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intensive care therapy intensive care unit

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https://www.readbyqxmd.com/read/29777985/liquid-chromatography-tandem-mass-spectrometry-for-the-quantification-of-moxifloxacin-ciprofloxacin-daptomycin-caspofungin-and-isavuconazole-in-human-plasma
#1
Julian Hösl, André Gessner, Nahed El-Najjar
A simple and precise ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) method was developed for the simultaneous analysis of five anti-infective agents used to treat severe infections [three antibiotics (daptomycin, moxifloxacin, ciprofloxacin) and two antifungals (isavuconazole, caspofungin)] in human plasma. Sample preparation was based on protein precipitation with ice cold methanol. All five agents were analyzed with the corresponding isotopically labeled internal standards. All analytes were detected in multiple reactions monitoring (MRM) using API 4000 triple-quadrupole mass spectrometer with electrospray (ESI) source operating in positive mode...
May 12, 2018: Journal of Pharmaceutical and Biomedical Analysis
https://www.readbyqxmd.com/read/29774388/withholding-or-withdrawing-of-life-sustaining-therapy-in-older-adults-%C3%A2-80-years-admitted-to-the-intensive-care-unit
#2
Bertrand Guidet, Hans Flaatten, Ariane Boumendil, Alessandro Morandi, Finn H Andersen, Antonio Artigas, Guido Bertolini, Maurizio Cecconi, Steffen Christensen, Loredana Faraldi, Jesper Fjølner, Christian Jung, Brian Marsh, Rui Moreno, Sandra Oeyen, Christina Agwald Öhman, Bernardo Bollen Pinto, Ivo W Soliman, Wojciech Szczeklik, Andreas Valentin, Ximena Watson, Tilemachos Zafeiridis, Dylan W De Lange
PURPOSE: To document and analyse the decision to withhold or withdraw life-sustaining treatment (LST) in a population of very old patients admitted to the ICU. METHODS: This prospective study included intensive care patients aged ≥ 80 years in 309 ICUs from 21 European countries with 30-day mortality follow-up. RESULTS: LST limitation was identified in 1356/5021 (27.2%) of patients: 15% had a withholding decision and 12.2% a withdrawal decision (including those with a previous withholding decision)...
May 17, 2018: Intensive Care Medicine
https://www.readbyqxmd.com/read/29773297/the-clinical-practice-of-high-flow-nasal-cannula-oxygen-therapy-in-adults-a-japanese-cross-sectional-multicenter-survey
#3
Jiro Ito, Kazuma Nagata, Susumu Sato, Akira Shiraki, Naoki Nishimura, Shinyu Izumi, Ryo Tachikawa, Takeshi Morimoto, Keisuke Tomii
BACKGROUND: High-flow nasal cannula oxygen therapy (HFNC) is widely used mainly in the acute care setting, but limited data are available on real-world practice in adults. The objective of this study was to describe HFNC practices in Japanese adults. METHODS: A retrospective cross-sectional multicenter survey of adult patients receiving HFNC from January through March 2015 was conducted in 33 participating hospitals in Japan. RESULTS: We obtained information on 321 patients (median age, 76; 218 men, 103 women; median estimated PaO2 /FI O2, 178 mm Hg) from 22 hospitals...
May 2018: Respiratory Investigation
https://www.readbyqxmd.com/read/29771684/antibiotic-treatment-induced-secondary-iga-deficiency-enhances-susceptibility-to-pseudomonas-aeruginosa-pneumonia
#4
Oliver H Robak, Markus M Heimesaat, Andrey A Kruglov, Sandra Prepens, Justus Ninnemann, Birgitt Gutbier, Katrin Reppe, Hubertus Hochrein, Mark Suter, Carsten J Kirschning, Veena Marathe, Jan Buer, Mathias W Hornef, Markus Schnare, Pascal Schneider, Martin Witzenrath, Stefan Bereswill, Ulrich Steinhoff, Norbert Suttorp, Leif E Sander, Catherine Chaput, Bastian Opitz
Broad-spectrum antibiotics are widely used in patients on intensive care units (ICU), many of which develop hospital-acquired infections with Pseudomonas aeruginosa. Although preceding antimicrobial therapy is known as a major risk factor for P. aeruginosa-induced pneumonia, the underlying mechanisms remain incompletely understood. Here we demonstrate that depletion of the resident microbiota by broad-spectrum antibiotic treatment inhibited TLR-dependent production of a proliferation inducing ligand (APRIL), resulting in a secondary IgA deficiency in the lung in mice and human ICU patients...
