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Critical illness weakness

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https://www.readbyqxmd.com/read/29343041/forgoing-life-sustaining-treatments-in-the-icu-to-withhold-or-to-withdraw-is-that-the-question
#1
Giuseppe R Gristina, Francesca Baroncelli, Marco Vergano
In the last decades, mortality from severe acute illnesses has considerably declined thanks to the advances in intensive care medicine. Meanwhile, critical care physicians realized that lifesustaining treatments (LST) may not be appropriate for every patient, and end-of-life care in the Intensive Care Unit (ICU) started to receive growing attention. Most deaths occurring in the ICU now follow a decision to forgo life-sustaining treatments (DFLST), which can be implemented either by withdrawing (WDLST) or withholding (WHLST) life-sustaining treatments...
January 17, 2018: Minerva Anestesiologica
https://www.readbyqxmd.com/read/29324487/renal-replacement-therapy-in-critically-ill-patients-who-when-why-and-how
#2
Melanie Meersch, Alexander Zarbock
PURPOSE OF REVIEW: The increasing incidence of acute kidney injury has the immediate effect of a growing need for renal replacement therapy (RRT). Shedding light on the questions of who, when, why, and how RRT should be performed is difficult to accomplish because of ambiguous study results, poor quality evidence, and low standardization. RECENT FINDINGS: Critically ill patients are exposed to multiple factors known to deteriorate kidney function. Especially severe fluid overload is strongly associated with worse outcome and may be considered as a trigger for initiating RRT...
January 10, 2018: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/29322491/influence-of-prehospital-function-and-strength-on-outcomes-of-critically-ill-older-adults
#3
D Clark Files, Rebecca Neiberg, Julia Rushing, Peter E Morris, Michael P Young, Hilsa Ayonayon, Tamara Harris, Anne Newman, Susan Rubin, Eric Shiroma, Denise Houston, Michael E Miller, Stephen B Kritchevsky
OBJECTIVES: To understand the influence of prehospital physical function and strength on clinical outcomes of critically ill older adults. DESIGN: Secondary analysis of prospective cohort study. SETTING: Health, Aging and Body Composition (Health ABC) Study. PARTICIPANTS: Of 3,075 older adult Health ABC participants, we identified 575 (60% white, 61% male, mean age 79) with prehospital function or grip strength measurements within 2 years of an intensive care unit stay...
January 11, 2018: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/29321220/against-proportional-shortfall-as-a-priority-setting-principle
#4
Samuel Altmann
As the demand for healthcare rises, so does the need for priority setting in healthcare. In this paper, I consider a prominent priority-setting principle: proportional shortfall. My purpose is to argue that proportional shortfall, as a principle, should not be adopted. My key criticism is that proportional shortfall fails to consider past health.Proportional shortfall is justified as it supposedly balances concern for prospective health while still accounting for lifetime health, even though past health is deemed irrelevant...
January 10, 2018: Journal of Medical Ethics
https://www.readbyqxmd.com/read/29301549/icu-acquired-weakness-should-medical-sovereignty-belong-to-any-specialist
#5
Domenico Intiso
ICU-acquired weakness (ICUAW), including critical illness polyneuropathy, critical illness myopathy, and critical illness polyneuropathy and myopathy, is a frequent disabling disorder in ICU subjects. Research has predominantly been performed by intensivists, whose efforts have permitted the diagnosis of ICUAW early during an ICU stay and understanding of several of the pathophysiological and clinical aspects of this disorder. Despite important progress, the therapeutic strategies are unsatisfactory and issues such as functional outcomes and long-term recovery remain unclear...
January 4, 2018: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29281198/alternobaric-vertigo-and-facial-baroparesis-caused-by-scuba-diving-and-relieved-by-chewing-pineapple-a-case-report
#6
Adam Bender-Heine, Zachary W Dillard, Matthew J Zdilla
Equalization of middle ear pressure is an important consideration for scuba divers. When middle ear pressure is asymmetric, a diver may experience alternobaric vertigo. Moreover, individuals with an underlying temporal bone dehiscence are predisposed to facial baroparesis. An understanding on behalf of fellow divers and emergency responders to recognize and differentiate facial baroparesis from decompression illness is critical. Misdiagnosis may lead to inappropriate treatment or unwarranted stoppage of diving...
