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https://www.readbyqxmd.com/read/29452805/perioperative-cardiopulmonary-exercise-testing-cpet-consensus-clinical-guidelines-on-indications-organization-conduct-and-physiological-interpretation
#1
D Z H Levett, S Jack, M Swart, J Carlisle, J Wilson, C Snowden, M Riley, G Danjoux, S A Ward, P Older, M P W Grocott
The use of perioperative cardiopulmonary exercise testing (CPET) to evaluate the risk of adverse perioperative events and inform the perioperative management of patients undergoing surgery has increased over the last decade. CPET provides an objective assessment of exercise capacity preoperatively and identifies the causes of exercise limitation. This information may be used to assist clinicians and patients in decisions about the most appropriate surgical and non-surgical management during the perioperative period...
March 2018: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/29452598/7-versus-14-days-of-antibiotic-treatment-for-critically-ill-patients-with-bloodstream-infection-a-pilot-randomized-clinical-trial
#2
Nick Daneman, Asgar H Rishu, Ruxandra Pinto, Pierre Aslanian, Sean M Bagshaw, Alex Carignan, Emmanuel Charbonney, Bryan Coburn, Deborah J Cook, Michael E Detsky, Peter Dodek, Richard Hall, Anand Kumar, Francois Lamontagne, Francois Lauzier, John C Marshall, Claudio M Martin, Lauralyn McIntyre, John Muscedere, Steven Reynolds, Wendy Sligl, Henry T Stelfox, M Elizabeth Wilcox, Robert A Fowler
BACKGROUND: Shorter-duration antibiotic treatment is sufficient for a range of bacterial infections, but has not been adequately studied for bloodstream infections. Our systematic review, survey, and observational study indicated equipoise for a trial of 7 versus 14 days of antibiotic treatment for bloodstream infections; a pilot randomized clinical trial (RCT) was a necessary next step to assess feasibility of a larger trial. METHODS: We conducted an open, pilot RCT of antibiotic treatment duration among critically ill patients with bloodstream infection across 11 intensive care units (ICUs)...
February 17, 2018: Trials
https://www.readbyqxmd.com/read/29452427/effect-of-routine-screening-head-ultrasounds-on-clinical-interventions-for-premature-infants
#3
Andrew Z Heling, Matthew M Laughon, Wayne A Price
OBJECTIVE: This article assesses whether routine, screening head ultrasound (HUS) studies performed at 7 to 14 postnatal days for premature infants are followed by clinical interventions. STUDY DESIGN: This retrospective cohort study included all inborn infants delivered at < 30 weeks' gestational age (GA) between January 1, 2012 and December 31, 2015 at a single center who had a routine, screening HUS performed between 7 and 14 postnatal days ( n = 303). We defined "clinical intervention" as a 7 to 14 postnatal day HUS that was followed by neurosurgical intervention prior to a 36- to 40-week postmenstrual age (PMA) HUS or elective withdrawal of critical care within 30 days of a positive HUS finding...
February 16, 2018: American Journal of Perinatology
https://www.readbyqxmd.com/read/29449161/ultrasound-training-in-surgical-critical-care-fellowship-a-survey-of-program-directors
#4
Thomas W Carver
OBJECTIVE: Surgical critical care (SCC) fellows are expected to receive training in critical care ultrasound (CCUS) but training is sporadic and there is no standardized curriculum to guide educators. Previous studies show wide variation in CCUS training during fellowship across specialties but SCC has been underrepresented. This study was performed to assess SCC program directors' views regarding CCUS during fellowship training. DESIGN: Adult SCC program directors were surveyed regarding the role of CCUS in fellowship training...
February 12, 2018: Journal of Surgical Education
https://www.readbyqxmd.com/read/29448873/comparison-of-self-reported-and-behavioral-pain-assessment-tools-in-critically-ill-patients
#5
Rima H Bouajram, Christian M Sebat, Dawn Love, Erin L Louie, Machelle D Wilson, Jeremiah J Duby
BACKGROUND: Self-reported and behavioral pain assessment scales are often used interchangeably in critically ill patients due to fluctuations in mental status. The correlation between scales is not well elucidated. The purpose of this study was to describe the correlation between self-reported and behavioral pain scores in critically ill patients. METHODS: Pain was assessed using behavioral and self-reported pain assessment tools. Behavioral pain tools included Critical Care Pain Observation Tool (CPOT) and Behavioral Pain Scale (BPS)...
