Monitoring Astronauts’ Status through Non-Invasive Positive Pressure Ventilation

Many hospitalized patients with respiratory failure are treated with non-invasive positive pressure ventilation (NiPPV). In many cases non-invasive ventilation can be used to successfully treat patients and subsequently avoid endotracheal intubation. Recent literature and clinical practice have shown that in patients who are protecting their airway, and in whom the pH is not dangerously low, the use of non-invasive positive pressure ventilation can be effective (1). Additional studies argue that NiPPV in more severely ill patients (pH \u3c 7.2) with chronic obstructive pulmonary disease (COPD) is no worse than endotracheal intubation (2,3) with regard to mortality, lengths of stay and readmission rates. Furthermore, better outcome was confirmed for patients who succeeded NiPPV and avoided endotracheal intubation. Thus, the non-invasive mode of ventilation can assist patients in ventilating equally or more effectively, and in many cases can be used to avoid the more invasive endotracheal intubation. Many studies have evaluated treatment failures of NiPPV. Failure rates range from 30-80% depending on the cause of respiratory failure and underlying medical condition(s) of patient population (4). Other studies have looked at factors which predict NiPPV failure, such as physiologic scoring (age, severity of underlying illness) and presence of acute respiratory distress syndrome (ARDS) or community acquired pneumonia (CAP) (5). Having an objective and real time means of early identification of patients that will fail NiPPV would greatly benefit patients by helping physicians intervene early with endotracheal intubation when indicated

Low-Dose Naltrexone for Pruritus in Systemic Sclerosis

Pruritus is a common symptom in systemic sclerosis (SSc), an autoimmune disease which causes fibrosis and vasculopathy in skin, lung, and gastrointestinal tract (GIT). Unfortunately, pruritus has limited treatment options in this disease. Pilot trials of low-dose naltrexone hydrochloride (LDN) for pruritus, pain, and quality of life (QOL) in other GIT diseases have been successful. In this case series we report three patients that had significant improvement in pruritus and total GIT symptoms as measured by the 10-point faces scale and the University of California Los Angeles Scleroderma Clinical Trials Consortium Gastrointestinal Tract 2.0 (UCLA SCTC GIT 2.0) questionnaire. This small case series suggests LDN may be an effective, highly tolerable, and inexpensive treatment for pruritus and GIT symptoms in SSc

The Vascular Microenvironment and Systemic Sclerosis

The role of the vascular microenvironment in the pathogenesis Systemic Sclerosis (SSc) is appreciated clinically as Raynaud's syndrome with capillary nail bed change. This manifestation of vasculopathy is used diagnostically in both limited and diffuse cutaneous subsets of SSc, and is thought to precede fibrosis. The degree of subsequent fibrosis may also be determined by the vascular microenvironment. This paper describes why the vascular microenvironment might determine the degree of end-organ damage that occurs in SSc, with a focus on vascular cell senescence, endothelial progenitor cells (EPC) including multipotential mesenchymal stem cells (MSC), pericytes, and angiogenic monocytes. An explanation of the role of EPC, pericytes, and angiogenic monocytes is important to an understanding of SSc pathogenesis. An evolving understanding of the vascular microenvironment in SSc may allow directed treatment

Evaluation of a pulmonary graphical display in the medical intensive care unit: An observational study

AbstractWe developed a pulmonary graphic display that depicts pulmonary physiological variables for intubated, mechanically ventilated patients in a graphical format. The pulmonary graphical display presents multiple respiratory variables and changes are depicted by alterations in shape and color. Learning how this new technology will be integrated and accepted by users is an important step before it is introduced into the clinical arena. This study observed use and acceptance of the pulmonary graphical display by health care providers in an intensive care unit. Investigators noted that physicians, respiratory therapists, and nurses observed the pulmonary graphical display on average six, three, and one times, respectively, per patient room entry. Based on questionnaires, the pulmonary graphical display was perceived as useful, a desirable addition to current ICU monitors, and an accurate representation of respiratory variables

Effective Auditing System for Respiratory Therapist Driven Protocols

Therapist driven protocols have become commonplace in many hospitals. At University of Utah Health we implemented protocol driven care in April 2008 and we have demonstrated improved patient outcomes through their use.2 In order to maintain our gains we developed, and have since refined, an audit process. The new audit process provides more timely, consistent, and detailed feedback to RTs. This has resulted in a decrease in protocol misallocation