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Kaweesak Chittawatanarat - One of the best experts on this subject based on the ideXlab platform.
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Spontaneous Breathing Trial with Low Pressure Support Protocol for Weaning Respirator in Surgical ICU
Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2009Co-Authors: Kaweesak Chittawatanarat, Chaweewan ThongchaiAbstract:Objective: Compare the effectiveness between spontaneous breathing trial with low-pressure Support Protocol and liberal or non-Protocol directed method. Material and Method: The authors conducted a retrospective study involving 577 patients who were arranged and appropriate to weaning from mechanical ventilation on general surgical intensive care unit between July 1, 2004 to June 30, 2007. Two hundred and twenty two patients were weaned by their host surgeons or team (liberal group). Three hundred and fifty five patients underwent once daily spontaneous breathing trial with low-pressure Support Protocol. Patients assigned to this Protocol had the pressure Support level decreased to 5-7 cm of water for up to two hours each day. If signs of intolerance occurred, the process was restrained while patients who tolerated the two-hour trial without signs of distress were extubated. The authors collected demographic data, cause of ICU admission, APACHE II score at arranged time to weaning, weaning process time, ventilator day, and ICU length of stay. Results: There was statistical difference between liberal and Protocol in age (59.2 + 19.3 vs. 55.6 + 19.8; p = 0.03) but there was no statistical difference in gender (male 74.3 vs. 67.9%; p = 0.2) and APACHE II score at arranged time to wean (14.7 + 7.4 vs. 15.3 + 6.3; p = 0.2). The median (inter-quartile) range duration of weaning process (29.5 (48) vs. 2.25 (2.9), p < 0.001), ventilator day (3 (4) vs. 2 (3), p < 0.001), and length of ICU stay (5 (5) vs. 3 (3), p < 0.001) were shorter in the Protocol group than the liberal group. Multivariate linear regression model also revealed significantly less duration of weaning process in the Protocol group than the liberal group in terms of weaning time (-63.6 (-74.7 to -2.6) hours), ventilator day (-3.0 (-3.7 to -2.2) days), and length of ICU stay (-2.9 days (-3.7 to -2.0); p < 0.001) (95% confidence interval). Conclusion: Spontaneous breathing trial with low-pressure Support Protocol for liberal from mechanical ventilator was effective to reduce weaning time, ventilator day, and length of ICU stay in general surgical intensive care units. Keywords: Intensive care units, Length of stay, Respiration, Artificial, Respiratory mechanics, Time factors, Ventilator weaning
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Effectiveness of a spontaneous breathing trial with a low-pressure Support Protocol for liberation from the mechanical ventilator in a general surgical ICU.
Critical Care, 2008Co-Authors: Kaweesak ChittawatanaratAbstract:Discontinuing patients from mechanical ventilation is an important problem in ICUs. The aim of this study is to compare the effectiveness between a spontaneous breathing trial with a low-pressure Support Protocol and a liberal or nonProtocol-directed method.
Peter Lichter - One of the best experts on this subject based on the ideXlab platform.
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In situ hybridization to metaphase chromosomes and interphase nuclei.
Current protocols in human genetics, 2005Co-Authors: Joan H M Knoll, Peter LichterAbstract:In situ hybridization is used to determine the chromosomal map location and the relative order of genes and DNA sequences within a chromosomal band. It can also be used to detect aneuploidy, gene amplification, and subtle chromosomal rearrangements. Fluorescence in situ hybridization (FISH), probably the most widely used method, is described in the first basic Protocol. Two Support Protocols are provided to amplify weak fluorescent signals obtained in FISH. Nonisotopic probes can also be detected by enzymatic reactions using horseradish peroxidase or alkaline phosphatase, as described in alternate Protocols. Nonisotopic labeling of DNA probes by nick translation is described in a Support Protocol. The order of closely spaced FISH probes along chromosomes in interphase nuclei can be determined. A basic Protocol for isotopic in situ hybridization (IISH) with (3)H is provided followed by a Support Protocol for preparation of autoradiographic emulsion.
