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Critical Care Clinics

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https://www.readbyqxmd.com/read/29907278/challenges-and-future-directions-in-left-ventricular-assist-device-therapy
#1
REVIEW
Manreet K Kanwar, Stephen Bailey, Srinivas Murali
The clinical use of left ventricular assist devices (LVADs) in the growing epidemic of heart failure has improved quality of life and long-term survival for this otherwise devastating disease. The current generation of commercially available devices offers a smaller profile that simplifies surgical implantation, a design that optimizes blood flow characteristics, with less adverse events and improved durability than their predecessors. Despite this, the risk for adverse events remains significant, as do burdens for patients and their caregivers...
July 2018: Critical Care Clinics
https://www.readbyqxmd.com/read/29907277/complications-of-durable-left-ventricular-assist-device-therapy
#2
REVIEW
Sitaramesh Emani
Heart failure patients on durable left ventricular assist device support experience improved survival, quality of life, and exercise capacity. The complication rate, however, remains unacceptably high, although it has declined with improvements in pump design, better patient selection, and greater understanding of the pump physiology and flow dynamics. Most complications are categorized as those related to the pump-patient interface or those related to patient physiology. It is hoped that further engineering progress, and better patient selection through risk stratification, will allow for left ventricular assist device to be totally biocompatible and perform effectively, without affecting biology and homeostasis of the different organ systems...
July 2018: Critical Care Clinics
https://www.readbyqxmd.com/read/29907276/device-management-and-flow-optimization-on-left-ventricular-assist-device-support
#3
REVIEW
Inna Tchoukina, Melissa C Smallfield, Keyur B Shah
The authors discuss principles of continuous flow left ventricular assist device (LVAD) operation, basic differences between the axial and centrifugal flow designs and hemodynamic performance, normal LVAD physiology, and device interaction with the heart. Systematic interpretation of LVAD parameters and recognition of abnormal patterns of flow and pulsatility on the device interrogation are necessary for clinical assessment of the patient. Optimization of pump flow using LVAD parameters and echocardiographic and hemodynamics guidance are reviewed...
July 2018: Critical Care Clinics
https://www.readbyqxmd.com/read/29907275/prevention-and-treatment-of-right-ventricular-failure-during-left-ventricular-assist-device-therapy
#4
REVIEW
Amresh Raina, Maria Patarroyo-Aponte
Left ventricular assist devices (LVAD) are increasingly used for the treatment of end-stage heart failure. Right ventricular (RV) failure after LVAD implantation is an increasingly common clinical problem, occurring in patients early after continuous flow LVAD implant. RV failure is associated with a substantial increase in post-LVAD morbidity and mortality. RV failure can be predicted using preoperative hemodynamic, clinical, and echocardiographic variables and a variety of risk prediction algorithms. However, RV failure may also develop due to unanticipated intraoperative or perioperative factors...
July 2018: Critical Care Clinics
https://www.readbyqxmd.com/read/29907274/a-targeted-management-approach-to-cardiogenic-shock
#5
REVIEW
Mithun Chakravarthy, Masaki Tsukashita, Srinivas Murali
Cardiogenic shock is a clinical syndrome characterized by low cardiac output and sustained tissue hypoperfusion resulting in end-organ dysfunction and death. In-hospital mortality rates range from 50% to 60%. Urgent diagnosis, timely transfer to a tertiary or quaternary medical facility with critical care management capabilities and multidisciplinary shock teams is a must to increase survival. Aggressive, hemodynamically guided medical management with careful monitoring of clinical and hemodynamic parameters with timely use of appropriate mechanical circulatory support devices is often necessary...
July 2018: Critical Care Clinics
https://www.readbyqxmd.com/read/29907273/extracorporeal-gas-exchange
#6
REVIEW
Onnen Moerer, Francesco Vasques, Eleonora Duscio, Francesco Cipulli, Federica Romitti, Luciano Gattinoni, Michael Quintel
Extracorporeal gas exchange is increasingly used for various indications. Among these are refractory acute respiratory failure, including the acute respiratory distress syndrome (ARDS), and the avoidance of ventilator-induced lung injury (VILI) by enabling lung-protective ventilation. Additionally, extracorporeal gas exchange allows the treatment of hypercapnic respiratory failure while helping to unload the respiratory muscles and avoid intubation and invasive ventilation, as well as facilitating weaning from the ventilator...
