Novel Treatment of Ventilator Dyssynchrony From Central Alveolar Hypoventilation Syndrome Utilizing Scheduled 5-Hydroxytryptamine-3 Receptor Antagonist.

Traumatic brain injury (TBI) occurs in a large percentage of surgical trauma patients and is one of the leading causes of death amongst young teens and adults. Furthermore, individuals with TBIs often require mechanical ventilation and admission to the intensive care unit. As a result of their TBIs, these patients can develop central alveolar hypoventilation (CAH) secondary to disruptions in neuromodulatory respiratory brainstem control and neural signal initiation and integration. Prior studies have primarily focused their attention on treatment of congenital disorders of CAH, and limited research is available on intubated trauma patients who have signs of ventilator dyssynchrony. Current case reports and animal studies have suggested that noradrenergic and specific serotonergic medications are able to target specific neurologic pathways in the respiratory circuit and induce ventilator synchrony. This case series describes the clinical course of TBI patients treated for ventilator dyssynchrony secondary to CAH with a daily scheduled 5-hydroxytryptamine-3 (5-HT3) receptor antagonist. All patients were ultimately extubated and discharged from the hospital.

Chronic wounds of the lower extremity: a preliminary performance measurement set.

BACKGROUND: Chronic wounds of the lower extremity, a well-known condition with a high prevalence, high cost, variable practice pattern, and poor clinical outcome, are often managed by a nonintegrated health care system. The authors formed a multispecialty expert work group to draft a preliminary performance measurement set for the care of chronic wounds of the lower extremity. METHODS: The authors conducted a systematic review of existing scientific literature addressing the assessment and treatment of chronic wounds of the lower extremity. Admissible studies were screened using explicit threshold criteria and appraised for methodologic rigor against criteria promulgated by the Agency for Healthcare Research and Quality. Nine candidate performance measures emerged from the research synthesis. To estimate work group consensus and negate bias, the authors used latent class analysis. RESULTS: A total of 55 clinical practice guidelines, 45 systematic reviews, three specialty society consensus statements, and seven health care technology assessments were reviewed. Only 46 were found to be of sufficient quality for use in measure development. Detailed specifications are reported for each performance measure, including period of assessment, method of reporting, sources of data, rationale, corresponding guidelines, and challenges to implementation. CONCLUSIONS: The authors conclude that the peer-reviewed literature, imperfect as it is, well characterizes the core processes of care entailed in the assessment and treatment of chronic wounds of the lower extremity. The authors found ample support for the creation of an initial performance measurement set. Devoid of consensus among relevant specialty associations and key public and private stakeholder groups, however, this work is primitive.