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Critical Care Research and Practice

Niels D Martin, Sagar P Patel, Kristen Chreiman, Jose L Pascual, Benjamin Braslow, Patrick M Reilly, Lewis J Kaplan
Background: Critically ill patients are often evaluated for an intra-abdominal catastrophe. In the absence of a preoperative diagnosis, abdominal exploration may be offered despite desperate circumstances. We hypothesize that (1) abdominal exploration for such patients is associated with a high mortality and (2) commonly obtained physiologic measures at laparotomy anticipate mortality. Methods: All acute care surgery (ACS) patients undergoing emergency laparotomy at a quaternary referral center during a 3-year period were reviewed...
2018: Critical Care Research and Practice
Nathan Murray, Utsav Malla, Ruan Vlok, Alice Scott, Olivia Chua, Thomas Melhuish, Leigh White
Introduction: In lab-based studies, buprenorphine appears to have a ceiling effect on respiratory depression but not on analgesia. There is increasing evidence in adult patients that buprenorphine has no ceiling effect on analgesia or side effects. The aim of this study was to investigate the efficacy and adverse effects of buprenorphine versus morphine in paediatric acute pain. Methods: A systematic review of five databases was performed until May 2018. Only randomised controlled trials were eligible for inclusion...
2018: Critical Care Research and Practice
Christos Lazaridis, Laith Altaweel, Dimitrios Karakitsos
No abstract text is available yet for this article.
2018: Critical Care Research and Practice
Gloria-Beatrice Wintermann, Jenny Rosendahl, Kerstin Weidner, Bernhard Strauß, Katja Petrowski
Objective: Major depressive disorder (MDD) is a common condition following treatment in the Intensive Care Unit (ICU). Long-term data on MDD in chronically critically ill (CCI) patients are scarce. Hence, the primary aim of the present study was to investigate the frequency and predictors of MDD after intensive care of CCI patients. Materials and Methods: In a prospective cohort study, patients with long-term mechanical ventilation requirements ( n =131) were assessed with respect to a diagnosis of MDD, using the Structured Clinical Interview for DSM-IV, three and six months after the transfer from acute ICU to post-acute ICU...
2018: Critical Care Research and Practice
Joost D J Plate, Linda M Peelen, Luke P H Leenen, Roderick M Houwert, Falco Hietbrink
Rationale , Aims , and Objectives . The Intermediate Care Unit (IMCU) is a hospital unit which is logistically situated between the hospital ward and the Intensive Care Unit (ICU). There is debate regarding the value of the IMCU. Understanding its value is compromised by the lack of adequate quality indicators. Therefore, this study identifies currently used IMCU indicators and evaluates their usefulness. Methods . Through a systematic literature search, currently used quality indicators were identified and evaluated for their importance using a proposed IMCU-specific quality measurement framework...
2018: Critical Care Research and Practice
Marcela Aparecida Leite, Erica Fernanda Osaku, Jaqueline Albert, Claudia Rejane Lima de Macedo Costa, Alessandra Madalena Garcia, Francieli do Nascimento Czapiesvski, Suely Mariko Ogasawara, Gladson Ricardo Flor Bertolini, Amaury Cezar Jorge, Péricles Almeida Delfino Duarte
Background: Deep and respiratory muscle disorders are commonly observed in critically ill patients. Neuromuscular electrical stimulation (NMES) is an alternative to mobilize and to exercise that does not require active patient participation and can be used on bedridden patients. Objective: Evaluate the effectiveness of the NMES therapy in quadriceps versus diaphragm subjects in mechanical ventilation (MV). Methods: Sixty-seven subjects in MV were included, divided into 3 groups: (a) control group (CG, n =26), (b) stimulation of quadriceps (quadriceps group-QG, n =24), and (c) stimulation of diaphragm (diaphragm group-DG, n =17)...
2018: Critical Care Research and Practice
Ibrahim Soliman, Waleed Tharwat Aletreby, Fahad Faqihi, Nasir Nasim Mahmood, Omar E Ramadan, Ahmad Fouad Mady, Babar Kahlon, Abdulrahman Alharthy, Peter Brindley, Dimitrios Karakitsos
Background: Dedicated neurocritical care units have dramatically improved the management and outcome following brain injury worldwide. Aim: This is the first study in the Middle East to evaluate the clinical impact of a neurocritical care unit (NCCU) launched within the diverse clinical setting of a polyvalent intensive care unit (ICU). Design and Methods: A retrospective before and after cohort study comparing the outcomes of neurologically injured patients...