January 1, 2018: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/29447402/intraoperative-endotracheal-cuff-pressure-study-how-education-and-availability-of-manometers-help-guide-safer-pressures
#6
Gregory J Stevens, Joel W Warfel, James K Aden, Scott D Blackwell
Introduction: Endotracheal intubation is a medical procedure that is often indicated in both the perioperative and critical care environments. Cuffed endotracheal tubes (ETT) allow for safer and more efficient delivery of positive pressure ventilation, as well as create a barrier to reduce the risk of micro-aspiration and anesthetic pollution in the operating room environment. Over-inflation of the endotracheal cuff can lead to serious and harmful sequelae. This study aimed to assess if departmental education paired with ready access to a manometer to assess cuff pressure would result in an improvement in the proportion of ETT cuff pressures in the goal range...
February 13, 2018: Military Medicine
https://www.readbyqxmd.com/read/29445882/procedure-rates-performed-by-emergency-medicine-residents-a-retrospective-review
#7
Joshua T Bucher, Christopher Bryczkowski, Grant Wei, Renee L Riggs, Anoop Kotwal, Brian Sumner, Jonathan V McCoy
BACKGROUND: The purpose of our study is to investigate rates of individual procedures performed by residents in our emergency medicine (EM) residency program. Different programs expose residents to different training environments. Our hypothesis is that ultrasound examinations are the most commonly performed procedure in our residency. METHODS: The study took place in an academic level I trauma center with multiple residency and fellowship programs including surgery, surgical critical care, trauma, medicine, pulmonary/critical care, anesthesiology and others...
February 14, 2018: International Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29445502/long-term-recovery-following-critical-illness-in-an-australian-cohort
#8
Kimberley J Haines, Sue Berney, Stephen Warrillow, Linda Denehy
Background: Almost all data on 5-year outcomes for critical care survivors come from North America and Europe. The aim of this study was to investigate long-term mortality, physical function, psychological outcomes and health-related quality of life in a mixed intensive care unit cohort in Australia. Methods: This longitudinal study evaluated 4- to 5-year outcomes. Physical function (six-minute walk test) and health-related quality of life (Short Form 36 Version 2) were compared to 1-year outcomes and population norms...
2018: Journal of Intensive Care
https://www.readbyqxmd.com/read/29444696/bedside-analysis-of-the-sublingual-microvascular-glycocalyx-in-the-emergency-room-and-intensive-care-unit-the-glyconurse-study
#9
Alexandros Rovas, Alexander-Henrik Lukasz, Hans Vink, Marc Urban, Jan Sackarnd, Hermann Pavenstädt, Philipp Kümpers
BACKGROUND: Deterioration of the endothelial glycocalyx (eGC), a protective carbohydrate-rich layer lining the luminal surface of the endothelium, plays a key role in vascular barrier dysfunction and eventually organ-failure in systemic inflammatory response syndrome and sepsis. Early detection of glycocalyx damage could thus become an important goal in critical care. This study was designed to determine the feasibility and reproducibility of quantitative, real-time glycocalyx measurements performed at bedside in the emergency room (ER) and intensive care unit (ICU)...
February 14, 2018: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/29444339/nursing-intensive-care-satisfaction-scale-nicss-development-and-validation-of-a-patient-centered-instrument
#10
M Romero-García, L de la Cueva-Ariza, Ll Benito-Aracil, T M Lluch-Canut, J Trujols-Albet, M A Martínez-Momblan, M E Juvé-Udina, P Delgado-Hito
AIM: To develop and validate the Nursing Intensive-Care-Satisfaction-Scale to measures satisfaction with nursing care from the critical care patient's perspective. BACKGROUND: Instruments that measure satisfaction with nursing cares have been designed and validated without taking the patient's perspective into consideration. Despite the benefits and advances in measuring satisfaction with nursing care, none instrument is specifically designed to assess satisfaction in intensive care units...
