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Biomedical subjects

M Muallem

Publications and source records attributed to M Muallem.

At least 19 recordsLinked to original sources
PubMed2001

Pattern of spontaneous breathing: potential marker for weaning outcome. Spontaneous breathing pattern and weaning from mechanical ventilation.

OBJECTIVE: To quantitatively assess the spontaneous breathing (SB) pattern, during minimal ventilatory support, of patients who pass or fail weaning trials from mechanical ventilation. DESIGN: A prospective, clinical trial. SETTING: Intensive care unit of a university teaching hospital. PATIENTS: Fifty-two tracheally intubated and hemodynamically stable patients who were judged clinically ready for extubation. METHODS: Using a computerized respiratory profile monitor, continuous respiratory parameters were obtained while patients were receiving four or less synchronized intermittent mandatory (SIMV) breaths and during CPAP trials. Coefficients of variation (CV) of spontaneous tidal volumes and flows during SIMV trials as well as the entropies and dimensions of the breathing patterns during CPAP trials were used to assess the dynamical breathing behaviors of the patients who passed or failed weaning trials. MEASUREMENTS AND RESULTS: Thirty-nine extubations were successful and 13 were not. The CV of the spontaneous tidal volumes (VT) and the spontaneous peak inspiratory flows (PF), the Kolmogorov entropy and the dimension of the SB patterns were compared in the two groups. The CV of VT (9.13 +/- 4.11 vs 26.07 +/- 6.94), the CV of PF (11.63 +/- 4.18 vs 29.88 +/- 12.07), the Kolmogorov entropy (0.09 +/- 0.03 bits/cycle vs 0.39 +/- 0.09 bits/cycle), and the dimension of the SB pattern (1.33 +/- 0.07 vs 3.93 +/- 0.47) were all significantly smaller (P < 0.05) in the successfully extubated group versus the group that failed extubation. CONCLUSION: The spontaneous breathing pattern during minimal mechanical ventilatory support is more chaotic in patients who failed extubation trials compared to patients who passed extubation trials. Thus, we speculate that characterizing the SB pattern during minimal ventilatory support might be a useful tool in differentiating between extubation success and failure.

Adult↗
PubMed2000

A new cut-off point of thyromental distance for prediction of difficult airway.

BACKGROUND: Difficult intubation, often unexpected, remains a primary concern for the anesthesiologist. None of the bedside tests have proven to be efficacious and highly predictive. The prupose of this study was to correlate the full range of thyromental distance with both the Cormack grade and the Mallampati score. METHODS: One hundred and sixty patients undergoing general anesthesia were included in the study. Patients with abnormal atlanto-occipital extension, small chin size and mouth opening were excluded from the study. The thyromental distance, the Mallampati score, and the Cormack grade were determined in all patients. The correlation between the thyromental distance and each of the Cormack grade and the Mallampati score was determined, as well as the correlation between the Mallampati score and the Cormack grade. The cut-off value of the tyromental distance that discriminated best between patients with easy glottic visualization (Cormack grade 1,2) vs. difficult visualization (Cormack grade 3,4) was derived. RESULTS: A significant and high correlation was observed between the thyromental distance and the Cormack grade (r = -0.72). In contrast, a lower correlation was observed between the thyromental distance and the Mallampati score (r = -0.41) and the Mallampati score and the Cormack grade (r = 0.47). A cut-off value for the TMD of 4 cm was the best in discriminating between patients with difficult and easy glottic visualization. The combination of TMD < or = 4 cm and Mallampati score of 3,4 predicted the patients with the most difficult glottic visualization. CONCLUSION: Patients with a thyromental distance greater than 4 cm can be easily intubated. In contrast, when the TMD < or = 4 cm, tracheal intubation is difficult in 48% of patients if the Mallampati score is 1,2 and in 79% if the Mallampati score is 3 or 4.

Adolescent↗
PubMed1999

Modification of an anesthesia machine for MRI suite.

The modification of a wall mounted anesthesia machine, rendering it nonmagnetic for use in the magnetic resonance imaging suite, is described. The modified anesthesia machine functioned properly at 1.8 m distance from 1.5 tesla electromagnet without degrading its imaging.

Anesthesiology↗
PubMed1999

Double T-piece, an injector, and Bird ventilator use in MRI suite.

The double T-piece breathing system is described. The Bird Ventilator Mark 2 is utilised as an oxygen pressure jet to drive an injector placed at the distal end of the double T-piece breathing system. An active anti-pollution assembly is employed. Both the double T-piece breathing system and the anti-pollution assembly are valveless. The injector's design is described. The ventilator functioned properly at 1.8 m distance from 1.5 tesla electromagnet without degrading its imaging. The Bird ventilator, the injector, and the double T-piece breathing system are small in size, easy to handle, and can be used for paediatric and adult patients.

Adult↗
PubMed1997

[Airbag-associated ocular trauma].

Airbags have received widespread recognition as an effective means of enhancing automobile safety. They are particularly effective in frontal and front angle collisions which otherwise would be fatal or cause serious injuries. Inflation of the bag helps protect the driver and front-seat-passenger from hitting the steering wheel, dashboard or windshield. In frontal crashes airbags have reduced driver deaths, hospital admission rates, and incidence of brain injury. On the other hand, an increasing variety of airbag-associated organ injuries has been reported, including blunt ocular and chemical trauma, 2 cases of ocular trauma due to airbags which resulted in choroidal rupture with disastrous outcome in terms of visual acuity are presented. Since the very first report in May 1991 of airbag-associated ocular trauma until June 1996, there has apparently been only 1 case of choroidal rupture due to airbag-associated trauma, presented in 1 sentence of a brief report. Although airbag-related eye trauma may be relatively infrequent, the severity of the injuries incurred, especially when the posterior segment of the eye was involved, warrants research on new airbag design that minimizes the risk of ocular injury. Meanwhile all cases of airbag-associated ocular trauma should be reported, so that medical staff, the general population and car manufacturers will become more aware of this medical issue.