July 2018: Critical Care Clinics
https://www.readbyqxmd.com/read/29907272/noninvasive-options
#7
REVIEW
Giuseppe Bello, Alessandra Ionescu Maddalena, Valentina Giammatteo, Massimo Antonelli
Noninvasive ventilation (NIV) has assumed a central role in the treatment of selected patients with acute respiratory failure due to exacerbated chronic obstructive pulmonary disease or acute cardiogenic pulmonary edema. Recent advances in the understanding of physiologic aspects of NIV application through different interfaces and ventilator settings have led to improved patient-machine interaction, enhancing favorable NIV outcome. In recent years, the growing role of NIV in the acute care setting has led to the development of technical innovations to overcome the problems related to gas leakage and dead space, improving the quality of the devices and optimizing ventilation modes...
July 2018: Critical Care Clinics
https://www.readbyqxmd.com/read/29907271/automation-of-mechanical-ventilation
#8
REVIEW
Richard D Branson
Closed loop control of mechanical ventilation is routine and operates behind the ventilator interface. Reducing caregiver interactions is neither an advantage for the patient or the staff. Automated systems causing lack of situational awareness of the intensive care unit are a concern. Along with autonomous systems must come monitoring and displays that display patients' current condition and response to therapy. Alert notifications for sudden escalation of therapy are required to ensure patient safety. Automated ventilation is useful in remote settings in the absence of experts...
July 2018: Critical Care Clinics
https://www.readbyqxmd.com/read/29907270/avoiding-respiratory-and-peripheral-muscle-injury-during-mechanical-ventilation-diaphragm-protective-ventilation-and-early-mobilization
#9
REVIEW
Annia Schreiber, Michele Bertoni, Ewan C Goligher
Both limb muscle weakness and respiratory muscle weakness are exceedingly common in critically ill patients. Respiratory muscle weakness prolongs ventilator dependence, predisposing to nosocomial complications and death. Limb muscle weakness persists for months after discharge from intensive care and results in poor long-term functional status and quality of life. Major mechanisms of muscle injury include critical illness polymyoneuropathy, sepsis, pharmacologic exposures, metabolic derangements, and excessive muscle loading and unloading...
July 2018: Critical Care Clinics
https://www.readbyqxmd.com/read/29907269/determinants-and-prevention-of-ventilator-induced-lung-injury
#10
REVIEW
Francesco Vasques, Eleonora Duscio, Francesco Cipulli, Federica Romitti, Michael Quintel, Luciano Gattinoni
Ventilator-induced lung injury develops from interactions between the lung parenchyma and applied mechanical power. In acute respiratory distress syndrome, the lung is smaller size with an inhomogeneous structure. The same mechanical force applied on a reduced parenchyma would produce volutrauma; the concentration of mechanical forces at inhomogeneous interfaces produces atelectrauma. Higher positive end-expiratory pressures favor volutrauma and reduce atelectrauma; lower values do the opposite. Volutrauma and atelectrauma harms and benefits, however, seem to be equivalent at 5 to 15 cm H2 O...
July 2018: Critical Care Clinics
https://www.readbyqxmd.com/read/29907268/asynchrony-consequences-and-management
#11
REVIEW
Tài Pham, Irene Telias, Thomas Piraino, Takeshi Yoshida, Laurent J Brochard
Poor synchrony between the delivery of mechanical breaths, the neural respiratory timing, and needs of patients is relatively frequent under mechanical ventilation in the intensive care unit. This review summarizes the current knowledge on the different types of dyssynchrony described to date, their mechanism, consequences, and potential management. There is still a long way to get to a comprehensive knowledge and uncertainties remain. Ongoing research and development of monitoring tools are urgently needed to allow a better appraisal of this area in a near future...
July 2018: Critical Care Clinics
https://www.readbyqxmd.com/read/29907267/critical-care-airway-management
#12
REVIEW
Etieno U Umobong, Paul H Mayo
Critical care airway management is associated with a variety of complications, including severe oxygen desaturation, life-threatening hypotension, and death. This article reviews aspects of airway management that are relevant to intensivists and emergency medicine clinicians tasked with improving the quality of urgent endotracheal intubation in the critically ill patient.
July 2018: Critical Care Clinics
https://www.readbyqxmd.com/read/29482910/fluid-therapy-in-the-critically-ill
#13
EDITORIAL
Andrew D Shaw, Sean M Bagshaw
No abstract text is available yet for this article.
