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Critical Care Research and Practice

Johannes Enevoldsen, Cristhian Potes, Minnan Xu-Wilson, Simon T Vistisen
Background: Extrasystoles may be useful for predicting the response to fluid therapy in hemodynamically unstable patients but their prevalence is unknown. The aim of this study was to estimate the availability of extrasystoles in intensive care unit patients diagnosed with sepsis. The study aim was not to validate the fluid responsiveness prediction ability of extrasystoles. Methods: Twenty-four-hour ECG recordings from a convenience sample of 50 patients diagnosed with sepsis were extracted from the MIMIC-II waveform database, and ECGs were visually examined for correct QRS complex detection...
2018: Critical Care Research and Practice
Claire Rimes-Stigare, Bo Ravn, Akil Awad, Klara Torlén, Claes-Roland Martling, Matteo Bottai, Johan Mårtensson, Max Bell
Background: Renal dysfunction after acute kidney injury (AKI) is common, potentially modifiable, but poorly understood. Acute kidney disease (AKD) describes renal dysfunction 7 to 90 days after AKI and is determined by percentage change in creatinine from baseline. Chronic kidney disease (CKD) is defined as the estimated glomerular filtration rate (eGFR) less than 60 ml/min/1.73 m2 persisting for more than 90 days. We compared CKD incidence using both creatinine- and cystatin C-based GFR with AKD incidence at 90 days in AKI survivors...
2018: Critical Care Research and Practice
Matthew Sczepanski, Paul Bozyk
Introduction: Tissue plasminogen activator (tPA) is commonly used in ischemic cerebral vascular accidents (CVAs). tPA is generally well tolerated; however, orolingual angioedema is a well-documented adverse effect. Angioedema is generally mild, transient, and unilateral but can manifest as severe, life-threatening upper airway obstruction requiring intubation. Reported incidence for all severities ranges from one to five percent, whereas reported incidence of severe cases ranges from 0...
2018: Critical Care Research and Practice
D Jochems, K J P van Wessem, R M Houwert, H B Brouwers, J W Dankbaar, M A van Es, M Geurts, A J C Slooter, L P H Leenen
Introduction: Traumatic brain injury (TBI) remains a major cause of death. Withdrawal of life-sustaining treatment (WLST) can be initiated if there is little anticipated chance of recovery to an acceptable quality of life. The aim of this study was firstly to investigate WLST rates in patients with moderate to severe isolated TBI and secondly to assess outcome data in the survivor group. Material and Methods: A retrospective cohort study was performed. Patients aged ≥ 18 years with moderate or severe isolated TBI admitted to the ICU of a single academic hospital between 2011 and 2015 were included...
2018: Critical Care Research and Practice
Peter M Reardon, Shannon M Fernando, Sasha Van Katwyk, Kednapa Thavorn, Daniel Kobewka, Peter Tanuseputro, Erin Rosenberg, Cynthia Wan, Brandi Vanderspank-Wright, Dalibor Kubelik, Rose Anne Devlin, Christopher Klinger, Kwadwo Kyeremanteng
Background: ICU care is costly, and there is a large variation in cost among patients. Methods: This is an observational study conducted at two ICUs in an academic centre. We compared the demographics, clinical data, and outcomes of the highest decile of patients by total costs, to the rest of the population. Results: A total of 7,849 patients were included. The high-cost group had a longer median ICU length of stay (26 versus 4 days, P < 0...
2018: 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
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