIC Project. Radiology. 2021;301(1):E361-E70.16.Au-Yong I, Higashi Y, Giannotti E, Fogarty A, Morling JR, Grainge M, et al. Chest Radiograph Scoring Alone or Combined with Other Risk Scores for Predicting Outcomes in COVID-19. Radiology. 2021:210986.17.Little BP. Disease Severity Scoring for COVID-19: A Welcome (Semi)Quantitative Role for Chest Radiography. Radiology. 2021:212212.18.Prokop M, van Everdingen W, van Rees Vellinga T, Quarles van Ufford H, Stoger L, Beenen L, et al. CO-RADS: A Categorical CT Assessment Scheme for Patients Suspected of Having COVID-19-Definition and Evaluation. Radiology. 2020;296(2):E97-E104.19.Ozel M, Aslan A, Arac S. Use of the COVID-19 Reporting and Data System (CO-RADS) classification and chest computed tomography involvement score (CT-IS) in COVID-19 pneumonia. Radiol Med. 2021;126(5):679-87.20.Byrne D, Neill SBO, Muller NL, Muller CIS, Walsh JP, Jalal S, et al. RSNA Expert Consensus Statement on Reporting Chest CT Findings Related to COVID-19: Interobserver Agreement Between Chest Radiologists. Can Assoc Radiol J. 2021;72(1):159-66.21.Fonseca E, Loureiro BMC, Strabelli DG, Farias LPG, Garcia JVR, Gama VAA, et al. Evaluation of the RSNA and CORADS classifications for COVID-19 on chest computed tomography in the Brazilian population. Clinics (Sao Paulo). 2021;76:e2476.22.Barisione E, Grillo F, Ball L, Bianchi R, Grosso M, Morbini P, et al. Fibrotic progression and radiologic correlation in matched lung samples from COVID-19 post-mortems. Virchows Arch. 2021;478(3):471-85.23.Kianzad A, Meijboom LJ, Nossent EJ, Roos E, Schurink B, Bonta PI, et al. COVID-19: Histopathological correlates of imaging patterns on chest computed tomography. Respirology. 2021;26(9):869-77.24.Aesif SW, Bribriesco AC, Yadav R, Nugent SL, Zubkus D, Tan CD, et al. Pulmonary Pathology of COVID-19 Following 8 Weeks to 4 Months of Severe Disease: A Report of Three Cases, Including One With Bilateral Lung Transplantation. Am J Clin Pathol. 2021;155(4):506-14.25.De Cobelli F, Palumbo D, Ciceri F, Landoni G, Ruggeri A, Rovere-Querini P, et al. Pulmonary Vascular Thrombosis in COVID-19 Pneumonia. J Cardiothorac Vasc Anesth. 2021.26.Vlachou M, Drebes A, Candilio L, Weeraman D, Mir N, Murch N, et al. Pulmonary thrombosis in Covid-19: before, during and after hospital admission. J Thromb Thrombolysis. 2021;51(4):978-84.27.Caruso D, Guido G, Zerunian M, Polidori T, Lucertini E, Pucciarelli F, et al. Postacute Sequelae of COVID-19 Pneumonia: 6-month Chest CT Follow-up. Radiology. 2021:210834.28.Han X, Fan Y, Alwalid O, Li N, Jia X, Yuan M, et al. Six-month Follow-up Chest CT Findings after Severe COVID-19 Pneumonia. Radiology. 2021;299(1):E177-E86.29.Solomon JJ, Heyman B, Ko JP, Condos R, Lynch DA. CT of Post-Acute Lung Complications of COVID-19. Radiology. 2021:211396.30.Wells AU, Devaraj A, Desai SR. Interstitial Lung Disease after COVID-19 Infection: A Catalog of Uncertainties. Radiology. 2021;299(1):E216-E8.31.Han X, Fan Y, Alwalid O, Zhang X, Jia X, Zheng Y, et al. Fibrotic Interstitial Lung Abnormalities at 1-year Follow-up CT after Severe COVID-19. Radiology. 2021:210972.32.Lindahl A, Reijula J, Malmberg LP, Aro M, Vasankari T, Makela MJ. Small airway function in Finnish COVID-19 survivors. Respir Res. 2021;22(1):237.33.Small Airways Disease is a Post-Acute Sequelae of SARS-CoV-2 Infection [Internet]. 2021.34.Lopes AJ, Mafort TT, da Cal MS, Monnerat LB, Litrento PF, Ramos I, et al. Impulse Oscillometry Findings and Their Associations With Lung Ultrasound Signs in COVID-19 Survivors. Respir Care. 2021.35.Wells AU, Devaraj A. Residual Lung Disease at 6-month Follow-up CT after COVID-19: Clinical Significance Is a Key Issue. Radiology. 2021:211284.