November 2017: Undersea & Hyperbaric Medicine: Journal of the Undersea and Hyperbaric Medical Society, Inc
https://www.readbyqxmd.com/read/29276219/indirect-calorimetry-measurement-of-energy-expenditure-related-to-body-position-changes-in-healthy-adults
#7
Kengo Obata, Tetsuya Yumoto, Soichiro Fuke, Kohei Tsukahara, Hiromichi Naito, Atsuyoshi Iida, Tetsuya Takahashi, Yoshihito Ujike, Atsunori Nakao
Early mobilization is advocated to prevent intensive care unit-acquired physical weakness, but the patient's workload and its changes in response to body position changes have not been established. We used indirect calorimetry to determine the energy expenditure (EE) in response to body position changes, and we assessed EE's correlation with respiratory parameters in healthy volunteers: 8 males and 8 females, mean age 23.4±1.3 years. The subjects started in the resting supine position followed by a 30° head-up position, a 60° head-up position, an upright sitting position, a standing position, and the resting supine position...
December 2017: Acta Medica Okayama
https://www.readbyqxmd.com/read/29261818/update-in-hospital-palliative-care-symptom-management-communication-caregiver-outcomes-and-moral-distress
#8
Rachel D Havyer, Daniel H Pomerantz, Robert L Jayes, Patricia F Harris, Stephanie M Harman, Aziz A Ansari
BACKGROUND: Updated knowledge of the palliative care (PC) literature is needed to maintain competency and best address the PC needs of hospitalized patients. We critiqued the recent PC literature with the highest potential to impact hospital practice. METHODS: We reviewed articles published between January 2016 and December 2016, which were identified through a handsearch of leading journals and a MEDLINE search. The final 9 articles selected were determined by consensus based on scientific rigor, relevance to hospital medicine, and impact on practice...
December 20, 2017: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
https://www.readbyqxmd.com/read/29248933/relationship-between-short-term-blood-pressure-variability-and-incidence-of-acute-kidney-injury-in-critically-ill-patients
#9
Zhichao Xie, Xuelian Liao, Wanhong Yin, Yan Kang, Jun Guo, Meizhu Lu
BACKGROUND/AIMS: Blood pressure (BP) variability is associated with cardiovascular events, and cerebral and renal damage. The aim of this study was to investigate any potential relationship between short-term BP variability and incidence of acute onset conditions, such as acute kidney injury (AKI), in critically ill patients. METHODS: BP was monitored to analyze its variability in critically ill patients in present study. Short-term BP variability was assessed as average real variability (ARV), standard deviation (SD) and coefficient of variation (CV) of 24-hour BP...
December 14, 2017: Kidney & Blood Pressure Research
https://www.readbyqxmd.com/read/29241382/causes-of-mortality-in-icu-acquired-weakness
#10
Linda van Wagenberg, Esther Witteveen, Luuk Wieske, Janneke Horn
BACKGROUND: Intensive care unit-acquired weakness (ICU-AW) is a common complication of critical illness and is associated with increased mortality, longer mechanical ventilation and longer hospital stay. Little is known about the causes of mortality in patients with ICU-AW. In this study, we aimed to give an overview of the causes of death in a population diagnosed with ICU-AW during hospital admission. METHODS: Data from a prospective cohort study in the mixed medical-surgical ICU of the Academic Medical Center in Amsterdam were used...
January 1, 2017: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/29222034/management-of-invasive-candidiasis-and-candidemia-in-critically-ill-adults-expert-opinion-of-the-european-society-of-anaesthesia-esa-intensive-care-scientific-subcommittee
#11
REVIEW
Ruth-Aoibheann OLeary, Sharon Einav, Marc Leone, Krisztina Madách, Claude Martin, Ignacio Martin-Loeches
OBJECTIVE: The global burden of invasive fungal disease is increasing. Candida albicans remains the leading cause of fungal blood stream infections although non-albicans Candidal infections are emerging. Areas of controversy regarding diagnosis and management are hampering our ability to respond effectively to this evolving threat. The purpose of this narrative review is to address current controversies and provide recommendations to supplement guidelines. DIAGNOSIS OF INVASIVE CANDIDIASIS: Diagnosis of invasive candidiasis requires a combination of diagnostic tests and patient risk factors...
