Non-invasive positive pressure ventilation versus invasive pressure support ventilation for post extubation respiratory distress in patients recovered from respiratory failure

Respiratory failure after a planned extubation is reported to be a common event, leading to reintubation and can occur in as many as 3-20% of extubated patients. It is crucial to identify the right time to extubate a patient, since re-intubation after pre-term extubation is associated with an increased risk for nosocomial pneumonia, prolonged intensive care unit [ICU] stay and death, and also accounts for substantially increased costs. This study was planned to assess the effectiveness of non-invasive pressure support ventilation [NIPPV] as a weaning technique in patients who develop respiratory distress after discontinuation of mechanical ventilation and extubation in comparison with conventional weaning through invasive pressure support ventilation. This is a randomized controlled study, sixty patients with either type I or II respiratory failure who developed post extubation respiratory failure were enrolled; they were randomly divided into two groups to receive either NIPPV or invasive pressure support ventilation. The primary outcome measure was the technique outcone; secondary outcome measures were incidence of complications, hemodynamic parameters, arterial blood gas parameters, ventilator parameters and length of ICU stay. Despite a longer time to failure observed with invasive pressure support ventilation, no statistically significant differences were observed in success rate, hemodynamic, and arterial blood gas parameters, although incidence of complications differs greatly according to the technique used. In a heterogonous group of patients; NIPPV is not superior to invasive pressure support ventilation in patients who developed post-extubation respiratory distress after successful weaning

effect of mild hypothermia on jugular venous bulb oxygen saturation and CSF glutamate in severe head trauma

Hypothermia has been used as a method of brain protection in patients with traumatic brain injury for many years. The protective effects of hypothermia are related to the inhibition of the excitatory amino acids [EAA] release including glutamate. The hypothermic decline of the cerebral metabolic rate of oxygen [CMRO[2]] is also another mechanism of brain protection because it maintains the aerobic metabolism of the brain. To study the effect of mild hypothermia on brain oxygenation and the release of the EAA glutamate in severe head trauma. Forty two patients [16 - 60 years old] with severe head trauma [Glasgow coma scale < 8] were classified according to the diagnosis by computed tomography into group 1 [global brain damage] [n=20] and group 2 [focal brain damage] [n=22] two cases in group 2 were died before completion of the study so they were excluded. The cerebrospinal [CSF] glutamate, the jugular venous bulb oxygen saturation, the jugular venous lactate, the Glasgow coma scale [GCS], the acute physiological and chronic health evaluation score [APACHE II] and the length of lCU stay and other hemodynamic variables were measured and recorded. Hypothermia decreased the cerebrospinal [CSF] glutamate, improved the jugular venous bulb oxygen saturation, decreased the jugular venous lactate, improved the Glasgow coma scale [GCS] and decreased the acute physiological and chronic health evaluation score [APACHE II], There were significant statistical differences [p < 0.001] in each group but there were no statistical significant differences between both groups. The length of ICU stay was shorter in the group 1 than in group 2. Mild Hypothermia is one of the mechanisms of brain protections through decreasing the level of the neurotoxic cerebrospinal excitatory amino acid glutamate and by improving the cerebral oxygenation and preventing the anaerobic metabolism by decreasing the level of serum lactate

Comparison between Nalbuphine and propofol for Treatment of intrathecal morphine-induced pruritus after cesarean section

Intrathecal opioids are frequently used in management of postoperative pain, but may be associated with many adverse effects such as pruritus, nausea, vomiting, urinary retention, and respiratory depression, which may limit their use. Our study was done to compare between nalbuphine [a mixed opioid agonist antagonist] and propofol [2-6 di-isopropylphenol] in treating intrathecal morphine-induced pruritus after cesarean delivery. It included one hundred forty one parturients undergoing elective cesarean section with spinal anesthesia and post-operative analgesia by intrathecal morphine [0.3 mg]. Ninty four parturients were reported to have moderate to severe pruritus. Without pre-medications, all women were hydrated with 500 to 1000 ml of normal saline before intrathecal injection of 7.5-10 mg of bupivacaine for spinal anesthesia and morphine 0.3 mg for postoperative pain control. Heart rate, mean blood pressure, respiratory rate and oxygen saturation were monitored. The degree and onset of pruritus were also recorded. Those parturients whose pruritus scores was >/= 3 or those who requested antipruritic treatment were assigned to receive either 3mg nalbuphine IV, 20mg propofol IV or placebo. The degree of success was reported when pruritus score decreased to 1 or 2 after treatment and then women were evaluated every 15 minutes for up to 4 hours to determine the duration of antipruritic response. The patients who continued to have pruritus scores >/= 3 were considered treatment failure after only a single dose of the study medicine. Any side effects from spinal anesthesia or from the drugs used were recorded. we were able to demonstrate that the success rate after treatment with 3 mg of nalbuphine was significantly greater than with 20 mg of propofol. Among the successfully treated patients, [8%] in the Nalbuphine group and [5.3%] in the Propofol group reported the recurrence of moderate to severe pruritus [pruritus score >/= 3] within 4 hours after administration of the study drug. Among all the treated patients, [21.9%] in the Nalbuphine group and [40.6%] in the Propofol group reported failure of success [moderate to severe pruritus [pruritus score >/= 3]] within 15 minutes after administration of the study drug. our study showed that nalbuphine [3 mg] was superior to propofol [20 mg] in the treatment of intrathecal morphine induced pruritus after cesarean delivery