2018: Critical Care Research and Practice
Alok Dabi, Aristides P Koutrouvelis
Direct oral anticoagulants (DOACs) are a new class of anticoagulants that directly inhibit either thrombin or factor Xa in the coagulation cascade. They are being increasingly used instead of warfarin or other vitamin K antagonists (VKAs). Adverse side effects of DOACs may result in hemorrhagic complications, including life-threatening intracranial hemorrhage (ICH), though to a much lesser degree than VKAs. Currently there are relatively limited indications for DOACS but their usage is certain to expand with the availability of their respective specific reversal agents...
2018: Critical Care Research and Practice
Aldo A Mendez, Edgar A Samaniego, Sunil A Sheth, Sudeepta Dandapat, David M Hasan, Kaustubh S Limaye, Bradley J Hindman, Colin P Derdeyn, Santiago Ortega-Gutierrez
Acute ischemic stroke (AIS) remains a leading cause of death and long-term disability. The paradigms on prehospital care, reperfusion therapies, and postreperfusion management of patients with AIS continue to evolve. After the publication of pivotal clinical trials, endovascular thrombectomy has become part of the standard of care in selected cases of AIS since 2015. New stroke guidelines have been recently published, and the time window for mechanical thrombectomy has now been extended up to 24 hours. This review aims to provide a focused up-to-date review for the early management of adult patients with AIS and introduce the new upcoming areas of ongoing research...
2018: Critical Care Research and Practice
Elahe Nematifard, Seyed Hossein Ardehali, Shaahin Shahbazi, Hassan Eini-Zinab, Zahra Vahdat Shariatpanahi
Background: The objective of the present study was to compare the ability of Acute Physiology and Chronic Health Evaluation (APACHE) scoring systems with the combination of an anthropometric variable score "adductor pollicis muscle (APM) thickness" to the APACHE systems in predicting mortality in the intensive care unit. Methods: A prospective observational study was conducted with the APM thickness in the dominant hand, and APACHE II and III scores were measured for each patient upon admission...
2018: Critical Care Research and Practice
Abbasali Ebrahimian, Seyed-Hossein Hashemi-Amrei, Mohammadreza Monesan
Introduction: Appropriate decision-making is essential in emergency situations; however, little information is available on how emergency decision-makers decide on the emergency status of the patients shifted to the emergency department of the hospital. This study aimed at explaining the factors that influence the emergency specialists' decision-making in case of emergency conditions in patients. Methods: This study was carried out with a qualitative content analysis approach...
2018: Critical Care Research and Practice
Rohit Marawar, Maysaa Basha, Advait Mahulikar, Aaron Desai, Kushak Suchdev, Aashit Shah
Refractory status epilepticus is defined as persistent seizures despite appropriate use of two intravenous medications, one of which is a benzodiazepine. It can be seen in up to 40% of cases of status epilepticus with an acute symptomatic etiology as the most likely cause. New-onset refractory status epilepticus (NORSE) is a recently coined term for refractory status epilepticus where no apparent cause is found after initial testing. A large proportion of NORSE cases are eventually found to have an autoimmune etiology needing immunomodulatory treatment...
2018: Critical Care Research and Practice
Jordan Michel Duval-Arnould, Heather Marie Newton, Leann McNamara, Branden Michael Engorn, Kareen Jones, Meghan Bernier, Pamela Dodge, Cheryl Salamone, Utpal Bhalala, Justin M Jeffers, Lilly Engineer, Marie Diener-West, Elizabeth Anne Hunt
Objective: We aimed to increase detection of pediatric cardiopulmonary resuscitation (CPR) events and collection of physiologic and performance data for use in quality improvement (QI) efforts. Materials and Methods: We developed a workflow-driven surveillance system that leveraged organizational information technology systems to trigger CPR detection and analysis processes. We characterized detection by notification source, type, location, and year, and compared it to previous methods of detection...
2018: Critical Care Research and Practice
Sean S Barnes, Marco A Grados, Sapna R Kudchadkar
Objectives: To characterize the engagement of child psychiatry by pediatric intensivists in cases of suspected delirium in a pediatric intensive care unit (PICU) prior to implementation of a delirium management algorithm with regards to recommendations, antipsychotic prescribing, and follow-up after PICU discharge. Design: Retrospective chart review. Setting: Single-center tertiary PICU. Subjects: Sixteen patients who received child psychiatry consultation for suspected delirium while in the PICU...