REFERÊNCIAS1.Pontone G, Scafuri S, Mancini ME, Agalbato C, Guglielmo M, Baggiano A, et al. Role of computed tomography in COVID-19. J Cardiovasc Comput Tomogr. 2021;15(1):27-36.2.Cereser L, Da Re J, Zuiani C, Girometti R. Chest high-resolution computed tomography is associated to short-time progression to severe disease in patients with COVID-19 pneumonia. Clin Imaging. 2021;70:61-6.3.Hochhegger B, Mandelli NS, Stuker G, Meirelles GSP, Zanon M, Mohammed TL, et al. Coronavirus Disease 2019 (COVID-19) Pneumonia Presentations in Chest Computed Tomography: A Pictorial Review. Curr Probl Diagn Radiol. 2021;50(3):436-42.4.Besutti G, Ottone M, Fasano T, Pattacini P, Iotti V, Spaggiari L, et al. The value of computed tomography in assessing the risk of death in COVID-19 patients presenting to the emergency room. Eur Radiol. 2021.5.Mogami R, Lopes AJ, Araujo Filho RC, de Almeida FCS, Messeder A, Koifman ACB, et al. Chest computed tomography in COVID-19 pneumonia: a retrospective study of 155 patients at a university hospital in Rio de Janeiro, Brazil. Radiol Bras. 2021;54(1):1-8.6.Cau R, Falaschi Z, Pasche A, Danna P, Arioli R, Arru CD, et al. CT findings of COVID-19 pneumonia in ICU-patients. J Public Health Res. 2021.7.Kanne JP, Bai H, Bernheim A, Chung M, Haramati LB, Kallmes DF, et al. COVID-19 Imaging: What We Know Now and What Remains Unknown. Radiology. 2021;299(3):E262-E79.8.Pourhoseingholi MA, Jafari R, Jafari NJ, Rahimi-Bashar F, Nourbakhsh M, Vahedian-Azimi A, et al. Predicting 1-year post-COVID-19 mortality based on chest computed tomography scan. J Med Virol. 2021;93(10):5694-6.9.Kato S, Ishiwata Y, Aoki R, Iwasawa T, Hagiwara E, Ogura T, et al. Imaging of COVID-19: An update of current evidences. Diagn Interv Imaging. 2021;102(9):493-500.10.Ozer H, Kilincer A, Uysal E, Yormaz B, Cebeci H, Durmaz MS, et al. Diagnostic performance of Radiological Society of North America structured reporting language for chest computed tomography findings in patients with COVID-19. Jpn J Radiol. 2021;39(9):877-88.11.Ramanan RV, Joshi AR, Venkataramanan A, Nambi SP, Badhe R. Incidental chest computed tomography findings in asymptomatic Covid-19 patients. A multicentre Indian perspective. Indian J Radiol Imaging. 2021;31(Suppl 1):S45-S52.12.Axiaq A, Almohtadi A, Massias SA, Ngemoh D, Harky A. The role of computed tomography scan in the diagnosis of COVID-19 pneumonia. Curr Opin Pulm Med. 2021;27(3):163-8.13.Ishfaq A, Yousaf Farooq SM, Goraya A, Yousaf M, Gilani SA, Kiran A, et al. Role of High Resolution Computed Tomography chest in the diagnosis and evaluation of COVID -19 patients -A systematic review and meta-analysis. Eur J Radiol Open. 2021;8:100350.14.Razek A, Fouda N, Fahmy D, Tanatawy MS, Sultan A, Bilal M, et al. Computed tomography of the chest in patients with COVID-19: what do radiologists want to know? Pol J Radiol. 2021;86:e122-e35.15.Revel MP, Boussouar S, de Margerie-Mellon C, Saab I, Lapotre T, Mompoint D, et al. Study of Thoracic CT in COVID-19: The STOIC Project. Radiology. 2021;301(1):E361-E70.16.Au-Yong I, Higashi Y, Giannotti E, Fogarty A, Morling JR, Grainge M, et al. Chest Radiograph Scoring Alone or Combined with Other Risk Scores for Predicting Outcomes in COVID-19. Radiology. 2021:210986.17.Little BP. Disease Severity Scoring for COVID-19: A Welcome (Semi)Quantitative Role for Chest Radiography. Radiology. 