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Current Protocols in Human Genetics - In Situ Hybridization to Metaphase Chromosomes and Interphase Nuclei
Current Protocols in Human Genetics, 2005Co-Authors: Joan H M Knoll, Peter LichterAbstract:In situ hybridization is used to determine the chromosomal map location and the relative order of genes and DNA sequences within a chromosomal band. It can also be used to detect aneuploidy, gene amplification, and subtle chromosomal rearrangements. Fluorescence in situ hybridization (FISH), probably the most widely used method, is described in the first basic Protocol. Two Support Protocols are provided to amplify weak fluorescent signals obtained in FISH. Nonisotopic probes can also be detected by enzymatic reactions using horseradish peroxidase or alkaline phosphatase, as described in alternate Protocols. Nonisotopic labeling of DNA probes by nick translation is described in a Support Protocol. The order of closely spaced FISH probes along chromosomes in interphase nuclei can be determined. A basic Protocol for isotopic in situ hybridization (IISH) with 3H is provided followed by a Support Protocol for preparation of autoradiographic emulsion.
P. G. P. Lawler - One of the best experts on this subject based on the ideXlab platform.
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Managing the airway in cervical spine injury. A review of the Advanced Trauma Life Support Protocol.
Anaesthesia, 1992Co-Authors: P. R. Wood, P. G. P. LawlerAbstract:Summary The American College of Surgeons' Advanced Trauma Life Support Protocol for managing the airway in patients with a cervical spine injury is reviewed. The relative risks and benefits of oral and nasotracheal intubation are discussed and the potential hazards of alternative methods of airway control are considered with particular respect to British practice.
Alon Angel - One of the best experts on this subject based on the ideXlab platform.
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Observational cohort study of IP-10's potential as a biomarker to aid in inflammation regulation within a clinical decision Support Protocol for patients with severe COVID-19.
PloS one, 2021Co-Authors: Shaul Lev, Tamar Gottesman, Gal Sahaf Levin, Doron Lederfein, Evgeny Berkov, Dror Diker, Aliza Zaidman, Amir Nutman, Tahel Ilan Ber, Alon AngelAbstract:Background Treatment of severely ill COVID-19 patients requires simultaneous management of oxygenation and inflammation without compromising viral clearance. While multiple tools are available to aid oxygenation, data Supporting immune biomarkers for monitoring the host-pathogen interaction across disease stages and for titrating immunomodulatory therapy is lacking. Methods In this single-center cohort study, we used an immunoassay platform that enables rapid and quantitative measurement of interferon γ-induced protein 10 (IP-10), a host protein involved in lung injury from virus-induced hyperinflammation. A dynamic clinical decision Support Protocol was followed to manage patients infected with severe acute respiratory syndrome coronavirus 2 and examine the potential utility of timely and serial measurements of IP-10 as tool in regulating inflammation. Results Overall, 502 IP-10 measurements were performed on 52 patients between 7 April and 10 May 2020, with 12 patients admitted to the intensive care unit. IP-10 levels correlated with COVID-19 severity scores and admission to the intensive care unit. Among patients in the intensive care unit, the number of days with IP-10 levels exceeding 1,000 pg/mL was associated with mortality. Administration of corticosteroid immunomodulatory therapy decreased IP-10 levels significantly. Only two patients presented with subsequent IP-10 flare-ups exceeding 1,000 pg/mL and died of COVID-19-related complications. Conclusions Serial and readily available IP-10 measurements potentially represent an actionable aid in managing inflammation in COVID-19 patients and therapeutic decision-making. Trial registration Clinicaltrials.gov, NCT04389645, retrospectively registered on May 15, 2020.
