Annals of palliative medicine
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Randomized Controlled Trial
Effects of different positive end-expiratory pressure titrating strategies on oxygenation and respiratory mechanics during one- lung ventilation: a randomized controlled trial.
Positive end-expiratory pressure (PEEP) is widely used to reduce the risk of hypoxemia and atelectasis during one-lung ventilation (OLV); however, the optimal strategy for PEEP titrating remains unclear.The purpose of the study was to investigate the effects of different PEEP titrating strategies on oxygenation and respiratory mechanics during OLV. ⋯ The PEEP titrating strategy according to dynamic compliance can improve respiratory mechanics, whereas it has no significant effects on oxygenation, dead space ratio, and intrapulmonary shunt, suggesting that it is better during OLV for thoracic surgery.
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Observational Study
Lung aeration and ventilation after general anesthesia in left lateral position: a prospective observational study using electrical impedance tomography.
Endoscopic submucosal dissection (ESD) under general anesthesia in left lateral position may lead to transient impairment of pulmonary function. We used electrical impedance tomography (EIT), an increasingly implied non-invasive instrument for bedside real-time monitoring regional changes in ventilation, to assess the changes of regional lung aeration and ventilation in patients undergoing ESD. ⋯ In patients with left lateral position undergoing ESD, left lung was characterized by decreased ventilation and more inhomogeneity while right lung was opposite after intubation. ESD procedure with carbon dioxide insufflation did not lead to significant changes in either regional ventilation or homogeneity. And the change of lung inhomogeneity during ESD procedure is transient.
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During veno-venous extracorporeal membrane oxygenation (VV-ECMO), systemic anticoagulation is required to prevent thrombotic complications within the circuit and oxygenator. The unfractionated heparin (UFH) is commonly administered as a standard anticoagulant, but in our institute recombinant human thrombomodulin (rhTM), instead of UFH, is used as an anticoagulant for VV-ECMO. In the present study, we reviewed whether rhTM could be applied effectively and safely as an anticoagulant agent during VV-ECMO. ⋯ In this retrospective study, we analyzed 15 patients with severe respiratory failure who were administered rhTM as an anticoagulant during VV-ECMO and found that anticoagulation therapy with rhTM is maybe a feasible option which allows for effective and safe VV-ECMO.
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Randomized Controlled Trial
Remifentanil injected during analepsia shortens length of postanesthesia care unit stay in patients undergoing laparoscopic surgery for endometrial cancer: a randomized controlled trial.
To guarantee efficient operating room (OR) activity, tracheal extubation is often performed in the postanesthesia care unit (PACU). Therefore, the ability of PACU to accommodate postoperative patients is crucial. Optimizing extubation management may speed up the turnover of PACU beds. The aim of the present study was to investigate the effect of remifentanil, which is used during analepsia, on the length of PACU stay in patients undergoing laparoscopic surgery for endometrial cancer. ⋯ Remifentanil, which is injected during analepsia, significantly shortens the duration of PACU stay without increasing adverse events in the peri-extubation period.
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Meta Analysis
Risk predictive models for delirium in the intensive care unit: a systematic review and meta-analysis.
An emerging approach to prevent delirium in an intensive care unit is the use of risk prediction models. At present, there is no scientific comparison of the predictive effect of the prediction model. This systematic review and meta-analysis aimed to compare the performance of available delirium risk prediction models for intensive care units. ⋯ The E-PRE-DELIRIC model, PRE-DELIRIC model, or both are recommended to predict ICU delirium risk. However, the recommendation should be considered with caution because of substantial heterogeneity. The protocol was registered with PROSPERO (CRD42019130802).