December 5, 2017: Journal of Hospital Infection
https://www.readbyqxmd.com/read/29217105/influence-of-muscle-strength-on-early-mobility-in-critically-ill-adult-patients-systematic-literature-review
#12
REVIEW
Audrey R Roberson, Angela Starkweather, Catherine Grossman, Edmund Acevedo, Jeanne Salyer
BACKGROUND: Muscle strength may be one indicator of readiness to mobilize that can be used to guide decisions regarding early mobility efforts and to progressively advance mobilization. OBJECTIVES: To provide a synthesis of current measures of muscle strength in the assessment of early mobilization in critically ill adult patients who are receiving MV therapy. METHODS: Research studies conducted between 2000-2015 were identified using PubMed, CINHAL, MEDLINE, and the Cochrane Database of Systematic Reviews databases using the search terms "muscle strength", "intensive care", "mechanical ventilation" and "muscle weakness"...
January 2018: Heart & Lung: the Journal of Critical Care
https://www.readbyqxmd.com/read/29208005/recovery-after-critical-illness-putting-the-puzzle-together-a-consensus-of-29
#13
REVIEW
Elie Azoulay, Jean-Louis Vincent, Derek C Angus, Yaseen M Arabi, Laurent Brochard, Stephen J Brett, Giuseppe Citerio, Deborah J Cook, Jared Randall Curtis, Claudia C Dos Santos, E Wesley Ely, Jesse Hall, Scott D Halpern, Nicholas Hart, Ramona O Hopkins, Theodore J Iwashyna, Samir Jaber, Nicola Latronico, Sangeeta Mehta, Dale M Needham, Judith Nelson, Kathleen Puntillo, Michael Quintel, Kathy Rowan, Gordon Rubenfeld, Greet Van den Berghe, Johannes Van der Hoeven, Hannah Wunsch, Margaret Herridge
In this review, we seek to highlight how critical illness and critical care affect longer-term outcomes, to underline the contribution of ICU delirium to cognitive dysfunction several months after ICU discharge, to give new insights into ICU acquired weakness, to emphasize the importance of value-based healthcare, and to delineate the elements of family-centered care. This consensus of 29 also provides a perspective and a research agenda about post-ICU recovery.
December 5, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29200161/noninvasive-measurement-of-hemoglobin-using-spectrophotometry-is-it-useful-for-the-critically-ill-child
#14
Basak Akyildiz
This study compared the accuracy of noninvasively measuring hemoglobin using spectrophotometry (SpHb) with a pulse CO-oximeter and laboratory hemoglobin (Hb) measurements. A total of 345 critically ill children were included prospectively. Age, sex, and factors influencing the reliabilityof SpHb such as SpO2, heart rate, perfusion index (PI), and vasoactive inotropic score were recorded. SpHb measurements were recorded during the blood draw and compared with the Hb measurement. Thirteen patients (low PI in 9 patients and no available Hb in 4 patients) were excluded and 332 children were eligible for final analysis...
December 1, 2017: Journal of Pediatric Hematology/oncology
https://www.readbyqxmd.com/read/29194689/new-device-for-non-volitional-evaluation-of-quadriceps-force-in-ventilated-patients
#15
Franco Laghi, Najeeb Khan, Thimothy Schnell, Dinas Aleksonis, Kendra Hammond, Hameeda Shaikh, Eileen Collins, Amal Jubran, Martin Tobin
INTRODUCTION: In mechanically ventilated patients, non-volitional assessment of quadriceps weakness using femoral-nerve stimulation (twitch force) while the leg rests on a right-angle trapezoid or dangles from the bed edge is impractical. Accordingly, we developed a knee-support apparatus for use in ventilated patients. METHODS: 90 subjects (12 ventilated patients, 28 ambulatory patients and 50 healthy subjects) were enrolled. Twitches with leg-dangling, trapezoid, and knee-support setups were compared...
