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Journal of Intensive Care Medicine

Joseph Philip, Christian Kegg, Dalia Lopez-Colon, Brian J Kelly, Robert M Lawrence, Matthew A Robinson, Ravi S Samraj, Mark S Bleiweis
BACKGROUND: There is no consensus for the length of prophylactic antibiotics after delayed chest closure (DCC) postcardiac surgery in pediatrics. In September 2014, our institution's pediatric cardiac intensive care unit changed the policy on length of prophylactic antibiotics after DCC from 5 days (control) to 2 days (study group). The objective of the study was to determine whether a 2-day course of antibiotics is as effective as a 5-day course in preventing blood stream and sternal wound infections in pediatric DCC...
August 8, 2018: Journal of Intensive Care Medicine
Anthony Gan, Avi Cohen, Laren Tan
Percutaneous dilatational tracheostomy is a minimally invasive procedure performed for those who require prolonged mechanical ventilation. It is a procedure that is performed routinely at the bedside in the intensive care unit. Complications nonetheless still occur, and as a result, several technique modifications have been employed. At Loma Linda University Medical Center, we have implemented a novel technique using augmented reality during percutaneous dilatational tracheostomy placement in an attempt to minimize such complications...
August 5, 2018: Journal of Intensive Care Medicine
Peter M Reardon, Krishan Yadav, Ariel Hendin, Alan Karovitch, Michael Hickey
Pulmonary embolism (PE) is a common disease process encountered in the acute care setting. It presents on a spectrum of severity with the most severe presentations carrying a substantial risk of morbidity and mortality. In recent years, a wide range of competing treatment strategies have been proposed for the high-risk PE including new catheter-based and extracorporeal techniques, and management has become more challenging. There is currently no consensus as to the optimal approach to treatment. Contemporary management decisions are informed by the balance between the risk of deterioration and the risk of harm from intervention, within the available resources...
August 1, 2018: Journal of Intensive Care Medicine
Mithun R Suresh, Kevin K Chung, Alicia M Schiller, Aaron B Holley, Jeffrey T Howard, Victor A Convertino
Hypovolemic shock exists as a spectrum, with its early stages characterized by subtle pathophysiologic tissue insults and its late stages defined by multi-system organ dysfunction. The importance of timely detection of shock is well known, as early interventions improve mortality, while delays render these same interventions ineffective. However, detection is limited by the monitors, parameters, and vital signs that are traditionally used in the intensive care unit (ICU). Many parameters change minimally during the early stages, and when they finally become abnormal, hypovolemic shock has already occurred...
August 1, 2018: Journal of Intensive Care Medicine
Rachel A Madrid, William McGee
Management of limited health-care resources has been of growing concern. Stewardship of health-care dollars and avoidance of low-value care is being increasingly recognized as a matter that affects all practitioners. This review aims to examine a particular pathological state with multifactorial origins: chronic critical illness (CCI). This condition exerts a large toll on society as well as individual patients and their families. Here, we offer a brief review as to the incidence/prevalence of CCI and suggestions for prevention...
July 31, 2018: Journal of Intensive Care Medicine
Jeffrey DellaVolpe, Ali Al-Khafaji
The development of acute kidney injury in the setting of liver disease is a significant event both before and after liver transplant. Whether acute kidney injury is the cause of or merely associated with worse outcomes, the development of renal failure is significant from a prognostic as well as from a diagnostic and therapeutic standpoint. Although not every etiology is reversible, there are number of etiologies that are correctable, to include hypovolemia, nephrotoxic medications, and acute tubular necrosis...
July 30, 2018: Journal of Intensive Care Medicine
Giorgio R Sansone, J Dermot Frengley, Allan Horland, John J Vecchione, Robert J Kaner
OBJECTIVE: To investigate the effects of the reinstitution of continuous mechanical ventilator support of >21 days in 370 prolonged mechanical ventilation (PMV) patients, all free from ventilator support for ≥5 days. METHODS: Four groups were formed based on the time and number of PMV reinstitutions and compared (group A: reinstitutions within 28 days, n = 51; group B: a single reinstitution after 28 days, n = 53; group C: multiple reinstitutions after 28 days, n = 52; and group D: no known reinstitutions, n = 214)...