May 17, 2018: Journal of Clinical Investigation
https://www.readbyqxmd.com/read/29768983/anticoagulation-monitoring-under-ecmo-support-a-comparative-study-between-the-activated-coagulation-time-and-the-anti-xa-activity-assay
#5
Clément Delmas, Aemilia Jacquemin, Fanny Vardon-Bounes, Bernard Georges, Felipe Guerrero, Nicolas Hernandez, Bertrand Marcheix, Thierry Seguin, Vincent Minville, Jean-Marie Conil, Stein Silva
PURPOSE: Extra Corporeal Membrane Oxygenation (ECMO) is used in cases of severe respiratory and/or circulatory failure over periods of several days to several weeks. Its circuitry requires a closely monitored anticoagulation therapy that is empirically supported by activated clotting time (ACT)-a method often associated with large inter- and intraindividual variability. We aimed to compare the measurement of heparin activity with ACT and the direct measurement of the heparin activity (anti-Xa) in a large ECMO population...
January 1, 2018: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/29767825/-palliative-sedation-development-and-consensus-of-a-german-language-documentation-template
#6
C Klein, C Wittmann, K N Wendt, C Ostgathe, S Stiel
BACKGROUND: Palliative sedation (PS) serves as a therapeutic option in cases of otherwise intractable suffering. As the use of sedative and hypnotic medication in many diverse situations is a core competency of anesthesiology, anesthesiologists are confronted with questions of sedative therapy at the end of life in institutions for specialized palliative care, in intensive care units and intermediate care wards. In recent years a number of guidelines have been published internationally but so far no official guidelines exist in Germany...
May 16, 2018: Der Anaesthesist
https://www.readbyqxmd.com/read/29766326/the-change-in-management-of-bronchiolitis-in-the-intensive-care-unit-between-2000-and-2015
#7
Minna Mecklin, Paula Heikkilä, Matti Korppi
This case-control study evaluated interventions for bronchiolitis in relation to time in the pediatric intensive care unit (PICU) during a 16-year surveillance period. Together, 105 infants aged < 12 months were treated for bronchiolitis in the PICU, and for them, we selected 210 controls admitted for bronchiolitis closest to cases. We collected data on treatments in the PICU, at the ward and in the emergency department for three periods: years 2000-2005, 2006-2010, and 2011-2015. Median hospital length of stay for PICU patients were 7 days (interquartile range 5-12), 5 days (4-8) and 8 days (4-12...
May 15, 2018: European Journal of Pediatrics
https://www.readbyqxmd.com/read/29766320/weaning-from-prolonged-veno-venous-extracorporeal-membrane-oxygenation-ecmo-after-transfer-to-a-specialized-center-a-retrospective-study
#8
Frederik Seiler, Franziska C Trudzinski, Sabrina I Hörsch, Annegret Kamp, Carlos Metz, Monika Flaig, Mohammad Alqudrah, Holger Wehrfritz, Markus Kredel, Ralf M Muellenbach, Hendrik Haake, Robert Bals, Philipp M Lepper
Veno-venous extracorporeal membrane oxygenation (vvECMO) is increasingly used as rescue therapy in severe respiratory failure. In patients with pre-existent lung diseases or persistent lung injury weaning from vvECMO can be challenging. This study sought to investigate outcomes of patients transferred to a specialized ECMO center after prolonged ECMO therapy. We performed a retrospective analysis of all patients admitted to our medical intensive care unit (ICU) between 01/2013 and 12/2016 who were transferred from an external ICU after > 8 days on vvECMO...
