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Critical Care: the Official Journal of the Critical Care Forum

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https://www.readbyqxmd.com/read/29792232/effect-of-postoperative-goal-directed-therapy-in-cancer-patients-undergoing-high-risk-surgery-a-randomized-clinical-trial-and-meta-analysis
#1
Aline Rejane Muller Gerent, Juliano Pinheiro Almeida, Evgeny Fominskiy, Giovanni Landoni, Gisele Queiroz de Oliveira, Stephanie Itala Rizk, Julia Tizue Fukushima, Claudia Marques Simoes, Ulysses Ribeiro, Clarice Lee Park, Rosana Ely Nakamura, Rafael Alves Franco, Patricia Inês Cândido, Cintia Rosa Tavares, Ligia Camara, Graziela Dos Santos Rocha Ferreira, Elisangela Pinto Marinho de Almeida, Roberto Kalil Filho, Filomena Regina Barbosa Gomes Galas, Ludhmila Abrahão Hajjar
BACKGROUND: Perioperative goal-directed hemodynamic therapy (GDHT) has been advocated in high-risk patients undergoing noncardiac surgery to reduce postoperative morbidity and mortality. We hypothesized that using cardiac index (CI)-guided GDHT in the postoperative period for patients undergoing high-risk surgery for cancer treatment would reduce 30-day mortality and postoperative complications. METHODS: A randomized, parallel-group, superiority trial was performed in a tertiary oncology hospital...
May 23, 2018: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29792219/effect-of-intensive-glycaemic-control-on-moderate-hypoglycaemia-and-icu-length-of-stay-in-severe-traumatic-brain-injury
#2
LETTER
Rafael A Núñez-Patiño, Andres Zorrilla-Vaca, Daniel Agustin Godoy
No abstract text is available yet for this article.
May 23, 2018: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29788993/acetylcholine-receptor-antagonists-in-acute-respiratory-distress-syndrome-much-more-than-muscle-relaxants
#3
EDITORIAL
Diana Jansen, Heder de Vries, Leo M A Heunks
Acetylcholine receptor antagonists have been shown to improve outcome in patients with severe acute respiratory distress syndrome. However, it is incompletely understood how these agents improve outcome. In the current editorial, we discuss the mechanisms of action of acetylcholine receptor antagonists beyond neuromuscular blockade.
May 22, 2018: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29784057/incidence-of-hypotension-according-to-the-discontinuation-order-of-vasopressors-in-the-management-of-septic-shock-a-prospective-randomized-trial-dovss
#4
Kyeongman Jeon, Jae-Uk Song, Chi Ryang Chung, Jeong Hoon Yang, Gee Young Suh
BACKGROUND: Vasopressin (AVP) is commonly added to norepinephrine (NE) to reverse shock in patients with sepsis. However, there are no data to support the appropriate strategy of vasopressor tapering in patients on concomitant NE and AVP who are recovering from septic shock. Therefore, the objective of this study was to evaluate the incidence of hypotension while tapering vasopressors in patients on concomitant NE and AVP recovering from septic shock. METHODS: Patients with septic shock receiving concomitant NE and AVP were randomly assigned to taper NE first (NE group) or AVP first (AVP group)...
May 21, 2018: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29759075/metabolic-profiles-in-community-acquired-pneumonia-developing-assessment-tools-for-disease-severity
#5
Pu Ning, Yali Zheng, Qiongzhen Luo, Xiaohui Liu, Yu Kang, Yan Zhang, Rongbao Zhang, Yu Xu, Donghong Yang, Wen Xi, Keqiang Wang, Yusheng Chen, Shuchang An, Zhancheng Gao
BACKGROUND: This study aimed to determine whether community-acquired pneumonia (CAP) had a metabolic profile and whether this profile can be used for disease severity assessment. METHODS: A total of 175 individuals including 119 CAP patients and 56 controls were enrolled and divided into two cohorts. Serum samples from a discovery cohort (n = 102, including 38 non-severe CAP, 30 severe CAP, and 34 age and sex-matched controls) were determined by untargeted ultra-high-performance liquid chromatography with tandem mass spectrometry (LC-MS/MS)-based metabolomics...
May 14, 2018: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29753330/ramped-position-an-uncertain-future
#6
LETTER
Luigi Vetrugno, Daniele Orso, Tiziana Bove
No abstract text is available yet for this article.
May 13, 2018: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29753321/influence-of-pathogen-and-focus-of-infection-on-procalcitonin-values-in-sepsis-patients-with-bacteremia-or-candidemia
#7
Daniel O Thomas-Rüddel, Bernhard Poidinger, Matthias Kott, Manfred Weiss, Konrad Reinhart, Frank Bloos
BACKGROUND: This study aimed to evaluate the accuracy of procalcitonin (PCT) serum concentrations to diagnose Gram-negative bacteremia and the association of PCT serum concentrations with more specific pathogens and the focus of infection. METHODS: Secondary analysis of the prospectively collected patient-level dataset from a cluster randomized quality improvement trial was performed. The trial included sepsis patients with organ dysfunction treated in the participating intensive care units from 2011 to 2015...