April 2018: Critical Care Clinics
https://www.readbyqxmd.com/read/29482909/why-rrs-where-rrs
#14
EDITORIAL
Michael A DeVita, Kenneth Hillman
No abstract text is available yet for this article.
April 2018: Critical Care Clinics
https://www.readbyqxmd.com/read/29482908/blood-product-administration-in-the-critical-care-and-perioperative-settings
#15
REVIEW
Sofie Louise Rygård, Lars Broksø Holst, Anders Perner
The critical care and perioperative settings are high consumers of blood products, with multiple units and different products often given to an individual patient. The recommendation of this review is always to consider the risks and benefits for a specific blood product for a specific patient in a specific clinical setting. Optimize patient status by treating anemia and preventing the need for red blood cell transfusion. Consider other options for correction of anemia and coagulation disorders and use an imperative non-overtransfusion policy for all blood products...
April 2018: Critical Care Clinics
https://www.readbyqxmd.com/read/29482907/does-fluid-type-and-amount-affect-kidney-function-in-critical-illness
#16
REVIEW
Neil J Glassford, Rinaldo Bellomo
Acute kidney injury (AKI) is common, although commonly used clinical diagnostic markers are imperfect. Intravenous fluid administration remains a cornerstone of therapy worldwide, but there is minimal evidence of efficacy for the use of fluid bolus therapy outside of specific circumstances, and emerging evidence associates fluid accumulation with worse renal outcomes and even increased mortality among critically ill patients. Artificial colloid solutions have been associated with harm, and chloride-rich solutions may adversely affect renal function...
April 2018: Critical Care Clinics
https://www.readbyqxmd.com/read/29482906/applied-physiology-of-fluid-resuscitation-in-critical-illness
#17
REVIEW
Sabrina Arshed, Michael R Pinsky
Fluids during resuscitation from shock increase mean systemic pressure and venous return. The pressure gradient for venous return must increase. Mean systemic pressure is the amount of vascular space in unstressed and stressed volume, mostly unstressed. Shock states can decrease mean systemic pressure by increasing unstressed volume, decreasing total blood volume, or decreasing the pressure gradient for venous return. Crystalloids across bodily spaces restore normal volume, whereas colloids remain in the intravascular space...
April 2018: Critical Care Clinics
https://www.readbyqxmd.com/read/29482905/intensivist-presence-at-code-events-is-associated-with-high-survival-and-increased-documentation-rates
#18
REVIEW
Mark Romig, Jordan Duval-Arnould, Bradford D Winters, Heather Newton, Adam Sapirstein
To better support the highest function of the Johns Hopkins Hospital adult code and rapid response teams, a team leadership role was created for a faculty intensivist, with the intention to integrate improve processes of care delivery, documentation, and decision-making. This article examines process and outcomes associated with the introduction of this role. It demonstrates that an intensivist has the potential to improve patient care while offsetting costs through improved billing capture.
April 2018: Critical Care Clinics
https://www.readbyqxmd.com/read/29482904/sepsis-rapid-response-teams
#19
REVIEW
Tammy Ju, Mustafa Al-Mashat, Lisbi Rivas, Babak Sarani
Sepsis rapid response teams are being incorporated into hospitals around the world. Based on the concept of the medical emergency team, the sepsis rapid response team consists of a specifically trained team of health care providers educated in the early recognition, diagnosis, and treatment of patients at risk of having or who have sepsis. Using hospital-wide initiatives consisting of multidisciplinary education, training, and specific resource utilization, such teams have been found to improve patient outcomes...
April 2018: Critical Care Clinics
https://www.readbyqxmd.com/read/29482903/a-decade-of-difficult-airway-response-team-lessons-learned-from-a-hospital-wide-difficult-airway-response-team-program
#20
REVIEW
Lynette Mark, Laeben Lester, Renee Cover, Kurt Herzer
A decade ago the Difficult Airway Response Team (DART) program was created at The Johns Hopkins Hospital as a multidisciplinary effort to address airway-related adverse events in the nonoperative setting. Root cause analysis of prior events indicated that a major factor in adverse patient outcomes was lack of a systematic approach for responding to difficult airway patients in an emergency. The DART program encompasses operational, safety, and educational initiatives and has responded to approximately 1000 events since its initiation, with no resultant adult airway-related adverse events or morbidity...
April 2018: Critical Care Clinics
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