2021:212212.18.Prokop M, van Everdingen W, van Rees Vellinga T, Quarles van Ufford H, Stoger L, Beenen L, et al. CO-RADS: A Categorical CT Assessment Scheme for Patients Suspected of Having COVID-19-Definition and Evaluation. Radiology. 2020;296(2):E97-E104.19.Ozel M, Aslan A, Arac S. Use of the COVID-19 Reporting and Data System (CO-RADS) classification and chest computed tomography involvement score (CT-IS) in COVID-19 pneumonia. Radiol Med. 2021;126(5):679-87.20.Byrne D, Neill SBO, Muller NL, Muller CIS, Walsh JP, Jalal S, et al. RSNA Expert Consensus Statement on Reporting Chest CT Findings Related to COVID-19: Interobserver Agreement Between Chest Radiologists. Can Assoc Radiol J. 2021;72(1):159-66.21.Fonseca E, Loureiro BMC, Strabelli DG, Farias LPG, Garcia JVR, Gama VAA, et al. Evaluation of the RSNA and CORADS classifications for COVID-19 on chest computed tomography in the Brazilian population. Clinics (Sao Paulo). 2021;76:e2476.22.Barisione E, Grillo F, Ball L, Bianchi R, Grosso M, Morbini P, et al. Fibrotic progression and radiologic correlation in matched lung samples from COVID-19 post-mortems. Virchows Arch. 2021;478(3):471-85.23.Kianzad A, Meijboom LJ, Nossent EJ, Roos E, Schurink B, Bonta PI, et al. COVID-19: Histopathological correlates of imaging patterns on chest computed tomography. Respirology. 2021;26(9):869-77.24.Aesif SW, Bribriesco AC, Yadav R, Nugent SL, Zubkus D, Tan CD, et al. Pulmonary Pathology of COVID-19 Following 8 Weeks to 4 Months of Severe Disease: A Report of Three Cases, Including One With Bilateral Lung Transplantation. Am J Clin Pathol. 2021;155(4):506-14.25.De Cobelli F, Palumbo D, Ciceri F, Landoni G, Ruggeri A, Rovere-Querini P, et al. Pulmonary Vascular Thrombosis in COVID-19 Pneumonia. J Cardiothorac Vasc Anesth. 2021.26.Vlachou M, Drebes A, Candilio L, Weeraman D, Mir N, Murch N, et al. Pulmonary thrombosis in Covid-19: before, during and after hospital admission. J Thromb Thrombolysis. 2021;51(4):978-84.27.Caruso D, Guido G, Zerunian M, Polidori T, Lucertini E, Pucciarelli F, et al. Postacute Sequelae of COVID-19 Pneumonia: 6-month Chest CT Follow-up. Radiology. 2021:210834.28.Han X, Fan Y, Alwalid O, Li N, Jia X, Yuan M, et al. Six-month Follow-up Chest CT Findings after Severe COVID-19 Pneumonia. Radiology. 2021;299(1):E177-E86.29.Solomon JJ, Heyman B, Ko JP, Condos R, Lynch DA. CT of Post-Acute Lung Complications of COVID-19. Radiology. 2021:211396.30.Wells AU, Devaraj A, Desai SR. Interstitial Lung Disease after COVID-19 Infection: A Catalog of Uncertainties. Radiology. 2021;299(1):E216-E8.31.Han X, Fan Y, Alwalid O, Zhang X, Jia X, Zheng Y, et al. Fibrotic Interstitial Lung Abnormalities at 1-year Follow-up CT after Severe COVID-19. Radiology. 2021:210972.32.Lindahl A, Reijula J, Malmberg LP, Aro M, Vasankari T, Makela MJ. Small airway function in Finnish COVID-19 survivors. Respir Res. 2021;22(1):237.33.Small Airways Disease is a Post-Acute Sequelae of SARS-CoV-2 Infection [Internet]. 2021.34.Lopes AJ, Mafort TT, da Cal MS, Monnerat LB, Litrento PF, Ramos I, et al. Impulse Oscillometry Findings and Their Associations With Lung Ultrasound Signs in COVID-19 Survivors. Respir Care. 2021.35.Wells AU, Devaraj A. Residual Lung Disease at 6-month Follow-up CT after COVID-19: Clinical Significance Is a Key Issue. Radiology. 2021:211284.