Adult↗
PubMed1997

Reduction of pneumococcal nasopharyngeal carriage in early infancy after immunization with tetravalent pneumococcal vaccines conjugated to either tetanus toxoid or diphtheria toxoid.

BACKGROUND: Pneumococcal nasopharyngeal colonization is important for transmission of the organisms. We assessed the ability of two tetravalent conjugate vaccines administered in early infancy to prevent carriage of vaccine-related pneumococci. METHODS: A vaccine containing pneumococcal type 6B, 14, 19F and 23F polysaccharide conjugated to tetanus toxoid (Pnc-T) and a vaccine containing the same four polysaccharides conjugated to diphtheria toxoid (Pnc-D) were compared with placebo, in a double blinded study (25 infants per group). Vaccines (or placebo) were injected at 2, 4 and 6 months of age. At 12 months of age a native (nonconjugate) polysaccharide vaccine was administered as a booster. Serum type-specific anticapsular antibody concentrations were measured and nasopharyngeal cultures were obtained at 2, 4, 6, 7, 12 and 13 months of age. RESULTS: In general carriage of all pneumococci (vaccine- and non-vaccine-related) was low at age 2 months and increased with age. However, for the vaccine-related serotypes (6A, 6B, 14, 19F and 23F) carriage was not increased with age in Pnc-D or Pnc-T recipients. Of all cultures obtained after the full primary series, 7 of 72 (10%), 3 of 62 (5%) and 19 or 70 (27%) were positive for the vaccine-related pneumococcal serotypes among the Pnc-D, Pnc-T and placebo recipients, respectively (P = 0.001 for Pnc-D vs. placebo; P = 0.014 for Pnc-T vs. placebo). Most of the antibiotic-resistant isolates belonged to the vaccine-related serotypes. CONCLUSIONS: A significant reduction in the carriage of vaccine-related strains after administration of conjugate vaccines was observed. These preliminary results suggest that transmission of specific pneumococcal serotypes most often associated with disease and antibiotic resistance may at least partially be controlled by immunization.

Bacterial Vaccines↗
PubMed1996

Reduction of nasopharyngeal carriage of pneumococci during the second year of life by a heptavalent conjugate pneumococcal vaccine.

Children 12-18 months old were randomized to receive one dose of a conjugate heptavalent pneumococcal vaccine, two doses of the same vaccine, or one dose of a 23-valent native polysaccharide vaccine. Before immunization, pneumococci included in the conjugate vaccine were isolated from 24% of the children, and an antibiotic-resistant pneumococcus was isolated from 22% of the children. The vaccines had no effect on carriage of non-vaccine-type pneumococci. In contrast, there was a significant reduction in carriage of vaccine-type pneumococci 3 months after one dose and 1 month after a second dose of conjugate vaccine (from 25% to 9% and 7%, respectively; P < .001). No effect was seen after vaccination with the nonconjugate vaccine. One year after immunization, carriage of antibiotic-resistant vaccine-type pneumococci in children receiving conjugate vaccine was lower than that in children receiving the nonconjugate vaccine (4% vs. 14%, P = .042). Conjugate pneumococcal vaccines may reduce spread of pneumococci in the community.

Antibodies, Bacterial↗
PubMed1996

Nasopharyngeal colonization in southern Israel with antibiotic-resistant pneumococci during the first 2 years of life: relation to serotypes likely to be included in pneumococcal conjugate vaccines.

Nasopharyngeal carriage of Streptococcus pneumoniae was studied in 162 healthy infants at ages 2, 4, 6, 7, 12, and 13 months and in an additional 352 healthy children at ages 12, 15, 18, 21, and 24 months. Carriage was 26%, 39%, and 62% at 2, 12, and 24 months, respectively, and the respective resistance to > or = 1 antibiotic was 11%, 19%, and 27%. The presence of an older sibling or antibiotic treatment during the month preceding the culture was associated with carriage of resistant pneumococci in infants, whereas attendance at large day care centers was associated with carriage during the second year of life. Antibiotic resistance was detected in all 7 serotypes included in the candidate pediatric conjugate vaccines and was significantly more prevalent among vaccine-type pneumococci than among non-vaccine-type pneumococci. The use of conjugate vaccines may reduce the spread of resistant pneumococci.

Anti-Bacterial Agents↗
PubMed1993

Jet ventilation in a case of tracheal obstruction secondary to a retrosternal goitre.

Intermittent jet ventilation was used during anaesthesia in a 66-yr-old woman who had severe tracheal narrowing secondary to compression by a retrosternal goitre. The trachea was intubated by a small-bore tube, which was placed above the site of narrowing. An injector was connected to the proximal end of the tracheal tube on one side and to the anaesthesia circuit on the other. Intermittent jets of 66% nitrous oxide in oxygen via the injector resulted in adequate oxygenation and carbon dioxide elimination. Arterial blood gas analysis during jet ventilation showed PaO2 150 mmHg, PaCO2 35 mmHg and pH 7.4. It is concluded that low-frequency jet ventilation may provide adequate oxygenation and carbon dioxide elimination in the presence of tracheal narrowing.

Aged↗