February 14, 2018: Journal of Advanced Nursing
https://www.readbyqxmd.com/read/29443814/danger-signals-in-the-icu
#11
Edward J Schenck, Kevin C Ma, Santosh B Murthy, Augustine M K Choi
OBJECTIVES: Sterile and infectious critical illnesses often result in vasoplegic shock and a robust systemic inflammatory response that are similar in presentation. The innate immune system is at the center of the response to both infectious and traumatic insults. Damage-associated molecular patterns are small molecules that are released from stressed or dying cells. Damage-associated molecular patterns activate pattern recognition receptors and coordinate the leading edge of the innate immune response...
February 13, 2018: Critical Care Medicine
https://www.readbyqxmd.com/read/29443720/retained-guidewires-in-the-veterans-health-administration-getting-to-the-root-of-the-problem
#12
Leila Cherara, Gary L Sculli, Douglas E Paull, Lisa Mazzia, Julia Neily, Peter D Mills
OBJECTIVES: The aims of this study were to investigate the demographics, causes, and contributing factors of retained guidewires (GWs) and to make specific recommendations for their prevention. METHODS: The Veterans Administration patient safety reporting system database for 2000-2016 was queried for cases of retained GWs (RGWs). Data extracted for each case included procedure location, provider experience, insertion site, urgency, time to discovery, root causes, and corrective actions taken...
February 13, 2018: Journal of Patient Safety
https://www.readbyqxmd.com/read/29441175/perioperative-factors-associated-with-pressure-ulcer-development-after-major-surgery
#13
Jeong Min Kim, Hyunjeong Lee, Taehoon Ha, Sungwon Na
Background: Postoperative pressure ulcers are important indicators of perioperative care quality, and are serious and expensive complications during critical care. This study aimed to identify perioperative risk factors for postoperative pressure ulcers. Methods: This retrospective case-control study evaluated 2,498 patients who underwent major surgery. Forty-three patients developed postoperative pressure ulcers and were matched to 86 control patients based on age, sex, surgery, and comorbidities...
February 2018: Korean Journal of Anesthesiology
https://www.readbyqxmd.com/read/29441169/perioperative-stroke-pathophysiology-and-management
#14
REVIEW
Sang-Bae Ko
Although perioperative stroke is uncommon during low-risk non-vascular surgery, if it occurs, it can negatively impact recovery from the surgery and functional outcome. Based on the Society for Neuroscience in Anesthesiology and Critical Care Consensus Statement, perioperative stroke includes intraoperative stroke, as well as postoperative stroke developing within 30 days after surgery. Factors related to perioperative stroke include age, sex, a history of stroke or transient ischemic attack, cardiac surgery (aortic surgery, mitral valve surgery, or coronary artery bypass graft surgery), and neurosurgery (external carotid-internal carotid bypass surgery, carotid endarterectomy, or aneurysm clipping)...
February 2018: Korean Journal of Anesthesiology
https://www.readbyqxmd.com/read/29440830/impact-of-intensive-care-unit-attending-physician-training-background-on-outcomes-in-children-undergoing-heart-operations
#15
Priya Bhaskar, Mallikarjuna Rettiganti, Jeffrey M Gossett, Punkaj Gupta
Background: The existing training pathways to become a pediatric cardiac intensivist are very variable with physicians coming from varied training backgrounds of pediatric critical care, pediatric cardiology, neonatology, or pediatric anesthesia. Aim: To evaluate the impact of cardiac Intensive Care Unit (ICU) attending physician training background on outcomes in children undergoing heart operations. Setting and Design: Patients in the age group from 1 day to 18 years undergoing heart operation at a Pediatric Health Information System database participating hospital were included (2010-2015)...
