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  • ISSN: 2333-6625
    Early Online
    Volume 6, Issue 1
    Research Article
    Rashid Nadeem*, Amin Sharieff, Sonam Tanna, Harpreet Sidhu, Janos Molnar, and Amin Nadeem
    Rationale: Atrial Fibrillation (AF) is a potent risk factor for ischemic cerebrovascular Accident (ICVA). Inflammation is potential pathogenic factor for atherosclerosis and ICVA. Chronic Obstructive pulmonary disease (COPD) is associated with increased inflammatory markers. Subjects frequently suffer from COPD and AF, may have higher risk for ICVA.
    Methods: Single center cross sectional study was performed. All subjects with diagnosis of COPD, AF and ICVA for duration of 5 years were categorized in three groups; COPD, AF, and COPD plus AF. Prevalence of ICVA was compared. Presence of confounding factors affecting ICVA risk was recorded for all subjects; age >65, type 2 Diabetes, Hypertension, peripheral vascular disease, dyslipidemia, and Congestive cardiac failure.
    Results: Total charts reviewed were 1821; only COPD 887, only AF 684, and both together 250. ICVA was documented in total 484 (26.6%) subjects. Individuals who had COPD and AF were 1.86 (95% CI 1.34 to 2.58, p<0.001) times as likely to have an ICVA compared to subjects who only have COPD or AF. Prevalence of ICVA was also significantly higher in subjects who have only AF versus those who have only COPD (P<0.001). In logistic Regression model while adjusting for all significantly different confounding factors, AF and COPD was found to be strong predictor of ICVA (p<0.001), much stronger than AF only (p=0.04). Odd ratio was 1.28 (95% CI 1.003 to 1.65) for AF only.
    Conclusion: Presence of COPD may increase the risk of ischemic stroke in subjects with Atrial Fibrillation.
    Research Article
    Sheila S Kun*, Cyndy Miller, Sally Davidson-Ward, Josephine Ellashek and Thomas G Keens
    Background and significance: It is estimated that 4800 children living in the USA are currently supported by mechanical ventilation at home. Despite advances in technology, the mortality rate of 21% remains high. Previous studies identified knowledge gap in the responses to emergencies in the home. Therefore, a training module focusing on the response to these emergencies is needed.
    Purpose /aims of the study: Childrens Hospital of Los Angeles (CHLA) approached regional home clinicians and formed an advisory panel to develop a training content for home mechanical ventilation (HMV) emergency management.
    Methods: We surveyed 28 HMV clinicians in So. California asking them to recall HMV emergencies in the home settings. We gathered this advisory panel for a focus group via the modified Delfi method to develop the training content of responses to HMV emergencies.
    Results: Ninety-two HMV emergency scenarios were recalled with 412 years of clinical experience on home HMV management. Data were categorized into 15 emergency situations. The expert panel deliberated on 1) the emergent situation 2) the immediate response 3) the possible causes and 4) pearls- the collective sharing of experiences on these encounters.
    Conclusion: A training didactic tool for in-home caregivers and nurses of HMV children was developed. We hope that providing focused education, based on real world experience and wisdom, will help reduce accidental deaths in children on HMV.
    Special Issue on Lung Transplantation
    Research Article
    Christiane Kugler1,3*, Hendrik Suhling2, Gregor Warnecke1, Axel Haverich1, Tobias Welte2 and Jens Gottlieb2
    Abstract: Background: Companion animals may have a positive impact on physical activities and on quality of life (QoL) in individuals. However, many lung transplant (LTx) patients are advised against them due to the risk of zoonotic infections.
    Methods: A single-center survey of 591 patients (response rate 87.0%) asked about current human animal bonds any time after LTx. Subgroups with, versus without, companion animals were compared regarding general QoL, physical activity levels, and clinical outcome parameters (FEV1, rejection, BOS, hospitalization).
    Results: Within a sample of 517 LTx patients, 25.1% (95% CI 21.7-29.2%) reported on having companion animals in their households. The majority reported to have dogs (n=84) or cats (n=38). Those caring for a companion animal were median 4.2 years post-transplant and more likely to engage in regular physical activities (OR 2.04; p=0.02; 95% CI 0.11-37.2), and to live in a family relationship (OR 1.62; p=0.004; 95% CI 1.45-1.89). Patients having companion animals did not differ in regard to clinical outcome, FEV1 (p=0.73), rejection (p=0.22), BOS (p=0.12), and hospitalization (p=0.81), compared to those without companion animals.
    Conclusions: Our findings indicate that some patients after LTx have companion animals in their households. Careful management of companion animals in selected patients might alleviate the risk of zoonotic diseases, and might have a positive benefit on patients' physical activity levels.
