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Cardiac ICU

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https://www.readbyqxmd.com/read/29440830/impact-of-intensive-care-unit-attending-physician-training-background-on-outcomes-in-children-undergoing-heart-operations
#1
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/29437639/soluble-gpvi-is-elevated-in-injured-patients-shedding-is-mediated-by-fibrin-activation-of-gpvi
#2
Samantha J Montague, Céline Delierneux, Christelle Lecut, Nathalie Layios, Robert J Dinsdale, Christine S-M Lee, Natalie S Poulter, Robert K Andrews, Peter Hampson, Christopher M Wearn, Nathalie Maes, Jonathan Bishop, Amy Bamford, Chris Gardiner, Woei Ming Lee, Tariq Iqbal, Naiem Moiemen, Steve P Watson, Cécile Oury, Paul Harrison, Elizabeth E Gardiner
Soluble glycoprotein VI (sGPVI) is shed from the platelet surface and is a marker of platelet activation in thrombotic conditions. We assessed sGPVI levels together with patient and clinical parameters in acute and chronic inflammatory conditions, including patients with thermal injury and inflammatory bowel disease and patients admitted to the intensive care unit (ICU) for elective cardiac surgery, trauma, acute brain injury, or prolonged ventilation. Plasma sGPVI was measured by enzyme-linked immunosorbent assay and was elevated on day 14 after thermal injury, and was higher in patients who developed sepsis...
February 13, 2018: Blood Advances
https://www.readbyqxmd.com/read/29433727/point-of-care-ultrasound-in-the-intensive-care-unit
#3
REVIEW
Steven J Campbell, Rabih Bechara, Shaheen Islam
Spreading beyond the realm of tertiary academic medical centers, point-of-care ultrasound in the intensive care unit is an important diagnostic tool. The real-time feedback garnered can lead to critical and clinically relevant changes in management and decrease potential complications. Bedside ultrasound evaluation in the intensive care setting with a small, portable equipment is well-suited for placement of central lines, lumbar puncture, thoracentesis or other bedside ICU procedures and in the evaluation of cardiac activity, pleural and abdominal cavity and the overall fluid volume...
March 2018: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/29431046/intermediate-care-units-a-survey-of-organization-practices-across-the-united-states
#4
Blair Wendlandt, Thomas Bice, Shannon Carson, Lydia Chang
PURPOSE: Intermediate care units (IMCUs) represent an alternative care setting with nurse staffing levels between those of the general ward and the intensive care unit (ICU). Despite rising prevalence, little is known about IMCU practices across US hospitals. The purpose of this study is to characterize utilization patterns and assess for variation. MATERIALS AND METHODS: A 14-item survey was distributed to a random nationwide sample of pulmonary and critical care physicians between January and April 2017...
January 1, 2018: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/29430443/electrical-impedance-tomography
#5
REVIEW
Beatriz Lobo, Cecilia Hermosa, Ana Abella, Federico Gordo
Continuous assessment of respiratory status is one of the cornerstones of modern intensive care unit (ICU) monitoring systems. Electrical impedance tomography (EIT), although with some constraints, may play the lead as a new diagnostic and guiding tool for an adequate optimization of mechanical ventilation in critically ill patients. EIT may assist in defining mechanical ventilation settings, assess distribution of tidal volume and of end-expiratory lung volume (EELV) and contribute to titrate positive end-expiratory pressure (PEEP)/tidal volume combinations...
January 2018: Annals of Translational Medicine
https://www.readbyqxmd.com/read/29429928/effect-of-remote-ischemic-preconditioning-on-intestinal-ischemia-reperfusion-injury-in-adults-undergoing-on-pump-cabg-surgery-a-randomized-controlled-pilot-trial
#6
Rafael Struck, Maria Wittmann, Stefan Müller, Patrick Meybohm, Andreas Müller, Soyhan Bagci
OBJECTIVE: Cardiopulmonary bypass (CPB) surgery commonly threatens the heart and remote organs with ischemia-reperfusion injury. Transient episodes of ischemia to nonvital tissue, known as remote ischemic preconditioning (RIPC), is thought to help local and remote vital organs to withstand subsequent ischemic insults. DESIGN: Prospective, randomized, double-blinded control trial. SETTING: Tertiary referral academic teaching hospital. PARTICIPANTS: Thirty patients undergoing elective CPB surgery INTERVENTION: RIPC was achieved via three 5-minute cycles of upper limb ischemia using a blood pressure cuff or control (sham cuff)...