September 2018: Journal of Intensive Care Medicine
Keren Fogelfeld, Richie K Rana, Guy W Soo Hoo
INTRODUCTION: Cerebral artery gas embolism (CAGE) is a rare but serious adverse event with potentially devastating neurologic sequelae. Bronchoscopy is a frequently performed procedure but with only a few reported cases of CAGE. METHODS: We report the first documented case of CAGE associated with electromagnetic navigational bronchoscopy. RESULTS: A 61-year-old man with a left lower lobe nodule underwent electromagnetic navigational bronchoscopy...
September 2018: Journal of Intensive Care Medicine
Will Jaffee, Spencer Hodgins, William T McGee
Severe sepsis and septic shock remain among the deadliest diseases managed in the intensive care unit. Fluid resuscitation has been a mainstay of early treatment, but the deleterious effects of excessive fluid administration leading to tissue edema are becoming clearer. A positive fluid balance at 72 hours is associated with significantly increased mortality, yet ongoing fluid administration beyond a durable increase in cardiac output is common. We review the pathophysiologic and clinical data showing the negative effects of edema on pulmonary, renal, central nervous, hepatic, and cardiovascular systems...
September 2018: Journal of Intensive Care Medicine
Kimia Honarmand, Emilie P Belley-Cote, Diana Ulic, Abubaker Khalifa, Andrew Gibson, Graham McClure, Nevena Savija, Fayez Alshamsi, Frederick D'Aragon, Bram Rochwerg, Erick H Duan, Tim Karachi, François Lamontagne, P J Devereaux, Richard P Whitlock, Deborah J Cook
BACKGROUND: Informed consent is a hallmark of ethical clinical research. An inherent challenge in critical care research is obtaining consent when patients lack decision-making capacity. One solution is deferred consent, which is often used for studies that are low risk or involve emergency interventions. Our objective was to describe a deferred consent model in a low-risk critical care study. METHODS: Prognostic Value of Elevated Troponins in Critical Illness Study was a prospective, pilot observational study of critically ill patients in 3 intensive care units, involving serial electrocardiograms and cardiac biomarkers...
August 2018: Journal of Intensive Care Medicine
Paulo Sérgio Lucas da Silva, Maria Eunice Reis, Thais Suelotto Machado Fonseca, Marcelo Cunio Machado Fonseca
PURPOSE: Reintubation following unplanned extubation (UE) is often required and associated with increased morbidity; however, knowledge of risk factors leading to reintubation and subsequent outcomes in children is still lacking. We sought to determine the incidence, risk factors, and outcomes related to reintubation after UEs. METHODS: All mechanically ventilated children were prospectively tracked for UEs over a 7-year period in a pediatric intensive care unit...
August 2018: Journal of Intensive Care Medicine
Leonardo Jönck Staub, Roberta Rodolfo Mazzali Biscaro, Rosemeri Maurici
BACKGROUND: Lung ultrasound (LUS) is an accurate tool to diagnose community-acquired pneumonia. However, it is not yet an established tool to diagnose ventilator-associated pneumonia (VAP). PURPOSE: To assess the evidence about LUS in the diagnosis of VAP, we conducted a systematic review of the literature. METHODS: We searched PubMed, Embase, Scopus, Web of Science, and LILACS. Two researchers independently selected the studies that met the inclusion criteria...
August 2018: Journal of Intensive Care Medicine
Ashraf Roshdy
Echodynamics refers to the use of echocardiography as hemodynamic tool mostly in intensive and acute care settings. It implies a smooth drift from the classic cardiology use to a more critical care adjusted use. A more personalized approach is advocated in critical care, and echo is one way to reach such goal. Correct application necessitates optimum understanding, interpretation, and finally integration into patients' clinical management. As more critical care doctors are advancing from basic focused echo examinations to a more advanced one, this article is trying to underlie many pitfalls of critical care echocardiography in order to guide better practice...
August 2018: Journal of Intensive Care Medicine
Amr S Omar, Hesham Ewila, Mahmoud Allam, Sameh Aboulnagah, Samy Hanoura, Praveen C Sivadasan, Ousama Bilal, Abdul Rasheed A Pattath, Abdulaziz AlKhulaifi
OBJECTIVES: Postoperative atrial fibrillation (POAF) remains a major risk after cardiac surgery. Twelve percent patients admitted to this unit postcardiac surgery experienced POAF, which led to hemodynamic instability, increased risk of stroke, and increased length of postoperative intensive care unit stay. Our aim was to decrease the incidence of POAF in the cardiothoracic intensive care unit by the end of April 2014. METHODS: Design-Retrospective data analysis...
