Continuous central venous saturation monitoring in critically ill patients

Table 1 (abstract P39). Patients\u2019 variables according to ScvO2 range ScvO2 75 Patients 15/37 36/37 36/37 SpO2 (%) 95.8 \ub1 3.0 95.0 \ub1 3.3 96.4 \ub1 2.3 HR (bpm) 90.6 \ub1 16.1 90.5 \ub1 18.1 90.7 \ub1 16.5 MAP (mmHg) 82.5 \ub1 10.6 83.4 \ub1 12.7 82.2 \ub1 11.7 CVP (mmHg) 18.3 \ub1 4.6 20.2 \ub1 8.2 19.2 \ub1 5.

The apparatus composition and architecture of Erismodus quadridactylus and the implications for element homology in prioniodinin conodonts

The apparatus composition and architecture of prioniodinin conodonts is poorly understood, largely because few prioniodinin taxa are represented by articulated oral feeding apparatuses (natural assemblages) in the fossil record, but also due to the highly variable gradational morphology of their constituent elements that makes apparatus reconstruction problematic. We describe here a natural assemblage of Erismodus quadridactylus (Stauffer), a prioniodinin, from the Sandbian (Late Ordovician) of North Dakota, USA. The assemblage demonstrates that the apparatus architecture of Erismodus is similar to those of late Palaeozoic prioniodinins namely, Kladognathus Rexroad and Hibbardella Bassler, but also has similarities with ozarkodinin apparatuses. In addition, there is evidence to suggest that E. quadridactylus shares topological similarities to balognathid architecture, with respect to the position of its inferred P elements. The apparatus composition and architecture presented here indicate that, at least with respect to the M–S array, an ‘ozarkodinin‐type’ bauplan is probably more widely representative across prioniodontids. The assemblage demonstrates that element morphotypes traditionally considered to lie within the S array are M elements, whereas others traditionally interpreted as P elements are found in the S array. These observations are used as a basis for refining concepts of element homology among prioniodinin conodonts and their closest relatives

Endotracheal tubes and fluid aspiration: An in vitro evaluation of new cuff technologies

© 2017 The Author(s). Background: Aspiration of subglottic secretions past the endotracheal tube (ETT) cuff is a prerequisite for developing ventilator-associated pneumonia (VAP). Subglottic secretion drainage (SSD) ETTs reduce aspiration of subglottic secretions and have demonstrated lower VAP rates. We compared the performance of seven SSD ETTs against a non-SSD ETT in preventing aspiration below inflated cuffs. Methods: ETTs were positioned vertically in 2 cm diameter cylinders. Four ml of a standard microbial suspension was added above inflated cuffs. After 1 h, aspiration was measured and ETTs demonstrating no leakage were subjected to rotational movement and evaluation over 24 h. Collected aspirated fluid was used to inoculate agar media and incubated aerobically at 37 °C for 24 h. The aspiration rate, volume and number of microorganisms that leaked past the cuff was measured. Experiments were repeated (×10) for each type of ETT, with new ETTs used for each repeat. Best performing ETTs were then tested in five different cylinder diameters (1.6, 1.8, 2.0, 2.2 and 2.4 cm). Experiments were repeated as above using sterile water. Volume and time taken for aspiration past the cuff was measured. Experiments were repeated (×10) for each type of ETT. Results were analysed using non-parametric tests for repeated measures. Results: The PneuX ETT prevented aspiration past the cuff in all experiments. All other ETTs allowed aspiration, with considerable variability in performance. The PneuX ETT was statistically superior in reducing aspiration compared to the SealGuard (p < 0.009), KimVent (p < 0.002), TaperGuard (p < 0.004), Lanz (p < 0.001), ISIS (p < 0.001), SACETT (p < 0.001) and Soft Seal (p < 0.001) ETTs. Of the 4 ETTs tested in differing cylinder sizes, the PneuX significantly reduced aspiration across the range of diameters compared to the SealGuard (p < 0.0001), TaperGuard (p < 0.0001) and KimVent (p < 0.0001) ETTs. Conclusions: ETTs showed substantial variation in fluid aspiration, relating to cuff material and design. Variability in performance was likely due to the random manner in which involutional folds form in the inflated ETT cuff. The PneuX ETT was the only ETT able to consistently prevent aspiration past the cuff in all experiments

Candida colonization of respiratory tract: to treat or not to treat, will we ever get an answer?

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Postoperative respiratory failure after major abdominal surgery: definition, diagnosis and prevention

Postoperative respiratory failure is one of the most important causes of morbidity, mortality and longer hospital stay in surgical patients, high incidence is comparable only with cardiac complications. However, no univocal and widely accepted definition is available throughout epidemiological studies. Different aspects are involved in the pathogenesis of postoperative respiratory complications, such as the kind of surgery, comorbidities, risk factors, and the population in study