May 13, 2018: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29751827/timp-2-igfbp7-predicts-acute-kidney-injury-in-out-of-hospital-cardiac-arrest-survivors
#8
Christoph Adler, Tobias Heller, Felix Schregel, Henning Hagmann, Martin Hellmich, Joana Adler, Hannes Reuter
BACKGROUND: Acute kidney injury (AKI) is a common complication after cardiopulmonary resuscitation (CPR) and predicts in-hospital mortality. To which extent post-resuscitation disease or the initial event of cardiac arrest and the duration of insufficient cardiac output triggers AKI is challenging to discriminate. Knowledge on molecular mediators of AKI is scarce. Early identification of patients at high risk of AKI is hampered by the low sensitivity of the established tests in clinical routine practice...
May 12, 2018: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29751822/experience-of-using-beta-d-glucan-assays-in-the-intensive-care-unit
#9
LETTER
A Dagens, N Mughal, A Sisson, L S P Moore
No abstract text is available yet for this article.
May 12, 2018: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29747699/clinical-chronobiology-a-timely-consideration-in-critical-care-medicine
#10
REVIEW
Helen McKenna, Gijsbertus T J van der Horst, Irwin Reiss, Daniel Martin
A fundamental aspect of human physiology is its cyclical nature over a 24-h period, a feature conserved across most life on Earth. Organisms compartmentalise processes with respect to time in order to promote survival, in a manner that mirrors the rotation of the planet and accompanying diurnal cycles of light and darkness. The influence of circadian rhythms can no longer be overlooked in clinical settings; this review provides intensivists with an up-to-date understanding of the burgeoning field of chronobiology, and suggests ways to incorporate these concepts into daily practice to improve patient outcomes...
May 11, 2018: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29747648/pulmonary-vein-signal-in-mitral-regurgitation
#11
LETTER
Tim Balthazar, Bart Jacobs, Jens-Uwe Voigt
No abstract text is available yet for this article.
May 11, 2018: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29747674/the-choice-of-a-postpyloric-tube-and-the-patient-s-position-in-our-procedure-a-response
#12
LETTER
Bei Hu, Bo Lv, Chunbo Chen
No abstract text is available yet for this article.
May 10, 2018: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29743094/feasibility-and-safety-of-low-flow-extracorporeal-co-2-removal-managed-with-a-renal-replacement-platform-to-enhance-lung-protective-ventilation-of-patients-with-mild-to-moderate-ards
#13
Matthieu Schmidt, Samir Jaber, Elie Zogheib, Thomas Godet, Gilles Capellier, Alain Combes
BACKGROUND: Extracorporeal carbon-dioxide removal (ECCO2 R) might allow ultraprotective mechanical ventilation with lower tidal volume (VT) (< 6 ml/kg predicted body weight), plateau pressure (Pplat ) (< 30 cmH2 O), and driving pressure to limit ventilator-induced lung injury. This study was undertaken to assess the feasibility and safety of ECCO2 R managed with a renal replacement therapy (RRT) platform to enable very low tidal volume ventilation of patients with mild-to-moderate acute respiratory distress syndrome (ARDS)...
May 10, 2018: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29743121/high-frequency-oscillatory-ventilation-guided-by-transpulmonary-pressure-in-acute-respiratory-syndrome-an-experimental-study-in-pigs
#14
Philipp Klapsing, Onnen Moerer, Christoph Wende, Peter Herrmann, Michael Quintel, Annalen Bleckmann, Jan Florian Heuer
BACKGROUND: Recent clinical studies have not shown an overall benefit of high-frequency oscillatory ventilation (HFOV), possibly due to injurious or non-individualized HFOV settings. We compared conventional HFOV (HFOVcon ) settings with HFOV settings based on mean transpulmonary pressures (PLmean ) in an animal model of experimental acute respiratory distress syndrome (ARDS). METHODS: ARDS was induced in eight pigs by intrabronchial installation of hydrochloric acid (0...
May 9, 2018: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29743098/impact-of-flow-and-temperature-on-patient-comfort-during-respiratory-support-by-high-flow-nasal-cannula
#15
Tommaso Mauri, Alessandro Galazzi, Filippo Binda, Laura Masciopinto, Nadia Corcione, Eleonora Carlesso, Marta Lazzeri, Elena Spinelli, Daniela Tubiolo, Carlo Alberto Volta, Ileana Adamini, Antonio Pesenti, Giacomo Grasselli
BACKGROUND: The high-flow nasal cannula (HFNC) delivers up to 60 l/min of humidified air/oxygen blend at a temperature close to that of the human body. In this study, we tested whether higher temperature and flow decrease patient comfort. In more severe patients, instead, we hypothesized that higher flow might be associated with improved comfort. METHODS: A prospective, randomized, cross-over study was performed on 40 acute hypoxemic respiratory failure (AHRF) patients (PaO2 /FiO2  ≤ 300 + pulmonary infiltrates + exclusion of cardiogenic edema) supported by HFNC...