November 28, 2017: Muscle & Nerve
https://www.readbyqxmd.com/read/29176465/can-pediatric-risk-of-mortality-score-prism-iii-be-used-effectively-in-initial-evaluation-and-follow-up-of-critically-ill-cancer-patients-admitted-to-pediatric-oncology-intensive-care-unit-poicu-a-prospective-study-in-a-tertiary-cancer-center-in-egypt
#16
Heba A Sayed, Amany M Ali, Mahmoud M Elzembely
Pediatric Risk of Mortality Score (PRISM III-12) is a physiology-based predictor for risk of mortality. We conducted prospective study from January 1, 2014 to 2015 in pediatric oncology intensive care unit (POICU) at South Egypt Cancer Institute, Egypt to explore the ability of 1st PRISM III-12 to predict the risk of mortality in critically ill cancer patients and the ability of serial PRISM III measured every 72 hours to follow-up the patients' clinical condition during POICU stay. In total, 123 (78 males) children were included...
November 23, 2017: Journal of Pediatric Hematology/oncology
https://www.readbyqxmd.com/read/29171917/increasing-motor-neuron-excitability-to-treat-weakness-in-sepsis
#17
Paul Nardelli, Randall Powers, Tim C Cope, Mark M Rich
OBJECTIVE: Weakness induced by critical illness (intensive care unit acquired weakness) is a major cause of disability in patients and is currently untreatable. We recently identified a defect in repetitive firing of lower motor neurons as a novel contributor to intensive care unit acquired weakness. In order to develop therapy for intensive care unit acquired weakness, it was necessary to determine the mechanism underlying the defect in repetitive firing. METHODS: Both computer simulation and in vivo dynamic voltage clamp of spinal motor neurons in septic rats were employed to explore potential mechanisms underlying defective repetitive firing...
November 24, 2017: Annals of Neurology
https://www.readbyqxmd.com/read/29167033/nursing-perceptions-of-the-emergency-severity-index-as-a-triage-tool-in-the-united-arab-emirates-a-qualitative-analysis
#18
Binoy Mistry, Kamna S Balhara, Jeremiah S Hinson, Xavier Anton, Iman Yassin Othman, Maysoon Abdel Latif E'nouz, Norman Agustin Avila, Sophia Henry, Scott Levin, Sarah Stewart De Ramirez
INTRODUCTION: With emergency department crowding becoming an increasing problem across the globe, nursing triage to prioritize patients receiving care is ever more important. ESI is the most common triage system used in the United States and is increasingly used worldwide. This qualitative study that explores emergency nursing perceptions of the ESI identifies strengths, weaknesses, and barriers to implementation of the ESI internationally. METHODS: We conducted a cross-sectional qualitative analysis using semistructured interviews of 27 emergency triage nurses...
November 19, 2017: Journal of Emergency Nursing: JEN: Official Publication of the Emergency Department Nurses Association
https://www.readbyqxmd.com/read/29130505/muscle-membrane-properties-in-a-pig-sepsis-model-effect-of-norepinephrine
#19
Delphine Boërio, Thiago D Corrêa, Stephan M Jakob, Karin A Ackermann, Hugh Bostock, Werner J Z'graggen
INTRODUCTION: Sepsis-induced myopathy and critical illness myopathy are common causes of muscle weakness in intensive care patients. This study investigated the effect of different mean arterial blood pressure (MAP) levels on muscle membrane properties following experimental sepsis. METHODS: Sepsis was induced with fecal peritonitis in 12 of 18 anesthetized and mechanically ventilated pigs. Seven were treated with a high (75-85 mmHg) and 5 were treated with a low (≥60 mmHg) MAP target for resuscitation...
November 11, 2017: Muscle & Nerve
https://www.readbyqxmd.com/read/29128195/-what-support-of-young-presenting-a-first-psychotic-episode-when-schooling-is-being-challenged
#20
M-N Vacheron, H Veyrat-Masson, E Wehbe
Psychiatric disorders (more specifically mood disorders and psychosis) represent the 1st cause of disability among young people. Unemployment rate between 75 to 95% for the person with schizophrenia. It is correlated to poor social integration and bad economic status, worse symptomatology loss of autonomy as well as global bad functioning. It is responsible of more than half of the overall cost of psychosis. The onset of most of psychiatric disorders occur between the age of 25 and 35 years old, a critical time in young adult life when they should build their professional as well as social future...
November 8, 2017: L'Encéphale
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