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Selected AbstractsReview of non-invasive ventilation in the emergency department: clinical considerations and management prioritiesJOURNAL OF CLINICAL NURSING, Issue 23 2009Louise Rose Aims and objectives., We aimed to synthesise evidence from published literature on non-invasive ventilation to inform nurses involved in the clinical management of non-invasive ventilation in the emergency department. Background., Non-invasive ventilation is a form of ventilatory support that does not require endotracheal intubation and is used in the early management of acute respiratory failure in emergency departments. Safe delivery of this intervention requires a skilled team, educated and experienced in appropriate patient selection, available devices and monitoring priorities. Design., Systematic review. Method., A multi-database search was performed to identify works published in the English language between 1998,2008. Search terms included: non-invasive ventilation, continuous positive airway pressure and emergency department. Inclusion and exclusion criteria for the review were identified and systematically applied. Results., Terminology used to describe aspects of non-invasive ventilation is ambiguous. Two international guidelines inform the delivery of this intervention, however, much research has been undertaken since these publications. Strong evidence exists for non-invasive ventilation for patients with acute exacerbation of congestive heart failure and chronic obstructive pulmonary disease. Non-invasive ventilation may be delivered with various interfaces and modes; little evidence is available for the superiority of individual interfaces or modes. Conclusions., Early use of non-invasive ventilation for the management of acute respiratory failure may reduce mortality and morbidity. Though international guidelines exist, specific recommendations to guide the selection of modes, settings or interfaces for various aetiologies are lacking due to the absence of empirical evidence. Relevance to clinical practice., Monitoring of non-invasive ventilation should focus on assessment of response to treatment, respiratory and haemodynamic stability, patient comfort and presence of air leaks. Complications are related to mask-fit and high air flows; serious complications are few and occur infrequently. The use of non-invasive ventilation has resource implications that must be considered to provide effective and safe management in the emergency department. [source] In Vivo Preclinical Anticoagulation Regimens After Implantation of Ventricular Assist DevicesARTIFICIAL ORGANS, Issue 7 2009Diyar Saeed Abstract Ventricular assist devices (VADs) have demonstrated successfully their ability to treat failing circulation of patients with end-stage heart failure. Among the main obstacles with these VADs is thromboembolic events that increase device-related morbidity and mortality. Prior to the clinical application of any newly developed VAD, the feasibility of the device is tested on animal models. Animal species have different hemostatic properties than human patients, and this factor creates a margin of error when comparing the occurrence of VAD-induced thrombosis in an animal versus a human. This detailed literature review provides a thorough documentation of various preclinical anticoagulation protocols used to date, including their outcomes and recommendations for future anticoagulation management strategies. In summary, the outcomes favor a sheep or pig model over other animal models, and discourage the application of a single anticoagulative agent to improve outcomes with any of the currently available devices. [source] Development of a large-scale biocalorimeter to monitor and control bioprocessesBIOTECHNOLOGY & BIOENGINEERING, Issue 2 2002D. Voisard Abstract Calorimetry has shown real potential at bench-scale for chemical and biochemical processes. The aim of this work was therefore to scale-up the system by adaptation of a standard commercially available 300-L pilot-scale bioreactor. To achieve this, all heat flows entering or leaving the bioreactor were identified and the necessary instrumentation implemented to enable on-line monitoring and dynamic heat balance estimation. Providing that the signals are sufficiently precise, such a heat balance would enable calculation of the heat released or taken up during an operational (bio)process. Two electrical Wattmeters were developed, the first for determination of the power consumption by the stirrer motor and the second for determination of the power released by an internal calibration heater. Experiments were designed to optimize the temperature controller of the bioreactor such that it was sufficiently rapid so as to enable the heat accumulation terms to be neglected. Further calibration experiments were designed to correlate the measured stirring power to frictional heat losses of the stirrer into the reaction mass. This allows the quantitative measurement of all background heat flows and the on-line quantitative calculation of the (bio)process power. Three test fermentations were then performed with B. sphaericus 1593M, a spore-forming bacterium pathogenic to mosquitoes. A first batch culture was performed on a complex medium, to enable optimization of the calorimeter system. A second batch culture, on defined medium containing three carbon sources, was used to show the fast, accurate response of the heat signal and the ability to perfectly monitor the different growth phases associated with growth on mixed substrates, in particular when carbon sources became depleted. A maximum heat output of 1100 W was measured at the end of the log-phase. A fed-batch culture on the same defined medium was then carried out with the feed rate controlled as a function of the calorimeter signal. A maximum heat output of 2250 W was measured at the end of the first log-phase. This work demonstrates that real-time quantitative calorimetry is not only possible at pilot-scale, but could be readily applied at even larger scales. The technique requires simple, readily available devices for determination of the few necessary heat flows, making it a robust, cost-effective technique for process development and routine monitoring and control of production processes. © 2002 Wiley Periodicals, Inc. Biotechnol Bioeng 80: 125,138, 2002 [source] Buddy balloon to deliver a percutaneous aortic valve device: A percutaneous shoehorn?,CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 5 2009Imad Sheiban MD Abstract Percutaneous aortic valve replacement is performed with increasing frequency in patients with severe aortic stenosis at prohibitive surgical risk. Currently available devices are however in their early development stage, and are thus quite bulky with a large profile, with ensuing difficulties in delivery of the device through a stenotic aortic valve. We report hereby a case in which we employed a buddy wire and balloon technique as a "shoehorn" to enable accurate delivery of a balloon-expandable aortic valve prosthesis from the transfemoral route. © 2009 Wiley-Liss, Inc. [source] | ||||||||||