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Real-time IP-10 measurements as a new tool for inflammation regulation within a clinical decision Support Protocol for managing severe COVID-19 patients
2020Co-Authors: Shaul Lev, Tamar Gottesman, Gal Sahaf Levin, Doron Lederfein, Evgeny Berkov, Dror Diker, Aliza Zaidman, Amir Nutman, Tahel Ilan Ber, Alon AngelAbstract:The challenge of treating severely ill COVID-19 patients is particularly great due to the need to simultaneously manage oxygenation and the inflammatory state without compromising viral clearance. Currently, there are many tools to aid in oxygen management and in monitoring viral replication. However, predictive biomarkers for monitoring the host immune response across COVID-19 disease stages and specifically, for titrating immunomodulatory therapy are lacking. We utilized a recently cleared platform (MeMed Key) that enables rapid and easy serial measurement of IP-10, a host protein implicated in lung injury due to viral-induced hyperinflammation. A dynamic clinical decision Support Protocol was employed for managing SARS-CoV-2 positive patients admitted to a COVID-19 dedicated medical center run by Clalit Health Services. This is the first Protocol to include real-time measurements of IP-10 as a potential aid for regulating inflammation. Overall, 502 serial real-time IP-10 measurements were performed on 52 patients recruited between 7th April 2020 to 10th May 2020, with 12 patients admitted to the intensive care unit (ICU). IP-10 levels correlated with increased COVID-19 severity score and ICU admission. Within the ICU admitted patients, the number of days with IP-10 measurements >1,000 pg/ml was associated with mortality. Upon administration of corticosteroid immunomodulatory therapy, a significant decrease in IP-10 levels was observed. Real-time IP-10 monitoring represents a new tool to aid in management and therapeutic decisions relating to the inflammatory status of COVID-19 patients.
Daniel J. Landsburg - One of the best experts on this subject based on the ideXlab platform.
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Effect of malnutrition-driven nutritional Support Protocol on clinical outcomes in autologous stem cell transplantation patients
Supportive Care in Cancer, 2020Co-Authors: Heather Lazarow, Ryan Singer, Charlene Compher, Cheryl Gilmar, Colleen R. Kucharczuk, Patricia Mangan, Kelly Salam, Kathleen Cunningham, Edward A. Stadtmauer, Daniel J. LandsburgAbstract:Purpose Poor nutrition status in patients receiving high-dose chemotherapy and autologous stem cell transplant (ASCT) has been associated with inferior clinical outcomes. We aim to determine whether a malnutrition-driven nutritional Support Protocol can improve these outcomes. Methods In this prospective cohort study, we assessed adults for malnutrition who were consecutively admitted for ASCT between October 2017 and March 2019 ( n = 251), and provided enteral or parenteral nutrition (EN/PN) to patients who were malnourished early in the transplantation admission. We compared their clinical outcomes with those of a historical cohort admitted between May 2016 and October 2017 ( n = 257) for whom nutrition assessment and initiation of EN/PN were not Protocol-driven. Results Patients receiving ASCT during the intervention period experienced decreased odds of prolonged hospital stay ( p = 0.023), central line–associated bloodstream infection ( p = 0.015), mucosal barrier injury ( p = 0.037), and high weight loss ( p = 0.002), in a multivariate analysis as compared with those receiving ASCT during the control period. Outcomes for ICU transfer, deconditioning on discharge, time to platelet engraftment, and unplanned 30-day hospital readmission did not differ significantly between groups. Conclusion A malnutrition-driven nutritional Support Protocol may improve outcomes for ASCT patients.
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Effect of malnutrition-driven nutritional Support Protocol on clinical outcomes in autologous stem cell transplantation patients
Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer, 2020Co-Authors: Heather Lazarow, Ryan Singer, Charlene Compher, Cheryl Gilmar, Colleen R. Kucharczuk, Kelly Salam, Kathleen Cunningham, Edward A. Stadtmauer, Patricia A. Mangan, Daniel J. LandsburgAbstract:Poor nutrition status in patients receiving high-dose chemotherapy and autologous stem cell transplant (ASCT) has been associated with inferior clinical outcomes. We aim to determine whether a malnutrition-driven nutritional Support Protocol can improve these outcomes. In this prospective cohort study, we assessed adults for malnutrition who were consecutively admitted for ASCT between October 2017 and March 2019 (n = 251), and provided enteral or parenteral nutrition (EN/PN) to patients who were malnourished early in the transplantation admission. We compared their clinical outcomes with those of a historical cohort admitted between May 2016 and October 2017 (n = 257) for whom nutrition assessment and initiation of EN/PN were not Protocol-driven. Patients receiving ASCT during the intervention period experienced decreased odds of prolonged hospital stay (p = 0.023), central line–associated bloodstream infection (p = 0.015), mucosal barrier injury (p = 0.037), and high weight loss (p = 0.002), in a multivariate analysis as compared with those receiving ASCT during the control period. Outcomes for ICU transfer, deconditioning on discharge, time to platelet engraftment, and unplanned 30-day hospital readmission did not differ significantly between groups. A malnutrition-driven nutritional Support Protocol may improve outcomes for ASCT patients.