August 2018: Journal of Intensive Care Medicine
Drayton A Hammond, Melanie N Smith, Kristen C Lee, Danielle Honein, April Miller Quidley
Heart failure (HF) is a societal burden due to its high prevalence, frequent admissions for acute decompensated heart failure (ADHF), and the economic impact of direct and indirect costs associated with HF and ADHF. Common etiologies of ADHF include medication and diet noncompliance, arrhythmias, deterioration in renal function, poorly controlled hypertension, myocardial infarction, and infections. Appropriate medical management of ADHF in patients is guided by the identification of signs and symptoms of fluid overload or low cardiac output and utilization of evidence-based practices...
August 2018: Journal of Intensive Care Medicine
Anna P Sattah, Michael H Secrist, Shawn Sarin
Endovascular treatments have become increasingly common for patients with a variety of thoracic aortic pathologies. Although considered less invasive than traditional open surgical approaches, they are nonetheless complex procedures. Patients undergo manipulation of an often calcified aorta near the origin of the carotid and subclavian vessels and have stents placed in a curved vessel adjacent to a perpetually beating heart. These stents can obstruct blood flow to the spinal cord, induce an inflammatory response, and in rare cases erode into the adjacent trachea or esophagus...
July 2018: Journal of Intensive Care Medicine
Jing Chen, Dalong Sun, Weiming Yang, Mingli Liu, Shufan Zhang, Jinhua Peng, Chuancheng Ren
OBJECTIVE: To evaluate the impact of telemedicine programs in intensive care unit (Tele-ICU) on ICU or hospital mortality or ICU or hospital length of stay and to summarize available data on implementation cost of Tele-ICU. METHODS: Controlled trails or observational studies assessing outcomes of interest were identified by searching 7 electronic databases from inception to July 2016 and related journals and conference literatures between 2000 and 2016. Two reviewers independently screened searched records, extracted data, and assessed the quality of included studies...
July 2018: Journal of Intensive Care Medicine
Sheldon Magder, Karim Serri, Sara Verscheure, Renée Chauvin, Peter Goldberg
PURPOSE: To obtain a point prevalence estimate of alterations in central venous pressure (CVP) produced by active expiration in a consecutive series of intensive care patients. METHODS: We evaluated CVP tracings taken by the nurses at their morning shift change in a consecutive series of 60 cardiac surgery and 59 noncardiac surgery patients. We also assessed change in values due to the change in transducer level. Three physicians and a nurse instructor independently reviewed the tracings and determined whether there was evidence of forced expiration and whether it was type A, defined by decreasing CVP during expiration, or type B, defined by increasing CVP during expiration...
July 2018: Journal of Intensive Care Medicine
Uwe Hamsen, Oliver Kamp, Chris Kaczmarek, Mirko Aach, Christian Waydhas, Thomas A Schildhauer, Oliver Jansen
BACKGROUND: Ankylosing spondylitis (AS) is a common disease with an incidence of approximately 0.5% in Europe, causing severe limitations of axial spine mobility and cervical kyphosis. Deformities of the cervical spine and the temporomandibular joints could increase the risk of complications while performing an intubation or tracheostomy. The percutaneous dilatational tracheostomy (PDT) is a standard procedure in intensive care medicine. However, the combination of cervical kyphosis and osteoporosis makes patient positioning challenging...
July 2018: Journal of Intensive Care Medicine
Nicole M Palm, Brian McKinzie, Pamela L Ferguson, Emily Chapman, Margaret Dorlon, Evert A Eriksson, Brent Jewett, Stuart M Leon, Alicia R Privette, Samir M Fakhry
OBJECTIVE: Stress gastropathy is a rare complication of the intensive care unit stay with high morbidity and mortality. There are data that support the concept that patients tolerating enteral nutrition have sufficient gut blood flow to obviate the need for prophylaxis; however, no robust studies exist. This study assesses the incidence of clinically significant gastrointestinal bleeding in surgical trauma intensive care unit (STICU) patients at risk of stress gastropathy secondary to mechanical ventilation receiving enteral nutrition without pharmacologic prophylaxis...
July 2018: Journal of Intensive Care Medicine
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