Contributor: Aaron Lessen, MD Educational Pearls: High flow nasal cannula (HFNC) has become more utilized with COVID pandemic Multiple studies have shown this method improves both oxygenation and ventilation Newer studies have shown the respiratory benefit of HFNC vs normal oxygen in patients suffering from CHF and those with do not intubate orders who are experiencing respiratory distress. Heated high flow is another option to provide ventilator and oxygen support to patients who either do not need or do not want to be intubated References Kang MG, Kim K, Ju S, et al. Clinical efficacy of high-flow oxygen therapy through nasal cannula in patients with acute heart failure . J Thorac Dis. 2019;11(2):410-417. doi:10.21037/jtd.2019.01.51 Peters SG, Holets SR, Gay PC. High-flow nasal cannula therapy in do-not-intubate patients with hypoxemic respiratory distress. Respir Care. 2013 Apr;58(4):597-600. doi: 10.4187/respcare.01887. PMID: 22781059. Sharma S, Danckers M, Sanghavi D, et al. High Flow Nasal Cannula. [Updated 2020 Jul 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK526071/ Summarized by Jackson Roos, MS4 | Edited by Erik Verzemnieks, MD The Emergency Medical Minute is excited to announce that we are now offering AMA PRA Category 1 credits™ via online course modules. To access these and for more information, visit our website at www.emergencymedicalminute.com/cme-courses/ and create an account.
From Essentials of Emergency Medicine NYC 2017, Reuben Strayer explains how the pulse ox might be the most useful bit of tech in the ED. Pearls: The pulse ox waveform is an excellent indicator of mechanical heart rate and peripheral perfusion. For patients breathing room air, pulse oximetry can be used to monitor for hypoventilation. Nail polish has minimal impact on the accuracy of pulse oximetry. If you are unable to get a good pulse ox waveform by adjusting or repositioning the probe, be concerned that the patient is poorly perfused. “The respiratory rate is the most vital of the vital signs.” Experienced doctors look at a patient who seems well, but understands that they’re not truly well, because they subconsciously notice tachypnea. Subconsciously is the only way to notice tachypnea, because respiratory rate is often not measured accurately. Since we don’t always have access to reliable respiratory rate, Strayer’s go-to vital sign is the oxygen saturation. “Reusable pulse oximeter probes are gross.” One study found that even when these probes are cleaned by standard procedure, ⅔ had bacteria cultured from them. Strayer recommends using single use probes in your department. Wilkins MC. Residual bacterial contamination on reusable pulse oximetrysensors. Respir Care. 1993 Nov;38(11):1155-60. PubMed PMID: 10145923. Data is conflicting about the effect of nail polish on pulse oximetry readings, but overall it is felt that the impact is minimal. Earlier data suggested that nail polish decreased sat readings by 2-10%, but more recent studies found minimal effect. If it seems that the waveform is affected by nail polish, you can remedy the situation by turning the probe 90 degrees, so it goes sideways through the finger. Yamamoto LG, et al. Nail polish does not significantly affect pulse oximetry measurements in mildly hypoxic subjects. Respir Care. 2008 Nov;53(11):1470-4. PubMed PMID: 18957149. As long as a patient is breathing room air, pulse ox can monitor ventilation and function as a hypoventilation alarm. Significantly hypercapnic patients saturate less than 95% when they’re breathing room air. So if you need to monitor a patient for hypoventilation, such as due to intoxication or procedural sedation, the pulse ox will do a great job of telling you if the patient is still breathing. If you need to give supplemental oxygen, then use capnography to monitor respirations. The pulse oximeter does so much more than provide oxygen saturation. It provides the photoplethysmogram (PPG) which is a waveform that tells you the “mechanical” heart rate. While telemetry gives the electrical heart rate, what really matters to your organs is the mechanical rate. This can be especially helpful during transvenous or transcutaneous pacing. When you have reliable tracing, the pulse ox heart rate is more reliable than the