May 15, 2018: Journal of Artificial Organs: the Official Journal of the Japanese Society for Artificial Organs
https://www.readbyqxmd.com/read/29766216/impact-of-angiotensin-converting-enzyme-inhibitors-or-receptor-blockers-on-post-icu-discharge-outcome-in-patients-with-acute-kidney-injury
#9
Etienne Gayat, Alexa Hollinger, Alain Cariou, Nicolas Deye, Antoine Vieillard-Baron, Samir Jaber, Benjamin G Chousterman, Qin Lu, Pierre François Laterre, Xavier Monnet, Michael Darmon, Marc Leone, Bertrand Guidet, Romain Sonneville, Jean-Yves Lefrant, Marie-Céline Fournier, Matthieu Resche-Rigon, Alexandre Mebazaa, Matthieu Legrand
PURPOSE: Acute kidney injury (AKI) is associated with the activation of the renin-angiotensin system. Whether angiotensin-converting enzyme inhibitors (ACEi) or angiotensin-receptor blockers (ARB) improve outcome in patients recovering from AKI remains unexplored. The purpose was to investigate the association between prescription of ACEi/ARB at intensive care unit (ICU) discharge and 1-year outcome in patients recovering from AKI. METHODS: Association between ACEi/ARB and 1-year mortality rate was explored in 1551 patients discharged from 21 European ICUs in an observational cohort...
May 15, 2018: Intensive Care Medicine
https://www.readbyqxmd.com/read/29762462/the-safety-and-utility-of-fiberoptic-bronchoscopy-in-the-very-elderly
#10
Cameron W McLaughlin, Andrew J Skabelund, Ellis R Easterling, Michael J Morris
BACKGROUND: Flexible bronchoscopy (FB) is a common modality for diagnostic sampling within the thorax. It is utilized often in the elderly population, but there is limited data on the safety and utility of the procedure in the very elderly. METHODS: FBs performed outside the intensive care unit in the San Antonio Military Health System on patients 85 years and older were reviewed. Outcomes including indications, complications, diagnostic yield, and final diagnosis were compared with a control group consisting of patients' ages of 65 to 79 years old...
May 14, 2018: Journal of Bronchology & Interventional Pulmonology
https://www.readbyqxmd.com/read/29758282/stevens-johnson-syndrome-toxic-epidermal-necrolysis-a-multicenter-retrospective-study-of-377-adult-patients-from-the-united-states
#11
Robert G Micheletti, Zelma Chiesa-Fuxench, Megan H Noe, Sasha Stephen, Maria Aleshin, Ashwin Agarwal, Jennifer Boggs, Adela R Cardones, Jennifer K Chen, Jonathan Cotliar, Mark Dp Davis, Arturo Dominguez, Lindy P Fox, Shayna Gordon, Ronald Hamrick, Baran Ho, Lauren C Hughey, Larry M Jones, Benjamin H Kaffenberger, Kimball Kindley, Daniela Kroshinsky, Bernice Y Kwong, Daniel D Miller, Arash Mostaghimi, Amy Musiek, Alex G Ortega-Loayza, Raj Patel, Alba Posligua, Monica Rani, Sandeep Saluja, Victoria R Sharon, Kanade Shinkai, Jessica St John, Nicole Strickland, Erika M Summers, Natalie Sun, Karolyn A Wanat, David A Wetter, Scott Worswick, Caroline Yang, David J Margolis, Joel M Gelfand, Misha Rosenbach
Stevens-Johnson syndrome / toxic epidermal necrolysis (SJS/TEN) is a rare, severe mucocutaneous reaction with few large cohorts reported. This multicenter retrospective study included patients with SJS/TEN seen by inpatient consultative dermatologists at 18 academic medical centers in the United States. 377 adult patients with SJS/TEN between 1/1/2000 and 6/1/2015 were entered, including 69.0% from 2010 onward. The most frequent cause of SJS/TEN was medication reaction (89.7%), most often trimethoprim / sulfamethoxazole (27...
