Abdominal functional electrical stimulation to assist ventilator weaning in critical illness: a double-blinded, randomised, sham-controlled pilot study

BACKGROUND: For every day a person is dependent on mechanical ventilation, respiratory and cardiac complications increase, quality of life decreases and costs increase by > $USD 1500. Interventions that improve respiratory muscle function during mechanical ventilation can reduce ventilation duration. The aim of this pilot study was to assess the feasibility of employing an abdominal functional electrical stimulation (abdominal FES) training program with critically ill mechanically ventilated patients. We also investigated the effect of abdominal FES on respiratory muscle atrophy, mechanical ventilation duration and intensive care unit (ICU) length of stay. METHODS: Twenty critically ill mechanically ventilated participants were recruited over a 6-month period from one metropolitan teaching hospital. They were randomly assigned to receive active or sham (control) abdominal FES for 30 min, twice per day, 5 days per week, until ICU discharge. Feasibility was assessed through participant compliance to stimulation sessions. Abdominal and diaphragm muscle thickness were measured using ultrasound 3 times in the first week, and weekly thereafter by a blinded assessor. Respiratory function was recorded when the participant could first breathe independently and at ICU discharge, with ventilation duration and ICU length of stay also recorded at ICU discharge by a blinded assessor. RESULTS: Fourteen of 20 participants survived to ICU discharge (8, intervention; 6, control). One control was transferred before extubation, while one withdrew consent and one was withdrawn for staff safety after extubation. Median compliance to stimulation sessions was 92.1% (IQR 5.77%) in the intervention group, and 97.2% (IQR 7.40%) in the control group (p = 0.384). While this pilot study is not adequately powered to make an accurate statistical conclusion, there appeared to be no between-group thickness changes of the rectus abdominis (p = 0.099 at day 3), diaphragm (p = 0.652 at day 3) or combined lateral abdominal muscles (p = 0.074 at day 3). However, ICU length of stay (p = 0.011) and ventilation duration (p = 0.039) appeared to be shorter in the intervention compared to the control group. CONCLUSIONS: Our compliance rates demonstrate the feasibility of using abdominal FES with critically ill mechanically ventilated patients. While abdominal FES did not lead to differences in abdominal muscle or diaphragm thickness, it may be an effective method to reduce ventilation duration and ICU length of stay in this patient group. A fully powered study into this effect is warranted. TRIAL REGISTRATION: The Australian New Zealand Clinical Trials Registry, ACTRN12617001180303. Registered 9 August 2017

Attentional Performance in Children and Adolescents with Tic Disorder and Co-Occurring Attention-Deficit/Hyperactivity Disorder: New Insights from a 2 × 2 Factorial Design Study

The aim of the present study was to investigate the effect of both tic disorder (TD) and attention-deficit/hyperactivity disorder (ADHD) on attentional functions. N = 96 children and adolescents participated in the study, including n = 21 subjects with TD, n = 23 subjects with ADHD, n = 25 subjects with TD+ADHD, and n = 27 controls. Attentional performance was tested based on four computerized attention tasks (sustained attention, divided attention, go/nogo and set shifting). The effect of TD as well as ADHD on attentional performance was tested using a 2 × 2 factorial approach. A diagnosis of TD had no negative impact on attentional functions but was associated with improved performance in the set shifting task. By contrast, regardless of a diagnosis of TD, subjects with ADHD were found to perform worse in the sustained attention, divided attention and go/nogo task. No interaction effect between the factors TD and ADHD was revealed for any of the attention measures. Our results add to findings from other areas of research, showing that in subjects with TD and ADHD, ADHD psychopathology is often the main source of impairment, whereas a diagnosis of TD has little or no impact on neuropsychological performance in most cases and even seems to be associated with adaptive mechanisms

DETERMINATION OF IBUPROFEN IN HUMAN-PLASMA BY SOLID-PHASE EXTRACTION AND REVERSED-PHASE HIGH-PERFORMANCE LIQUID-CHROMATOGRAPHY

A new, sensitive and simple method for the rapid quantitative determination of ibuprofen in human plasma has been developed. This method involves the use of a solid phase extraction on “Baker” C-18 disposable extraction columns for sample clean-up and uses mefenamic acid as an internal standard.Separation and quantitation are performed by reversed-phase liquid chromatography using a Nucleosil C18 column and methanol−0.04 M phosphoric acid (80:20, v/v), as the mobile phase.Detection was achieved by UV-absorbance measurements at 229 nm

LACK OF INFLUENCE OF CO-TRIMOXAZOLE ON THEOPHYLLINE PHARMACOKINETICS

In an open cross-over experiment, the influence of the antimicrobial agent co-trimoxazole on the single-dose pharmacokinetics of theophylline was studied in six healthy adults by comparing the pharmacokinetic parameters found after intravenous administration of theophylline without and with co-medication of co-trimoxazole for the previous 8 d. Theophylline concentrations in plasma were measured by high-performance liquid chromatography (HPLC) analysis. During each treatment, a concentration-time curve was evaluated. No influence of co-trimoxazole on the rate of elimination and volume of distribution of theophylline could be found, as a result of which theophylline concentrations in plasma were not significantly different in both periods of drug administration. A similar lack of influence of co-trimoxazole may apply to the steady-state pharmacokinetics of theophylline. The present study suggests that both drugs can be given concomitantly without the need for dosage adjustment of theophylline