Mechanical ventilation and long-term neurocognitive impairment after acute respiratory distress syndrome

We read with great attention and interest the paper by Sasannejad et al. on long-term cognitive impairment after acute respiratory distress syndrome (ARDS) [1]. In this comprehensive review, the authors report data that widely range from epidemiology and pathophysiology to possible therapies, from hypoxemia and delirium to mechanical ventilation (MV)

Perioperative neurocognitive disorder. Comment

We read with great interest the review article by Eckenhoff et al. on the different approaches used in preclinical perioperative neurocognitive disorder research.1 In this review, the authors provided data on the various preclinical models used in scientific literature to study perioperative neurocognitive disorder that include molecular, cell culture, brain slices, and animal models. Surprisingly, the possible role of mechanical ventilation as cause of perioperative neurocognitive disorder is not mentioned

Mechanical ventilation and neurocritical patients. Is there a role for anti-neuroinflammatory therapies?

We read with great attention and interest the review by Robba and colleagues on mechanical ventilation (MV) in patients with acute ischemic stroke [1]. The authors examined the pathophysiology of stroke and the risk for pulmonary complications (brain-lung “dangerous” crosstalk, immunological response after stroke, stroke-associated pneumonia, and dysphagia) then concluding with useful recommendations on optimal ventilator settings and therapeutic strategies

Harmful effects of mechanical ventilation on neurocognitive functions

Whether mechanical ventilation (MV) induces neurotoxicity that can trigger or accelerate chronic cognitive disorders is controversial [1, 2]. The relationship between MV and neurocognitive impairment—that persisted at hospital discharge and at 1-year follow up—was first reported in 1999 in MV-treated ARDS patients [3]. Since then, several preclinical and clinical studies have investigated the mechanisms, localization, and timing of brain damage induced by MVand possible preventive/therapeutic strategies

Lidocaine pretreatment for the prevention of propofol-induced transient motor disturbances in children during anesthesia induction: a randomized controlled trial in children undergoing invasive hematologic procedures.

Background: We examined the effect of lidocaine pretreatment before propofol administration on the incidence of transient motor disturbances and on propofol requirements for anesthesia induction in infants and children undergoing repeated painful diagnostic and therapeutic hematological procedures. Methods: A series of 358 children subgrouped according to the presence of a peripheral-vein or central venous catheter were randomly assigned to receive an intravenous dose of 2% lidocaine (2.0 mgÆkg)1) or an equivalent volume of saline, 1 min before propofol (1.5–3.5 mgÆkg)1) injected for anesthesia induction. Results: The incidence of spontaneous movements was significantly lower in patients pretreated with lidocaine than in those receiving placebo (2.5% vs 29%; P 0.001, by chi-square test), as was the propofol induction dose (1.6 ± 0.2 mgÆkg)1 vs (2.2 ± 0.3 mgÆkg)1; (P 0.001) and pain at the injection site in patients peripheral-vein catheter (12% vs. 54%; P 0.001). Lidocaine administration also improved children’s acceptance as reported by parents on the Observational Scale of Behavioral Distress administered 2 h after the procedure (6.5 ± 2.5 vs. 9.4 ± 3.3; P 0.001). Bouts of coughing developed significantly more frequently after lidocaine pretreatment than after placebo (62.5% vs. 17.5%; P 0.001). Conclusions: Because lidocaine pretreatment before the induction of propofol-based anesthesia decreases propofol-induced motor disturbances, lowers hypnotic requirements and reduces pain at the injection site, without inducing untoward events, thus improving children’s and parental acceptance, it should become standard practice in infants and children undergoing repeated painful diagnostic and therapeutic hematological procedures

Impact and Implementation of Simulation-Based Training for Safety

Patient safety is an issue of imminent concern in the high-risk field of medicine, and systematic changes that alter the way medical professionals approach patient care are needed. Simulation-based training (SBT) is an exemplary solution for addressing the dynamic medical environment of today. Grounded in methodologies developed by the aviation industry, SBT exceeds traditional didactic and apprenticeship models in terms of speed of learning, amount of information retained, and capability for deliberate practice. SBT remains an option in many medical schools and continuing medical education curriculums (CMEs), though its use in training has been shown to improve clinical practice. Future simulation-based anesthesiology training research needs to develop methods for measuring both the degree to which training translates into increased practitioner competency and the effect of training on safety improvements for patients

Wearable High Voltage Compliant Current Stimulator for Restoring Sensory Feedback

Transcutaneous Electrical Nerve Stimulation (TENS) is a promising technique for eliciting referred tactile sensations in patients with limb amputation. Although several studies show the validity of this technique, its application in daily life and away from laboratories is limited by the need for more portable instrumentation that guarantees the necessary voltage and current requirements for proper sensory stimulation. This study proposes a low-cost, wearable high-voltage compliant current stimulator with four independent channels based on Components-Off-The-Shelf (COTS). This microcontroller-based system implements a voltage-current converter controllable through a digital-to-analog converter that delivers up to 25 mA to load up to 3.6 kΩ. The high-voltage compliance enables the system to adapt to variations in electrode-skin impedance, allowing it to stimulate loads over 10 kΩ with currents of 5 mA. The system was realized on a four-layer PCB (115.9 mm × 61 mm, 52 g). The functionality of the device was tested on resistive loads and on an equivalent skin-like RC circuit. Moreover, the possibility of implementing an amplitude modulation was demonstrated

Mid-sagittal plane detection for advanced physiological measurements in brain scans

Objective: The process of diagnosing many neurodegenerative diseases, such as Parkinson's and progressive supranuclear palsy, involves the study of brain magnetic resonance imaging (MRI) scans in order to identify and locate morphological markers that can highlight the health status of the subject. A fundamental step in the pre-processing and analysis of MRI scans is the identification of the mid-sagittal plane, which corresponds to the mid-brain and allows a coordinate reference system for the whole MRI scan set. Approach: To improve the identification of the mid-sagittal plane we have developed an algorithm in Matlab® based on the k-means clustering function. The results have been compared with the evaluation of four experts who manually identified the mid-sagittal plane and whose performances have been combined with a cognitive decisional algorithm in order to define a gold standard. Main results: The comparison provided a mean percentage error of 1.84%. To further refine the automatic procedure we trained a machine learning system using the results from the proposed algorithm and the gold standard. We tested this machine learning system and obtained results comparable to medical raters with a mean absolute error of 1.86 slices. Significance: The system is promising and could be directly incorporated into broader diagnostic support systems