July 27, 2017: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/29426301/the-comt-polymorphism-is-not-associated-with-the-incidence-of-acute-kidney-injury-after-cardiac-surgery-a-prospective-cohort-study
#7
Mehmet Oezkur, Attila Magyar, Phillip Thomas, Andreas Reif, Stefan Störk, Peter U Heuschmann, Rainer G Leyh, Martin Wagner
BACKGROUND: The Catechol-O-methyltransferase (COMT) represents the key enzyme in catecholamine degradation. Recent studies suggest that the COMT rs4680 polymorphism is associated with the response to endogenous and exogenous catecholamines. There are, however, conflicting data regarding the COMT Met/Met phenotype being associated with an increased risk of acute kidney injury (AKI) after cardiac surgery. The aim of the current study is to prospectively investigate the impact of the COMT rs4680 polymorphism on the incidence of AKI in patients undergoing cardiac surgery...
February 9, 2018: BMC Nephrology
https://www.readbyqxmd.com/read/29422171/strict-versus-liberal-insulin-therapy-in-the-cardiac-surgery-patient-an-evidence-based-practice-development-implementation-and-evaluation-project
#8
Jacqueline M Gordon, Lori S Lauver, Harleah G Buck
BACKGROUND: Hyperglycemia post-cardiac surgery is associated with poor clinical outcomes. Recent studies suggest maintaining liberal glycemic control (<180mg/dL) using a continuous insulin infusion (CII) versus strict control achieves optimal outcomes and prevents hypoglycemia. PURPOSE: To develop, implement and evaluate a nurse managed liberal CII protocol. METHODS: Retrospective review of 144 strict CII patient records and 147 liberal CII patient records...
February 2018: Applied Nursing Research: ANR
https://www.readbyqxmd.com/read/29415177/effect-of-levosimendan-on-clinical-outcomes-in-adult-patients-undergoing-cardiac-surgery-a-meta-analysis-of-randomized-controlled-trials
#9
Xiaoyang Zhou, Caibao Hu, Zhaojun Xu, Peng Liu, Yuchu Zhang, Lingling Sun, Yang Wang, Xiaofei Gao
It is currently unknown whether levosimendan can improve clinical outcomes in patients undergoing cardiac surgery. This meta-analysis aimed to assess the effect of levosimendan on mortality and the duration of intensive care unit (ICU) and hospital stay in adult patients undergoing cardiac surgery. A comprehensive search for eligible articles was conducted in PubMed, OVID and Cochrane databases of clinical trials and the Web of Science from database inception to August 2017. Stata/SE 11.0 was used to calculate the pooled odds ratio for postoperative mortality and the pooled standardized mean difference (SMD) for the duration of ICU stay and hospital stay...
February 3, 2018: Interactive Cardiovascular and Thoracic Surgery
https://www.readbyqxmd.com/read/29413721/isoflurane-or-propofol-sedation-in-patients-with-targeted-temperature-management-after-cardiopulmonary-resuscitation-a-single-center-study
#10
Dawid Leander Staudacher, Sarah-Kristin Hamilton, Daniel Duerschmied, Paul Marc Biever, Manfred Zehender, Christoph Bode, Tobias Wengenmayer
PROPOSE: Targeted temperature management improves outcomes in comatose patients after cardiac arrest. Short lasting sedatives might enable rapid awakening after targeted temperature management and therefore early prognostication and extubation. Aim of the present study was to compare sedation with volatile isoflurane to intravenous propofol. MATERIALS AND METHODS: All patients after cardiopulmonary resuscitation undergoing targeted temperature management treated between 01/2014 and 02/2017 at a single tertiary referral hospital were screened...