May 11, 2018: Journal of Investigative Dermatology
https://www.readbyqxmd.com/read/29756521/cost-analysis-of-initial-treatment-with-endovascular-revascularization-open-surgery-or-primary-major-amputation-in-patients-with-peripheral-artery-disease
#12
Linda Tang, Sharath C V Paravastu, Shannon D Thomas, Elaine Tan, Eric Farmer, Ramon L Varcoe
PURPOSE: To compare the total initial treatment costs for open surgery, endovascular revascularization, and primary major amputation within a single-payer healthcare system. METHODS: A multicenter, retrospective analysis was undertaken to evaluate 1138 patients with symptomatic peripheral artery disease (PAD) who underwent 1017 endovascular procedures, 86 open surgeries, and 35 major amputations between 2013 and 2016. A cost-mix analysis was performed on individual patient data generated for selected diagnosis-related groups...
May 1, 2018: Journal of Endovascular Therapy
https://www.readbyqxmd.com/read/29755996/evaluation-of-clinical-pharmacy-services-in-the-intensive-care-unit-of-a-tertiary-university-hospital-in-the-northwest-of-iran
#13
Ata Mahmoodpoor, Arman Kalami, Kamran Shadvar, Taher Entezari-Maleki, Hadi Hamishehkar
Objective: Current literature indicates that the presence of clinical pharmacists in hospitals results in improved patient care, rational drug therapy, and treatment costs. This study assessed the clinical pharmacy services in the intensive care unit (ICU) of a tertiary hospital at Tabriz University of Medical Sciences, Iran. Methods: During a 9-month cross-sectional study (2014-2015), the clinical pharmacy interventions in 27 sessions and educational activities for patients and health-care professionals were randomly assessed based on the Australian guideline and standard of practice for clinical pharmacy...
January 2018: Journal of Research in Pharmacy Practice
https://www.readbyqxmd.com/read/29755085/-subdural-hematoma-after-open-heart-surgery-for-infective-endocarditis-presenting-with-pre-operative-intracranial-hemorrhage-infarction-report-of-a-case
#14
Ryuta Tai, Yosuke Kuroko, Makoto Mohri, Masakazu Yamaoka
A 47-year-old woman with a history of radiation enteritis and implantation of a central venous port was admitted to our intensive care unit(ICU) suffering from high fever. She was diagnosed with active infective endocarditis due to catheter-related blood stream infection. Although echocardiography showed a large vegetation on the mitral valve, surgical therapy was postponed for 5 weeks because of intracranial hemorrhage infarction. On the 3rd day after mitral valve repair, she developed consciousness disturbance and computed tomography(CT) revealed acute subdural hematoma of the posterior cranial fossa...
May 2018: Kyobu Geka. the Japanese Journal of Thoracic Surgery
https://www.readbyqxmd.com/read/29754841/-risks-associated-with-the-use-of-non-steroidal-anti-inflammatory-drugs-during-pneumonia
#15
REVIEW
G Voiriot, M Chalumeau, J Messika, D Basille, B Philippe, J-D Ricard, C Andrejak, V Jounieaux, O Sanchez, M Fartoukh
INTRODUCTION: Outpatient treatment of community-acquired pneumonia (CAP) patients with non-steroidal anti-inflammatory drugs (NSAIDs) is frequent, although this is not based on clinical recommendations and there is no scientific evidence supporting better symptom relief in comparison to acetaminophen. STATE OF THE ART: Experimental data suggest that NSAIDs alter the intrinsic functions of neutrophils, limit their locoregional recruitment, alter bacterial clearance and delay the resolution of inflammatory processes during acute bacterial pulmonary challenge...
May 10, 2018: Revue des Maladies Respiratoires
https://www.readbyqxmd.com/read/29753159/defining-incidence-and-risk-factors-for-catheter-associated-bloodstream-infections-in-an-outpatient-adult-hematopoietic-cell-transplant-program
#16
Marissa K McDonald, Kathryn A Culos, Katie S Gatwood, Caleb Prow, Heidi Chen, Bipin N Savani, Michael Byrne, Adetola A Kassim, Brian G Engelhardt, Madan Jagasia, Gowri Satyanarayana
BACKGROUND: Allogeneic hematopoietic cell transplant (HCT) patients are at an increased risk of developing central line-associated bloodstream infections (CLABSIs) due to prolonged periods of myelosuppression, immunosuppression, and indwelling catheter days. CLABSIs are among the most serious complications in HCT recipients and can lead to prolonged hospitalizations, intensive care unit (ICU) admissions, lengthy antimicrobial therapies, and increased mortality. There is a lack of data regarding the incidence and risk factors associated with the development of CLABSIs in the HCT population undergoing outpatient transplantation...