    Special Issue on Pulmonary Hypertension
    Review Article
    Armin Sablotzki*, Hans-Juergen Seyfarth, Jochen Gille, Stefan Gerlach, Michael Malcharek and Elke Czeslick
    Abstract: Pulmonary hypertension is a major reason for elevated perioperative morbidity and mortality, even in non-cardiac surgical procedures. Patients more often experience serious complications, such as right-ventricular failure, arrhythmias, and early postoperative death. Preoperatively patients should be thoroughly prepared for the intervention and allowed plenty of time for consideration. All specialty disciplines involved in treatment should play a role in these preparations. After selecting each of the suitable individual anesthetic and surgical procedures, intra operative management should focus on avoiding all circumstances that could contribute to exacerbating pulmonary hypertension (hypoxemia, hypercapnia, acidosis, hypothermia, hypervolemia, and insufficient anesthesia and analgesia). Due to possible induction of hypotension, intravenous vasodilators (milrinone, dobutamine, prostacyclin, Na-nitroprusside, and nitroglycerine) should be administered with the greatest care. A method of treating elevationsin pulmonary pressure with selective pulmonary vasodilation by inhalation should be available intraoperatively (iloprost, nitrogen monoxide, prostacyclin, and milrinone) in addition to invasive hemodynamic monitoring. During the postoperative phase, patients must be monitored continuously and receive sufficient analgesic therapy over an adequate period of time. All in all, perioperative management of patients with pulmonary hypertension presents an interdisciplinary challenge that requires the adequate involvement of anesthetists, surgeons, pulmonologists, and cardiologists alike.
    Special Issue on Hospital Pulmonary Sleep Medicine
    Case Study
    Patricia Kroekel*
    Abstract: Obstructive sleep apnea (OSA) is a common sleep disorder the American Academy of sleep medicine note that it effective 2% to 4% of the adult population. This article follows two patients with sleep apnea and who are experiencing cardiac and pulmonary complications as a result of it. In one case noncompliance and the other newly diagnosed with OSA. In this case study we consulted different members of the healthcare team to assist with maintaining compliance with use of CPAP machines, not only in the hospital but a home monitoring system to keep the patients in touch with the healthcare team. We found that the most successful patient at home like any other chronic condition is patient is motivated to improve and they have a support home environment.
    Review Article
    David Visco, Michelle Niesley, Mark Lewis*
    Abstract: Introduction: Sleep disorders affect 10-15% of the US population, which has significant implications for quality of life. Oncology patients often experience more prominent detrimental effects of sleep deprivation. Fatigue is one of the most debilitating symptoms, and occurs in 75% ofpatients with cancer.
    Methods: Eastern Regional Medical Center implemented a process by which subjective and objective sleep screening assessment is standard practice for all patients new to the center. Patients were provided both a combined sleep questionnaire and an at-home sleep screen device. This device links the physiology of autonomic, respiratory, and mathematically captures electro cortical activity collectively referred to as cardiopulmonary coupling.
    Results and discussion: This retrospective review encompassed a total 1,207 new patients seen between March 2013 and April 2014. They were stratified into three populations having completed: subjective questionnaires, objective screening, and completed both measures.For the 242 patients who completed the subjective questionnaire, 65% were considered to have a likelihood of sleep disturbance, and 68% of patients reported feeling tired/fatigued/sleepy during the day. The objective screening notes 71% of patients had poor sleep quality. Interestingly for both measure, patients who had poor scores subjectively actually outperformed their counterparts on the objective sleep assessment.
    Conclusion: The results of this study emphasize the importance of utilizing both subjective and objective assessments for sleep analysis. Assessing sleep with only one of these tools would not provide an accurate account of sleep disturbance. The ability to assess overall sleep quality, as well as low and high frequency coupling has proven valuable in determining further diagnostic testing or evaluations. The contradictions found between subjective, self-reported data and the objective data obtained through the Sleep Image® device suggest other factors may contribute to patients feeling sleep deprived or well rested.
    Stephan Steiner*, Stefanie Keymel
    Abstract: Sleep related breathing disorders (SRBD) are common in critically ill as well as in postoperative patients. Because of anatomical reasons the risk of difficulties of endotracheal intubation is increased in these patients. Furthermore, awareness of SRBD might influence management of weaning and reduce the risk of post-extubation failure. The use of sedatives and analgetics should be minimized to prevent overlap and aggravation of apneas which might have detrimental effects. If possible, non-invasive ventilation should be used immediately after extubation. There are no data on long term outcome of critically ill patients who are diagnosed with SRBD.
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