February 2, 2018: Journal of Critical Care
https://www.readbyqxmd.com/read/29410174/mortality-after-spontaneous-subarachnoid-hemorrhage-causality-and-validation-of-a-prediction-model
#11
Yasser B Abulhasan, Najayeb Alabdulraheem, Gabrielle Simoneau, Mark R Angle, Jeanne Teitelbaum
OBJECTIVE: To evaluate primary causes of death after spontaneous subarachnoid hemorrhage (SAH) and externally validate the HAIR score, a prognostication tool, in a single academic institution. METHODS: We reviewed all SAH patients admitted to our Neuro-ICU between 2010 and 2016. Univariate and multivariate logistic regressions were performed to identify predictors of in-hospital mortality. The HAIR score predictors were Hunt and Hess grade at treatment decision, age, intraventricular hemorrhage, and re-bleeding within 24 hours...
January 31, 2018: World Neurosurgery
https://www.readbyqxmd.com/read/29409553/diagnostic-errors-in-paediatric-cardiac-intensive-care
#12
Priya N Bhat, John M Costello, Ranjit Aiyagari, Paul J Sharek, Claudia A Algaze, Mjaye L Mazwi, Stephen J Roth, Andrew Y Shin
Introduction Diagnostic errors cause significant patient harm and increase costs. Data characterising such errors in the paediatric cardiac intensive care population are limited. We sought to understand the perceived frequency and types of diagnostic errors in the paediatric cardiac ICU. METHODS: Paediatric cardiac ICU practitioners including attending and trainee physicians, nurse practitioners, physician assistants, and registered nurses at three North American tertiary cardiac centres were surveyed between October 2014 and January 2015...
February 7, 2018: Cardiology in the Young
https://www.readbyqxmd.com/read/29406373/creating-a-high-frequency-electronic-database-in-the-picu-the-perpetual-patient
#13
David Brossier, Redha El Taani, Michael Sauthier, Nadia Roumeliotis, Guillaume Emeriaud, Philippe Jouvet
OBJECTIVE: Our objective was to construct a prospective high-quality and high-frequency database combining patient therapeutics and clinical variables in real time, automatically fed by the information system and network architecture available through fully electronic charting in our PICU. The purpose of this article is to describe the data acquisition process from bedside to the research electronic database. DESIGN: Descriptive report and analysis of a prospective database...
February 5, 2018: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/29402360/-effect-of-lactic-acid-levels-on-the-prognosis-of-critically-ill-patients-after-cardiac-and-non-cardiac-surgery-an-analysis-of-549-cases
#14
Rongqing Sun, Ke Chao, Hongfu Yang
OBJECTIVE: To compare the impact of mean lactate concentration and lactate variability on postoperative outcome after cardiac surgery and non-cardiac surgery in critical patients, and to explore the prognostic value of the first lactate and the highest lactate during the first 24 hours in intensive care unit (ICU). METHODS: A retrospective study was conducted. The postoperative patients of cardiac surgery and non-cardiac surgery who were transferred to ICU immediately, and who were at least 18 years old and whose ICU lengths of stay were at least 1 day, and who were admitted to ICU of the First Affiliated Hospital of Zhengzhou University from September 2014 to September 2016 were enrolled...
February 2018: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
https://www.readbyqxmd.com/read/29395815/association-of-oral-intake-and-transient-mixed-venous-oxygen-desaturation-in-patients-undergoing-fast-track-postoperative-care-after-open-heart-surgery
#15
Yuichi Maki, Daisuke Toyoda, Keiko Tomichi, Jun Onodera, Yoshifumi Kotake
OBJECTIVE: The impact of early resumption of oral intake after cardiac surgery on hemodynamics has not been characterized. The authors examined the effects of early oral intake on the oxygen supply-demand relationship in patients undergoing on-pump cardiac surgery in an early recovery after surgery program. DESIGN: Prospective data were collected in postcardiac surgical patients in a multidisciplinary intensive care unit (ICU) during an 18-month period. SETTING: Single institution study...