telemetry heart rate. The pulse ox can measure the peripheral perfusion index which is a more sensitive and earlier indicator of hypoperfusion than blood pressure. This is a numerical value which indicates the strength of the pulsations read by the pulse oximeter. It is based on the amplitude of the pulse ox waveform and expressed as a number between 1 (low) and 10 (high). The perfusion index dips before the stroke volume drops and long before the heart rate rises. Many monitors will report the perfusion index in tiny print after the word PERF. Lima AP, Beelen P, Bakker J. Use of a peripheral perfusion index derived from the pulse oximetry signal as a noninvasive indicator of perfusion. Crit Care Med.2002 Jun;30(6):1210-3. PubMed PMID: 12072670. van Genderen ME, et al. Peripheral perfusion index as an early predictor for central hypovolemia in awake healthy volunteers. Anesth Analg. 2013 Feb;116(2):351-6. PubMed PMID: 23302972. What if you don’t have a reliable pulse ox tracing? Most of the time this is because the probe is poorly positioned, the patient is moving too much, or there’s a lot of ambient light. If you’ve corrected for these problems and you still don’t have a good tracing, you should be concerned that the patient is poorly perfused. One study of 20,000 anesthesia cases showed that pulse ox failure was directly related to worsening physical status. Moller JT, et al. Randomized evaluation of pulse oximetry in 20,802 patients: I. Design, demography, pulse oximetry failure rate, and overall complication rate. Anesthesiology. 1993 Mar;78(3):436-44. PubMed PMID: 8457044. How does the pulse ox measure oxygen saturation and what is the best way to position the oximeter probe on the finger? One side of the pulse ox puts emits visible (red) light and infrared light. On the other side is the detector. The percent oxygen saturation is calculated based on the different way in which oxyhemoglobin absorbs visible and infrared light compared with deoxyhemoglobin. The pulse ox measures carboxyhemoglobin as if it were oxyhemoglobin, giving a falsely elevated pulse ox reading for a victim of carbon monoxide poisoning. The best spot for a peripheral pulse ox is a place with a lot of capillaries and arterioles, like the fingertips, earlobes, nose, or forehead. Functionally, it doesn’t seem to matter whether the emitter is on the dorsum, volar aspect, or even side of the finger. For convenience sake, most find it ergonomically superior to have the cord and emitter on the dorsum of the finger. Mannheimer PD. The light-tissue interaction of pulse oximetry. Anesth Analg.2007 Dec;105(6 Suppl):S10-7. Review. PubMed PMID: 18048891 Vegfors M, Lennmarken C. Carboxyhaemoglobinaemia and pulse oximetry. Br JAnaesth. 1991 May;66(5):625-6. PubMed PMID: 2031826 DeMeulenaere, Susan. "Pulse oximetry: uses and limitations." The Journal for Nurse Practitioners 3.5 (2007): 312-317. Link. Chan ED, et al. Pulse oximetry: understanding its basic principles facilitates appreciation of its limitations. Respir Med. 2013 Jun;107(6):789-99. PMID: 23490227
Kontakt: ivajuntan@gmail.com Musik: Blind Love Dub by Jeris (c) copyright 2017 Licensed under a Creative Commons Attribution (3.0) license. http://dig.ccmixter.org/files/VJ_Memes/55416 Ft: Kara Square (mindmapthat) Dagens huvudartikel: Frat JP, Coudroy R, Thille AW. Non-invasive ventilation or high-flow oxygen therapy: When to choose one over the other? Respirology. 2018. Och så lite annat matnyttigt som vi tar upp på temat: Frat JP, Thille AW, Mercat A, Girault C, Ragot S, Perbet S, et al. High-flow oxygen through nasal cannula in acute hypoxemic respiratory failure. N Engl J Med. 2015;372(23):2185-96. Patel BK, Wolfe KS, Pohlman AS, Hall JB, Kress JP. Effect of Noninvasive Ventilation Delivered by Helmet vs Face Mask on the Rate of Endotracheal Intubation in Patients With Acute Respiratory Distress Syndrome: A Randomized Clinical Trial. JAMA. 2016;315(22):2435-41. Sklar MC, Mohammed A, Orchanian-Cheff A, Del Sorbo L, Mehta S, Munshi L. The Impact of High-Flow Nasal Oxygen in the Immunocompromised Critically Ill: A Systematic Review and Meta-Analysis. Respir Care. 2018;63(12):1555-66. Azoulay E, Lemiale V, Mokart D, Nseir S, Argaud L, Pene F, et al. Effect of High-Flow Nasal Oxygen vs Standard Oxygen on 28-Day Mortality in Immunocompromised Patients With Acute Respiratory Failure: The HIGH Randomized Clinical Trial. JAMA. 2018;320(20):2099-107. Dugan KC, Hall JB, Patel BK. High-Flow Nasal Oxygen-The Pendulum Continues to Swing in the Assessment of Critical Care Technology. JAMA. 2018;320(20):2083-4. Xu Z, Li Y, Zhou J, Li X, Huang Y, Liu X, et al. High-flow nasal cannula in adults with acute respiratory failure and after extubation: a systematic review and meta-analysis. Respir Res. 2018;19(1):202. http://emcrit.org/pulmcrit/pulmcrit-does-the-high-trial-debunk-high-flow-nasal-cannula/