May 9, 2018: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29729670/sepsis-is-a-preventable-public-health-problem
#16
LETTER
Jordan A Kempker, Henry E Wang, Greg S Martin
There is a paradigm shift happening for sepsis. Sepsis is no longer solely conceptualized as problem of individual patients treated in emergency departments and intensive care units but also as one that is addressed as public health issue with population- and systems-based solutions. We offer a conceptual framework for sepsis as a public health problem by adapting the traditional model of primary, secondary, and tertiary prevention.
May 6, 2018: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29728151/development-and-validation-of-a-pre-hospital-red-flag-alert-for-activation-of-intra-hospital-haemorrhage-control-response-in-blunt-trauma
#17
Sophie Rym Hamada, Anne Rosa, Tobias Gauss, Jean-Philippe Desclefs, Mathieu Raux, Anatole Harrois, Arnaud Follin, Fabrice Cook, Mathieu Boutonnet, Arie Attias, Sylvain Ausset, Mathieu Boutonnet, Gilles Dhonneur, Jacques Duranteau, Olivier Langeron, Catherine Paugam-Burtz, Romain Pirracchio, Guillaume de St Maurice, Bernard Vigué, Alexandra Rouquette, Jacques Duranteau
BACKGROUND: Haemorrhagic shock is the leading cause of early preventable death in severe trauma. Delayed treatment is a recognized prognostic factor that can be prevented by efficient organization of care. This study aimed to develop and validate Red Flag, a binary alert identifying blunt trauma patients with high risk of severe haemorrhage (SH), to be used by the pre-hospital trauma team in order to trigger an adequate intra-hospital standardized haemorrhage control response: massive transfusion protocol and/or immediate haemostatic procedures...
May 5, 2018: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29728150/delirium-prediction-in-the-intensive-care-unit-comparison-of-two-delirium-prediction-models
#18
Annelies Wassenaar, Lisette Schoonhoven, John W Devlin, Frank M P van Haren, Arjen J C Slooter, Philippe G Jorens, Mathieu van der Jagt, Koen S Simons, Ingrid Egerod, Lisa D Burry, Albertus Beishuizen, Joaquim Matos, A Rogier T Donders, Peter Pickkers, Mark van den Boogaard
BACKGROUND: Accurate prediction of delirium in the intensive care unit (ICU) may facilitate efficient use of early preventive strategies and stratification of ICU patients by delirium risk in clinical research, but the optimal delirium prediction model to use is unclear. We compared the predictive performance and user convenience of the prediction  model for delirium (PRE-DELIRIC) and early prediction model for delirium (E-PRE-DELIRIC) in ICU patients and determined the value of a two-stage calculation...
May 5, 2018: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29728116/implications-for-paediatric-shock-management-in-resource-limited-settings-a-perspective-from-the-feast-trial
#19
Kirsty Anne Houston, Elizabeth C George, Kathryn Maitland
BACKGROUND: Although the African "Fluid Expansion as Supportive therapy" (FEAST) trial showed fluid resuscitation was harmful in children with severe febrile illness managed in resource-limited hospitals, the most recent evidence reviewed World Health Organization (WHO) guidelines continue to recommend fluid boluses in children with shock according to WHO criteria "WHO shock", arguing that the numbers included in the FEAST trial were too small to provide reasonable certainty...
May 4, 2018: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29724231/pathophysiology-echocardiographic-evaluation-biomarker-findings-and-prognostic-implications-of-septic-cardiomyopathy-a-review-of-the-literature
#20
REVIEW
Robert R Ehrman, Ashley N Sullivan, Mark J Favot, Robert L Sherwin, Christian A Reynolds, Aiden Abidov, Phillip D Levy
BACKGROUND: Sepsis is a common condition encountered by emergency and critical care physicians, with significant costs, both economic and human. Myocardial dysfunction in sepsis is a well-recognized but poorly understood phenomenon. There is an extensive body of literature on this subject, yet results are conflicting and no objective definition of septic cardiomyopathy exists, representing a critical knowledge gap. OBJECTIVES: In this article, we review the pathophysiology of septic cardiomyopathy, covering the effects of key inflammatory mediators on both the heart and the peripheral vasculature, highlighting the interconnectedness of these two systems...
May 4, 2018: Critical Care: the Official Journal of the Critical Care Forum
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