January 2018: Annals of Pediatric Cardiology
https://www.readbyqxmd.com/read/29440801/a-retrospective-study-of-end-of-life-care-decisions-in-the-critically-ill-in-a-surgical-intensive-care-unit
#16
Yi Lin Lee, Yee Yian Ong, Sze Ying Thong, Shin Yi Ng
Aim: Progress in medical care and technology has led to patients with more advanced illnesses being admitted to the Intensive Care Unit (ICU). The practice of approaching end-of-life (EOL) care decisions and limiting care is well documented in Western literature but unknown in Singapore. We performed a retrospective cohort study to describe the practice of EOL care in patients dying in a Singapore surgical ICU (SICU). The surgical critical care population was chosen as it is unique because surgeons are frequently involved in the EOL process...
January 2018: Indian Journal of Palliative Care
https://www.readbyqxmd.com/read/29439083/psychological-outcomes-following-a-nurse-led-preventative-psychological-intervention-for-critically-ill-patients-poppi-protocol-for-a-cluster-randomised-clinical-trial-of-a-complex-intervention
#17
Alvin Richards-Belle, Paul R Mouncey, Dorothy Wade, Chris R Brewin, Lydia M Emerson, Richard Grieve, David A Harrison, Sheila Harvey, David Howell, Monty Mythen, Zia Sadique, Deborah Smyth, John Weinman, John Welch, Kathryn M Rowan
INTRODUCTION: Acute psychological stress, as well as unusual experiences including hallucinations and delusions, are common in critical care unit patients and have been linked to post-critical care psychological morbidity such as post-traumatic stress disorder (PTSD), depression and anxiety. Little high-quality research has been conducted to evaluate psychological interventions that could alleviate longer-term psychological morbidity in the critical care unit setting. Our research team developed and piloted a nurse-led psychological intervention, aimed at reducing patient-reported PTSD symptom severity and other adverse psychological outcomes at 6 months, for evaluation in the POPPI trial...
February 8, 2018: BMJ Open
https://www.readbyqxmd.com/read/29438568/haemodynamic-assessment-and-support-in-sepsis-and-septic-shock-in-resource-limited-settings
#18
David Misango, Rajyabardhan Pattnaik, Tim Baker, Martin W Dünser, Arjen M Dondorp, Marcus J Schultz
Background: Recommendations for haemodynamic assessment and support in sepsis and septic shock in resource-limited settings are largely lacking. Methods: A task force of six international experts in critical care medicine, all of them members of the Global Intensive Care Working Group of the European Society of Intensive Care Medicine and with extensive bedside experience in resource-limited intensive care units, reviewed the literature and provided recommendations regarding haemodynamic assessment and support, keeping aspects of efficacy and effectiveness, availability and feasibility and affordability and safety in mind...
February 9, 2018: Transactions of the Royal Society of Tropical Medicine and Hygiene
https://www.readbyqxmd.com/read/29438467/prophylactic-antimicrobial-therapy-for-acute-aspiration-pneumonitis
#19
Vlad Dragan, Lex Wei, Marion Elligsen, Alex Kiss, Sandra A N Walker, Jerome A Leis
Background: Prophylactic antimicrobial therapy is frequently prescribed for acute aspiration pneumonitis following macro-aspiration with the intent of preventing the development of aspiration pneumonia; however, few clinical studies have examined the benefits and harms of this practice. Methods: A retrospective cohort study design was used to assess outcomes of patients receiving antimicrobial prophylaxis with those receiving supportive care only during the initial two days following an acute aspiration pneumonitis episode...
February 9, 2018: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
https://www.readbyqxmd.com/read/29438177/eeg-factors-after-pediatric-cardiac-arrest
#20
Nicholas S Abend, Douglas J Wiebe, Rui Xiao, Shavonne L Massey, Mark Fitzgerald, France Fung, Alexis A Topjian
PURPOSE: We aimed to determine whether conventional standardized EEG features could be consolidated into a more limited number of factors and whether the derived factor scores changed during the acute period after pediatric cardiac arrest. METHODS: Children resuscitated after cardiac arrest underwent conventional continuous EEG monitoring. The EEG was scored in 12-hour epochs for up to 72-hours after return of circulation by an electroencephalographer using standardized critical care EEG terminology...
February 12, 2018: Journal of Clinical Neurophysiology: Official Publication of the American Electroencephalographic Society
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