A novel capnogram analysis to guide ventilation during cardiopulmonary resuscitation: clinical and experimental observations.

Background: Cardiopulmonary resuscitation (CPR) decreases lung volume below the functional residual capacity and can generate intrathoracic airway closure. Conversely, large insufflations can induce thoracic distension and jeopardize circulation. The capnogram (CO signal) obtained during continuous chest compressions can reflect intrathoracic airway closure, and we hypothesized here that it can also indicate thoracic distension.

The other face of advanced paternal age: a scoping review of its terminological, social, public health, psychological, ethical and regulatory aspects.

Background: There is a global tendency for parents to conceive children later in life. The maternal dimension of the postponement transition has been thoroughly studied, but interest in the paternal side is more recent. For the moment, most literature reviews on the topic have focused on the consequences of advanced paternal age (APA) on fertility, pregnancy and the health of the child.

Gastric insufflation during cardiopulmonary resuscitation: A study in human cadavers.

Introduction: Bag-valve-mask ventilation is the first-line ventilation method during cardiopulmonary resuscitation (CPR). Risks include excessive volume delivery and gastric insufflation, the latter increasing the risk of pneumonia. The efficacy of ventilation can also be reduced by airway closure.

Intrathoracic Airway Closure Impacts CO Signal and Delivered Ventilation during Cardiopulmonary Resuscitation.

Rationale: End-tidal CO (EtCO) is used to monitor cardiopulmonary resuscitation (CPR), but it can be affected by intrathoracic airway closure. Chest compressions induce oscillations in expired CO, and this could reflect variable degrees of airway patency.

Objectives: To understand the impact of airway closure during CPR, and the relationship between the capnogram shape, airway closure, and delivered ventilation.

How Ventilation Is Delivered During Cardiopulmonary Resuscitation: An International Survey.

Background: Recommendations regarding ventilation during cardiopulmonary resuscitation (CPR) are based on a low level of scientific evidence. We hypothesized that practices about ventilation during CPR might be heterogeneous and may differ worldwide. To address this question, we surveyed physicians from several countries on their practices during CPR.

Aerosolized Vasodilators for the Treatment of Pulmonary Hypertension in Cardiac Surgical Patients: A Systematic Review and Meta-analysis.

Background: In cardiac surgery, pulmonary hypertension is an important prognostic factor for which several treatments have been suggested over time. In this systematic review and meta-analysis, we compared the efficacy of inhaled aerosolized vasodilators to intravenously administered agents and to placebo in the treatment of pulmonary hypertension during cardiac surgery. We searched MEDLINE, CENTRAL, EMBASE, Web of Science, and clinicaltrials.

Comparison of inhaled milrinone, nitric oxide and prostacyclin in acute respiratory distress syndrome.

Aim: To evaluate the safety and efficacy of inhaled milrinone in acute respiratory distress syndrome (ARDS).

Methods: Open-label prospective cross-over pilot study where fifteen adult patients with hypoxemic failure meeting standard ARDS criteria and monitored with a pulmonary artery catheter were recruited in an academic 24-bed medico-surgical intensive care unit. Random sequential administration of iNO (20 ppm) or nebulized epoprostenol (10 μg/mL) was done in all patients.

Nasal high-flow therapy for type II respiratory failure in COPD: A report of four cases.

Herein we present a report of four cases of severe type II respiratory failure that had contraindications both to conventional non-invasive ventilation and to endotracheal intubation. In all four cases, we successfully used a high-flow nasal oxygen device as a rescue device, with very reassuring outcomes.

Development of theory-based knowledge translation interventions to facilitate the implementation of evidence-based guidelines on the early management of adults with traumatic spinal cord injury.

Rationale: Optimal, early management following a spinal cord injury (SCI) can limit individuals' disabilities and costs related to their care. Several knowledge syntheses were recently published to guide health care professionals with regard to early interventions in SCI patients. However, no knowledge translation (KT) intervention, selected according to a behaviour change theory, has been proposed to facilitate the use of SCI guidelines in an acute care setting.

Effect of ventilatory variability on occurrence of central apneas.

Objective: To compare the influence of 2 ventilation strategies on the occurrence of central apneas.

Methods: This was a prospective, comparative, crossover study with 14 unsedated subjects undergoing weaning from mechanical ventilation in the medical ICU of Hôpital du Sacré-Cœur, Montréal, Québec, Canada. The subjects were ventilated alternately in neurally adjusted ventilatory assist (NAVA) and pressure support ventilation (PSV) modes.

Clinical review: Update on neurally adjusted ventilatory assist--report of a round-table conference.

Conventional mechanical ventilators rely on pneumatic pressure and flow sensors and controllers to detect breaths. New modes of mechanical ventilation have been developed to better match the assistance delivered by the ventilator to the patient's needs. Among these modes, neurally adjusted ventilatory assist (NAVA) delivers a pressure that is directly proportional to the integral of the electrical activity of the diaphragm recorded continuously through an esophageal probe.

Sleep quality in mechanically ventilated patients: comparison between NAVA and PSV modes.

Background: Mechanical ventilation seems to occupy a major source in alteration in the quality and quantity of sleep among patients in intensive care. Quality of sleep is negatively affected with frequent patient-ventilator asynchronies and more specifically with modes of ventilation. The quality of sleep among ventilated patients seems to be related in part to the alteration between the capacities of the ventilator to meet patient demand.

Preliminary evaluation of a new index to predict the outcome of a spontaneous breathing trial.

Background: The available predictors of spontaneous-breathing-trial (SBT) success/failure lack accuracy. We devised a new index, the CORE index (compliance, oxygenation, respiration, and effort).

Objective: To compare the CORE index to the CROP index (compliance, rate, oxygenation, and pressure), airway-occlusion pressure 0.

Diaphragmatic electromyography during cryoballoon ablation: a novel concept in the prevention of phrenic nerve palsy.

Background: Hemidiaphragmatic paralysis is the most frequent complication associated with cryoballoon ablation for atrial fibrillation. To date, no preventive strategy has proved effective.

Objective: We sought to assess the feasibility of diaphragmatic electromyography during cryoballoon ablation, explore the relationship between altered signals and phrenic nerve palsy, and define characteristic changes that herald hemidiaphragmatic paralysis.

Patient-ventilator interaction during pressure support ventilation and neurally adjusted ventilatory assist.

Objective: To compare the effect of pressure support ventilation and neurally adjusted ventilatory assist on breathing pattern, patient-ventilator synchrony, diaphragm unloading, and gas exchange. Increasing the level of pressure support ventilation can increase tidal volume, reduce respiratory rate, and lead to delayed ventilator triggering and cycling. Neurally adjusted ventilatory assist uses diaphragm electrical activity to control the timing and pressure of assist delivery and is expected to enhance patient-ventilator synchrony.