Brain death, you'd be surprised to know, has its roots in non-neurologic specialties. Specialties like pulmonary critical care, cardiology, and transplant surgery. How the term was conceived, why it was needed, and what it means in our current practice of medicine will be the focus of this week's BrainWaves episode. Featuring Drs. Joshua Levine and Mike Rubenstein. Produced by James E. Siegler. Music by Chris Zabriskie, Damiano Baldoni, Josh Woodward, and Julie Maxwell. BrainWaves' podcasts and online content are intended for medical education purposes only and should not be used for routine clinical decision making. Please refer to local and regional policies on how brain death is determined at your institution. REFERENCES Kacmarek RM. The mechanical ventilator: past, present, and future. Respir Care. 2011;56:1170-80. De Georgia MA. History of brain death as death: 1968 to the present. J Crit Care. 2014;29:673-8. West JB. The physiological challenges of the 1952 Copenhagen poliomyelitis epidemic and a renaissance in clinical respiratory physiology. J Appl Physiol (1985). 2005;99:424-32. A definition of irreversible coma. Report of the Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death. JAMA : the journal of the American Medical Association. 1968;205:337-40. Wijdicks EF, Varelas PN, Gronseth GS, Greer DM and American Academy of N. Evidence-based guideline update: determining brain death in adults: report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2010;74:1911-8.
Ep #17 A Primer on Intrathoracic Pressure Regulation & The Physiology of CPR with Dr. Keith Lurie Happy #EMSWeek #EMSStrong #EMSNation Sponsored by @PerfectCPR Apple Watch App with Audio and Haptic Feedback to Optimize Cardiac Arrest Training and Improve Quality of CPR PerfectCPR.com Dr. Keith Lurie is a practicing cardiac electrophysiologist and resuscitation scientist who, over the past 25 years, has devoted himself to study novel ways to resuscitate patients experiencing sudden cardiac arrest. Dr. Lurie earned his bachelors degree at Yale University and his medical degree at Stanford University. He studied cardiovascular medicine at the University of California in San Francisco and later joined the faculty there. He has been on the faculty at the University of Minnesota since 1991. As one of the leading innovators in the field, he has helped to develop new devices and methods that optimize cardio-pulmonary resuscitation (CPR) and, in turn, improve survival chances following cardiac arrest. In addition, he has become a respected thought leader in developing and implementing a systems-based approach to managing and treating sudden cardiac death events. Some of his most notable contributions include the development and assessment of various resuscitative techniques such as the impedance threshold device (ITD), active compression-decompression (ACD) CPR and the use of intra-thoracic pressure regulation to modulate cerebral and systemic circulation in states of severe hypotension and head injury. He has also helped to develop devices to treat heart failure and abnormal heart rhythms. He has mentored scores of research and clinical fellows over the past 30 years and he actively collaborates with multiple scientist colleagues worldwide. A professor of Emergency Medicine and Internal Medicine at the University of Minnesota, Dr. Lurie also directs an NIH-funded research laboratory at Hennepin County Medical Center in Minneapolis and he is a consultant for Zoll Medical. Selected Peer-Reviewed Publications (Selected from over 200 publications): Lurie KG, Nemergut EC, Yannopoulos D, Sweeney M. The physiology of cardiopulmonary resuscitation. Anesth Analg. 