2018: Critical Care Research and Practice
Angelica Venni, Francesca Ioia, Silvia Laviola, Francesca Frigieri, Alessandra Pieri, Simona Marilli, Daniela Balzi, Piercarlo Ballo, Stefano Gori, Diletta Guarducci
Background: Postdischarge deterioration in health-related quality of life (HRQoL) is a major clinical issue for patients after an intensive care unit (ICU) hospitalization. A significant proportion of these patients is known to develop a progressive worsening of mental and physical performance-the so-called post-intensive care syndrome (PICS). Aim: We aimed at exploring the effects of a structured program for the management of ICU patients, aimed at improving postdischarge HRQoL and reducing the risk of PICS...
2018: Critical Care Research and Practice
Ibrahim Soliman, Garrett G R J Johnson, Lawrence M Gillman, Frederick A Zeiler, Fahad Faqihi, Waleed Tharwat Aletreby, Abdullah Balhamar, Nasir Nasim Mahmood, Shahzad Ahmad Mumtaz, Abdulrahman Alharthy, Christos Lazaridis, Dimitrios Karakitsos
Background: New sonographic quality criteria to optimize optic nerve sheath diameter (ONSD) measurements were suggested. The latter were correlated to elevated intracranial pressure (ICP) in traumatic brain injury (TBI). Aim: We investigated whether ONSD measurements were correlated to simultaneous ICP measurements in severe TBI. Methods: Forty patients with severe TBI (Marshall Scale ≥II and GCS ≤8) participated in the study. All patients had an intraparenchymal ICP catheter inserted, while ONSD was measured bilaterally, upon admission and over the next 48 hours, based on the new sonographic criteria...
2018: Critical Care Research and Practice
Gul Gursel, Kamil Inci, Zenfira Alasgarova
Background: Diaphragm dysfunction (DD) is frequently seen in critically ill patients, and ultrasound could be a useful tool to detect it and to predict extubation success or failure in mechanically ventilated patients. Besides, it would also be useful in differential diagnosis of dyspnea and respiratory failure. The aim of this study is to evaluate usefulness and accuracy of pocket-sized ultrasound devices (PSDs) in assessment of DD in intensive care unit (ICU) patients in comparison with standard ultrasound devices (SD)...
2018: Critical Care Research and Practice
Syed Omar Kazmi, Sanjeev Sivakumar, Dimitrios Karakitsos, Abdulrahman Alharthy, Christos Lazaridis
Extracorporeal membrane oxygenation (ECMO) is a life-saving technique that is widely being used in centers throughout the world. However, there is a paucity of literature surrounding the mechanisms affecting cerebral physiology while on ECMO. Studies have shown alterations in cerebral blood flow characteristics and subsequently autoregulation. Furthermore, the mechanical aspects of the ECMO circuit itself may affect cerebral circulation. The nature of these physiological/pathophysiological changes can lead to profound neurological complications...
2018: Critical Care Research and Practice
Daniel J Minter, Sean D Levy, Sowmya R Rao, Paul F Currier
Background: The United States (US) is experiencing a growing shortage of critical care medicine (CCM) trained physicians. Little is known about the exposures to CCM experienced by internal medicine (IM) residents or factors that may influence their decision to pursue a career in pulmonary/critical care medicine (PCCM). Methods: We conducted a survey of US IM residency program directors (PDs) and then used multivariable logistic regression to identify factors that were predictive of residency programs with a higher percentage of graduates pursuing careers in PCCM...
2018: Critical Care Research and Practice
Hatem Elmoutaz Mahmoud, Doaa Abou Elkassim Rashwan
Patients with sleep apnea are prone to postoperative respiratory complications, requiring restriction of sedatives during perioperative care. We performed a prospective randomized study on 24 patients with obstructive sleep apnea (OSA) who underwent elective surgery under general anesthesia. The patients were equally divided into two groups: Group Dex : received dexmedetomidine loading dose 1 mcg/kg IV over 10 min followed by infusion of 0.2-0.7 mcg/kg/hr; Group KFL : received ketofol as an initial bolus dose 500 mcg/kg IV (ketamine/propofol 1 : 1) and maintenance dose of 5-10 mcg/kg/min...
2018: Critical Care Research and Practice
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