Respiratory care
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Extended periods of hypocarbia in preterm infants may be associated with intraventricular hemorrhage, periventricular leukomalacia, and bronchopulmonary dysplasia. To evaluate the current anesthetic practice in preterm neonates, we retrospectively reviewed the intraoperative course with regard to [Formula: see text] and ventilation during non-cardiac surgical procedures in infants <60 weeks postmenstrual age. ⋯ The incidence of at least one arterial blood gas that demonstrated inadvertent hyperventilation in neonates was high during intraoperative care. These data may provide the baseline for future studies that address more rigorous monitoring and control of [Formula: see text] during intraoperative care. Although the duration of the anesthetic care and surgical procedure is brief compared with the neonatal ICU length of stay because there is no demonstrated benefit of hypocapnia and, in fact, well-documented harm associated with hyperventilation in neonates, care should be directed at limiting inadvertent hyperventilation. (ClinicalTrials.gov registration NCT03823716.).
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Poor oral health has long been recognized as a clinical risk factor for developing lung infections. Recent data using culture-independent techniques assessing the microbiome in healthy subjects have demonstrated that chronic microaspiration establishes a very similar microbial community between the mouth and lung, suggesting these 2 anatomic regions are closely intertwined. ⋯ This review describes common dental conditions and potential mechanisms by which poor oral health may contribute to lung disease. We also review the current literature drawing associations between poor oral health and lung disease.
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The COVID-19 pandemic is creating ventilator shortages in many countries that is sparking a conversation about placing multiple patients on a single ventilator. However, on March 26, 2020, six leading medical organizations released a joint statement warning clinicians that attempting this technique could lead to poor outcomes and high mortality. Nevertheless, hospitals around the United States and abroad are considering this technique out of desperation (eg, New York), but there is little data to guide their approach. The overall objective of this study is to utilize a computational model of mechanically ventilated lungs to assess how patient-specific lung mechanics and ventilator settings impact lung tidal volume (VT). ⋯ Assigning patients to preset ventilators based on their required level of support on the lower PEEP/higher [Formula: see text] scale of the National Institute of Health's National Heart, Lung, and Blood Institute ARDS Clinical Network (ARDSNet), secondary to lung mechanics, could be used to overcome some of the legitimate concerns of placing multiple patients on a single ventilator. We emphasize that our results are currently based on a computational model that has not been validated against any preclinical or clinical data. Therefore, clinicians considering this approach should not look to our study as an exact estimate of predicted patient VT values.