11/2015 Kwon Y, Debaty G, Puertas L, Metzger A, Rees J, McKnite S, Yannopoulos D, Lurie K. Effect of regulating airway pressure on intrathoracic pressure and vital organ perfusion pressure during cardiopulmonary resuscitation: A non-randomized interventional cross-over study. Scandinavian journal of trauma, resuscitation and emergency medicine. 2015;23:83 Debaty G, Metzger A, Lurie K. Evaluation of zoll medical's resqcpr system for cardiopulmonary resuscitation. Expert review of medical devices. 2015;12:505-516 Smith G, Dwork N, O'Connor D, Sikora U, Lurie K, Pauly J, Ellerbee A. Automated, depth resolved estimation of the attenuation coefficient from optical coherence tomography data. IEEE transactions on medical imaging. 2015 Lurie KL, Gurjarpadhye AA, Seibel EJ, Ellerbee AK. Rapid scanning catheterscope for expanded forward-view volumetric imaging with optical coherence tomography. Optics letters. 2015;40:3165-3168 Debaty G, Metzger A, Rees J, McKnite S, Puertas L, Yannopoulos D, Lurie K. Enhanced perfusion during advanced life support improves survival with favorable neurologic function in a porcine model of refractory cardiac arrest. Crit Care Med. 2015;43:1087-1095 Salzman JG, Frascone RJ, Burkhart N, Holcomb R, Wewerka SS, Swor RA, Mahoney BD, Wayne MA, Domeier RM, Olinger ML, Aufderheide TP, Lurie KG. The association of health status and providing consent to continued participation in an out-of-hospital cardiac arrest trial performed under exception from informed consent. Acad Emerg Med. 2015;22:347-353 Metzger A, Rees J, Kwon Y, Matsuura T, McKnite S, Lurie KG. Intrathoracic pressure regulation improves cerebral perfusion and cerebral blood flow in a porcine model of brain injury. Shock. 2015;44 Suppl 1:96-102 Debaty G, Shin SD, Metzger A, Kim T, Ryu HH, Rees J, McKnite S, Matsuura T, Lick M, Yannopoulos D, Lurie K. Tilting for perfusion: Head-up position during cardiopulmonary resuscitation improves brain flow in a porcine model of cardiac arrest. Resuscitation. 2015;87:38-43 Bartos JA, Matsuura TR, Sarraf M, Youngquist ST, McKnite SH, Rees JN, Sloper DT, Bates FS, Segal N, Debaty G, Lurie KG, Neumar RW, Metzger JM, Riess ML, Yannopoulos D. Bundled postconditioning therapies improve hemodynamics and neurologic recovery after 17 min of untreated cardiac arrest. Resuscitation. 2015;87:7-13 Gold B, Puertas L, Davis SP, et al. Awakening after cardiac arrest and post resuscitation hypothermia: are we pulling the plug too early? Resuscitation. Feb 2014;85(2):211-214. Metzger A, Rees J, Segal N, et al. "Fluidless" resuscitation with permissive hypotension via impedance threshold device therapy compared with normal saline resuscitation in a porcine model of severe hemorrhage. The journal of trauma and acute care surgery. Aug 2013;75(2 Suppl 2):S203-209. Frascone RJ, Wayne MA, Swor RA, et al. Treatment of non-traumatic out-of-hospital cardiac arrest with active compression decompression cardiopulmonary resuscitation plus an impedance threshold device. Sep 2013;84(9):1214-1222. Yannopoulos D, Segal N, Matsuura T, et al. Ischemic post-conditioning and vasodilator therapy during standard cardiopulmonary resuscitation to reduce cardiac and brain injury after prolonged untreated ventricular fibrillation. Aug 2013;84(8):1143-1149. Sarraf M, Sharma A, Caldwell E, McKnite S, Aufderheide T, Lurie K, Neumar R, Riess M, Yannopoulos D. Postconditioning with inhaled sevoflurane at the initiation of cpr improves hemodynamics and mitigates post-cardiac arrest myocardial injury after 15 min of untreated ventricular fibrillation. Crit Care Med. 2012;40:1-328 Yannopoulos D, Segal N, McKnite S, Aufderheide TP, Lurie KG. Controlled pauses at the initiation of sodium nitroprusside-enhanced cardiopulmonary resuscitation facilitate neurological and cardiac recovery after 15 mins of untreated ventricular fibrillation. Crit Care Med. 2012;40:1562-1569 Segal N, Matsuura T, Caldwell E, Sarraf M, McKnite S, Zviman M, Aufderheide TP, Halperin HR, Lurie KG, Yannopoulos D. Ischemic postconditioning at the initiation of cardiopulmonary resuscitation facilitates functional cardiac and cerebral recovery after prolonged untreated ventricular fibrillation. Resuscitation. 