May 9, 2018: Biology of Blood and Marrow Transplantation
https://www.readbyqxmd.com/read/29752817/national-treatment-guidelines-decreased-the-use-of-racemic-adrenaline-for-bronchiolitis-in-four-finnish-university-hospitals
#17
Sauli Palmu, Minna Mecklin, Paula Heikkilä, Katri Backman, Ville Peltola, Marjo Renko, Matti Korppi
AIM: Inhaled racemic adrenaline was used for bronchiolitis in many hospitals in Finland prior to new national current care guidelines for bronchiolitis in 2014, which limited its recommendations to on-demand rescue therapy. We studied the drug's use before and after the new guidelines to gauge changes in prescribing habits. METHODS: This 2012-2016 study analysed how many 0.5 ml doses of racemic adrenaline were used for children by emergency rooms, paediatric wards and paediatric intensive care units at four university hospitals and estimated drug and staff costs...
May 12, 2018: Acta Paediatrica
https://www.readbyqxmd.com/read/29752171/association-between-furosemide-exposure-and-patent-ductus-arteriosus-in-hospitalized-infants-of-very-low-birth-weight
#18
Elizabeth J Thompson, Rachel G Greenberg, Karan Kumar, Matthew Laughon, P Brian Smith, Reese H Clark, Andromeda Crowell, Layla Shaw, Louis Harrison, Gabrielle Scales, Nicole Bell, Christoph P Hornik
OBJECTIVE: To evaluate the association between furosemide exposure and patent ductus arteriosus (PDA) in a large, contemporary cohort of hospitalized infants with very low birth weight (VLBW). STUDY DESIGN: Using the Pediatrix Medical Group Clinical Data Warehouse, we identified all inborn infants of VLBW <37 weeks of gestation discharged from the neonatal intensive care unit after the first postnatal week from 2011 to 2015. We defined PDA as any medical (ibuprofen or indomethacin) or surgical PDA therapy...
May 8, 2018: Journal of Pediatrics
https://www.readbyqxmd.com/read/29750814/one-year-mortality-after-recovery-from-critical-illness-a-retrospective-cohort-study
#19
Sharukh Lokhandwala, Ned McCague, Abdullah Chahin, Braiam Escobar, Mengling Feng, Mohammad M Ghassemi, David J Stone, Leo Anthony Celi
RATIONALE: Factors associated with one-year mortality after recovery from critical illness are not well understood. Clinicians generally lack information regarding post-hospital discharge outcomes of patients from the intensive care unit, which may be important when counseling patients and families. OBJECTIVE: We sought to determine which factors among patients who survived for at least 30 days post-ICU admission are associated with one-year mortality. METHODS: Single-center, longitudinal retrospective cohort study of all ICU patients admitted to a tertiary-care academic medical center from 2001-2012 who survived ≥30 days from ICU admission...
2018: PloS One
https://www.readbyqxmd.com/read/29749505/identification-of-genes-and-pathways-associated-with-multiple-organ-dysfunction-syndrome-by-microarray-analysis
#20
Changwei Gu, Wanhai Qiao, Lina Wang, Minmin Li, Kang Song
Multiple organ dysfunction syndrome (MODS) is characterized by the development of progressive physiological dysfunction of ≥2 organs or organ systems and is responsible for the majority of the morbidity and mortality among patients in intensive care units. The aim of the present study was to investigate the potential genes and pathways associated with MODS. The microarray dataset GSE60088 was downloaded from the Gene Expression Omnibus and used to identify differentially expressed genes (DEGs) between organ tissues (lung, liver and kidney) obtained from a murine model of MODS and healthy controls...
May 4, 2018: Molecular Medicine Reports
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