December 20, 2017: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/29393044/early-warning-score-challenges-and-opportunities-in-the-care-of-deteriorating-patients%C3%A2
#16
John Asger Petersen
Clinical deterioration of patients hospitalized on general wards is often preceded by worsening vital signs. If identified early and acted upon quickly, it is conjectured that further deterioration can be prevented. To this means the early warning score (EWS) was implemented in all hospitals in the Capital Region of Denmark in 2013. EWS consists of an aggregated weighted track-and-trigger system (TTS), to identify at-risk patients early, and a treatment protocol to escalate care appropriately and determine the level of competency of the provider...
February 2018: Danish Medical Journal
https://www.readbyqxmd.com/read/29390270/anesthetic-management-of-off-pump-simultaneous-coronary-artery-bypass-grafting-and-lobectomy-case-report-and-literature-review
#17
Xian Zhao, Yuhong Li, Hai-Ying Kong, Lin Zhang, Xiao-Hong Wen
RATIONALE: Survey data show approximately 10% patients with lung cancer may present concomitant coronary heart disease. Simultaneous surgery is a challenge for anesthetist. We review our experience in the anesthesia with 5 patients who required simultaneous off-pump coronary artery bypass grafting (OPCABG) and pulmonary resection for lung cancer. PATIENT CONCERNS: Between 2014 and 2016, 5 patients with ASA (American Society of Anesthesiologists) grade II or III, underwent combined OPCABG and lung resection in the first Affiliated Hospital, Zhejiang University School of Medicine...
December 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/29389767/outcomes-of-donation-after-cardiac-death-liver-grafts-from-donors-%C3%A2-50-years-of-age-a-multi-center-analysis
#18
Kristopher P Croome, Amit K Mathur, David D Lee, Adyr A Moss, Charles B Rosen, Julie K Heimbach, C Burcin Taner
INTRODUCTION: As the population in the United States continues to age, an increase in the number of potential DCD donors with advanced chronological age can be expected. The aim of this study was to analyze a multi-institutional experience in liver transplantation using DCD donor age ≥50 years. METHODS: All DCD LT performed at Mayo Clinic Florida, Mayo Clinic Rochester and Mayo Clinic Arizona from 2002-2016 were included. Recipients of DCD LT were divided into 2 groups: those with donor age ≥50 years(N=155) and those with donor age <50 years(N=316)...
January 31, 2018: Transplantation
https://www.readbyqxmd.com/read/29389698/goal-directed-fluid-resuscitation-protocol-based-on-arterial-waveform-analysis-of-major-burn-patients-in-a-mass-burn-casualty
#19
Hao-Yu Chiao, Chang-Yi Chou, Yuan-Sheng Tzeng, Chih-Hsin Wang, Shyi-Gen Chen, Niann-Tzyy Dai
BACKGROUND: Adequate fluid titration during the initial resuscitation period of major burn patients is crucial. This study aimed to evaluate the feasibility and efficacy of a goal-directed fluid resuscitation protocol that used hourly urine output plus the arterial waveform analysis FloTrac (Edwards LifeSciences, Irvine, Calif) system for major burns to avoid fluid overload. METHODS: We conducted a retrospective cohort study of 43 major burn patients at the Tri-Service General Hospital after the Formosa Fun Coast Dust Explosion on June 27, 2015...
January 31, 2018: Annals of Plastic Surgery
https://www.readbyqxmd.com/read/29383510/epidemiology-causes-evolution-and-outcome-in-a-single-center-cohort-of-1116-critically-ill-patients-with-hypoxic-hepatitis
#20
Astrid Van den Broecke, Laura Van Coile, Alexander Decruyenaere, Kirsten Colpaert, Dominique Benoit, Hans Van Vlierberghe, Johan Decruyenaere
BACKGROUND: Hypoxic hepatitis (HH) is a type of acute hepatic injury that is histologically characterized by centrilobular liver cell necrosis and that is caused by insufficient oxygen delivery to the hepatocytes. Typical for HH is the sudden and significant increase of aspartate aminotransferase (AST) in response to cardiac, circulatory or respiratory failure. The aim of this study is to investigate its epidemiology, causes, evolution and outcome. METHODS: The screened population consisted of all adults admitted to the intensive care unit (ICU) at the Ghent University Hospital between January 1, 2007 and September 21, 2015...
January 30, 2018: Annals of Intensive Care
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