2012;83:1397-1403 Convertino VA, Parquette B, Zeihr J, Traynor K, Baia D, Baumblatt M, Vartanian L, Suresh M, Metzger A, Gerhardt RT, Lurie KG, Lindstrom D. Use of respiratory impedance in prehospital care of hypotensive patients associated with hemorrhage and trauma: A case series. The journal of trauma and acute care surgery. 2012;73:S54-59 Yannopoulos D, Matsuura T, Schultz J, et al. Sodium nitroprusside enhanced cardiopulmonary resuscitation improves survival with good neurological function in a porcine model of prolonged cardiac arrest. Crit Care Med. Jun 2011;39(6):1269-1274. Yannopoulos D, Kotsifas K, Lurie KG. Advances in cardiopulmonary resuscitation. Heart Fail Clin. Apr 2011;7(2):251-268, ix. Lurie KG, Coffeen P, Shultz J, McKnite S, Detloff B, Mulligan K. Improving active compression-decompression cardiopulmonary resuscitation with an inspiratory impedance valve. Circulation 1995;91(6):1629-32. Plaisance P, Lurie KG, Vicaut E, Adnet F, Petit JL, Epain D, Ecollan P, Gruat R, Cavagna P, Biens J and others. A comparison of standard cardiopulmonary resuscitation and active compression-decompression resuscitation for out-of-hospital cardiac arrest. French Active Compression-Decompression Cardiopulmonary Resuscitation Study Group. N Engl J Med 1999;341(8):569-75. Lurie KG, Voelckel WG, Zielinski T, McKnite S, Lindstrom P, Peterson C, Wenzel V, Lindner KH, Samniah N, Benditt D. Improving standard cardiopulmonary resuscitation with an inspiratory impedance threshold valve in a porcine model of cardiac arrest. Anesth Analg 2001;93(3):649-55. Lurie KG, Zielinski T, McKnite S, Aufderheide T, Voelckel W. Use of an inspiratory impedance valve improves neurologically intact survival in a porcine model of ventricular fibrillation. Circulation 2002;105(1):124-9. Aufderheide TA, Sigurdsson G, Pirrallo RG, Yannopoulos D, McKnite S, van Briesen C, Sparks C, Conrad CJ, Provo CA, Lurie KG. Hyperventilation-induced hypotension during CPR. 2004;109:1960-65. Aufderheide TP, Pirrallo RG, Provo TA, Lurie KG. Clinical evaluation of an inspiratory impedance threshold device during standard cardiopulmonary resuscitation in patients with out-of-hospital cardiac arrest. Critical Care Medicine. 2005, Apr;33(4):734-40. Pirrallo RG, Aufderheide TP, Provo TA, Lurie KG. Effect of an inspiratory impedance threshold device on hemodynamics during conventional manual cardiopulmonary resuscitation. 2005 Jul;66(1):13-20. Aufderheide T, Alexander C, Lick C, Myers B, Romig L, Vartanian L, Stothert J, S. M, Matsuura T, Yannopoulos D and others. From laboratory science to six emergency medical services systems: New understanding of the physiology of cardiopulmonary resuscitation increases survival rates after cardiac arrest. Crit Care Med 2008;36(Suppl):S397-S404. Lurie KG, Yannopoulos D, McKnite SH, Herman ML, Idris AH, Nadkarni VM, Tang W, Gabrielli A, Barnes TA, Metzger AK. Comparison of a 10-breaths-per-minute versus a 2-breaths-per-minute strategy during cardiopulmonary resuscitation in a porcine model of cardiac arrest. Respir Care 2008;53(7):862-70. Metzger A, Yannopoulos D, Lurie KG. Instrumental Management of CPR. Severe Acute Heart Failure Syndromes: A Practical Approach for Physicians. Mebazaa, A., Gheorghiade, M., Zannad, F., Parrillo, J.E. (eds.). Springer-Verlag, London Ltd. 2008, pp. 43-51. Metzger A, Lurie K. Harnessing Cardiopulmonary Interactions to Improve Circulation and Outcomes After Cardiac Arrest and Other States of Low Blood Pressure. In: Iaizzo PA, editor. Handbook of Cardiac Anatomy, Physiology, and Devices: Springer Science; 2009. p 583-604. Nichol G, Aufderheide TP, Eigel B, Neumar RW, Lurie KG, Bufalino VJ, Callaway CW, Menon V, Bass RR, Abella BS and others. Regional systems of care for out-of-hospital cardiac arrest: A policy statement from the American Heart Association. Circulation;121(5):709-29. Yannopoulos D, Matsuura T, McKnite S, Goodman N, Idris A, Tang W, Aufderheide TP, Lurie KG. No assisted ventilation cardiopulmonary resuscitation and 24-hour neurological outcomes in a porcine model of cardiac arrest. Crit Care Med;38(1):254-60. Query us on Twitter: www.twitter.com/EMS_Nation Like us on Facebook: www.facebook.com/prehospitalnation Wishing Everyone a safe tour! ~Faizan H. Arshad, MD @emscritcare www.emsnation.org
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