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https://www.readbyqxmd.com/read/29679694/the-introduction-of-a-rapid-response-system-in-acute-hospitals-a-pragmatic-stepped-wedge-cluster-randomised-controlled-trial
#1
Filip Haegdorens, Peter Van Bogaert, Ella Roelant, Koen De Meester, Marie Misselyn, Kristien Wouters, Koenraad G Monsieurs
AIM: Deterioration of hospitalised patients is often missed, misinterpreted, and mismanaged. Rapid Response Systems (RRSs) have been proposed to solve this problem. This study aimed to investigate the effect of an RRS on the incidence of unexpected death, cardiac arrest with cardiopulmonary resuscitation (CPR), and unplanned intensive care unit (ICU) admission. METHODS: We conducted a stepped wedge cluster randomised controlled trial including 14 Belgian acute care hospitals with two medical and two surgical wards each...
April 18, 2018: Resuscitation
https://www.readbyqxmd.com/read/29679597/management-of-dyspnea-in-the-terminally-ill
#2
REVIEW
Lara Pisani, Nicholas S Hill, Angela Maria Grazia Pacilli, Massimiliano Polastri, Stefano Nava
The genesis of dyspnea involves the activation of several mechanisms that are mediated and perceived depending on previous experiences, values, emotions and beliefs. Breathlessness may become unbearable, especially in terminally ill patients, whether afflicted by respiratory, cardiac or cancer-related disorders, due to a final stage of a chronic process, an acute event or both. Compared to pain, palliation of dyspnea has received relatively little attention in clinical practice and the medical literature. This is particularly true when the breathlessness is associated with acute respiratory failure since most of the studies on pharmacological and non-pharmacological treatments of respiratory distress have excluded such patients...
April 18, 2018: Chest
https://www.readbyqxmd.com/read/29678977/minimizing-icu-neurological-dysfunction-with-dexmedetomidine-induced-sleep-mindds-protocol-for-a-randomised-double-blind-parallel-arm-placebo-controlled-trial
#3
Kenneth T Shelton, Jason Qu, Federico Bilotta, Emery N Brown, Gaston Cudemus, David A D'Alessandro, Hao Deng, Alan DiBiasio, Jacob A Gitlin, Eunice Y Hahm, Lauren E Hobbs, Timothy T Houle, Reine Ibala, Marco Loggia, Kara J Pavone, Shahzad Shaefi, George Tolis, M Brandon Westover, Oluwaseun Akeju
INTRODUCTION: Delirium, which is prevalent in postcardiac surgical patients, is an acute brain dysfunction characterised by disturbances in attention, awareness and cognition not explained by a pre-existing neurocognitive disorder. The pathophysiology of delirium remains poorly understood. However, basic science and clinical studies suggest that sleep disturbance may be a modifiable risk factor for the development of delirium. Dexmedetomidine is a α-2A adrenergic receptor agonist medication that patterns the activity of various arousal nuclei similar to sleep...
April 20, 2018: BMJ Open
https://www.readbyqxmd.com/read/29678435/prediction-of-patient-length-of-stay-on-the-intensive-care-unit-following-cardiac-surgery-a-logistic-regression-analysis-based-on-the-cardiac-operative-mortality-risk-calculator-euroscore
#4
Katherine Meadows, Richard Gibbens, Caroline Gerrard, Alain Vuylsteke
OBJECTIVE: The aim of this study was to develop a statistical model based on patient parameters to predict the length of stay (LOS) in the intensive care unit (ICU) following cardiac surgery in a single center. DESIGN: Data were collected from patients admitted to the ICU following cardiac surgery over a 10-year period (2006-2016). Both the additive and logistic EuroSCORE were calculated, and logistic regression analysis was carried out to formulate a model relating the predicted LOS to the EuroSCORE...
March 7, 2018: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/29677008/evolution-of-acute-kidney-injury-and-its-association-with-systemic-hemodynamics-in-children-with-fluid-refractory-septic-shock
#5
Akash Deep, Hiremath Sagar, Chulananda Goonasekera, Palaniswamy Karthikeyan, Joe Brierley, Abdel Douiri
OBJECTIVES: There are no studies in pediatrics evaluating the progression of acute kidney injury in septic shock. We investigated the evolution of sepsis-associated acute kidney injury and its association with systemic hemodynamics in children with fluid-refractory septic shock. DESIGN: Prospective cohort study. SETTING: PICU of a tertiary care hospital. PATIENTS: All patients with fluid-refractory septic shock (n = 61) between September 2010 and February 2014...
April 19, 2018: Critical Care Medicine
https://www.readbyqxmd.com/read/29672418/perioperative-use-of-levosimendan-improves-clinical-outcomes-in-patients-post-cardiac-surgery-a-systematic-review-and-meta-analysis
#6
Hua Qiang, Xiu Luo, Jian-Hua Huo, Zhi-Quan Wang
Severe postoperative complications can affect cardiac surgery patients. Levosimendan is a novel calcium sensitizer commonly administered after cardiac surgery. However, the patient benefits are controversial. PubMed, Embase, and the Cochrane library were systematically searched for randomized controlled trials (RCTs) comparing levosimendan with control in adult cardiac surgery patients. Twenty-five studies (3247 patients) were included. Pooled data indicated that levosimendan reduced mortality after cardiac surgery (OR 0...
April 3, 2018: Journal of Cardiovascular Pharmacology
https://www.readbyqxmd.com/read/29671149/biological-scoring-system-for-early-prediction-of-acute-bowel-ischemia-after-cardiac-surgery-the-palm-score
#7
Elie Zogheib, Cyril Cosse, Charles Sabbagh, Simon Marx, Thierry Caus, Marc Henry, Joseph Nader, Mathurin Fumery, Michael Bernasinski, Patricia Besserve, Faouzi Trojette, Cedric Renard, Pierre Duhaut, Said Kamel, Jean-Marc Regimbeau, Hervé Dupont
BACKGROUND: Bowel ischemia is a life-threatening emergency defined as an inadequate vascular perfusion leading to bowel inflammation resulting from impaired colonic/small bowel blood supply. Main issue for physicians regarding bowel ischemia diagnosis lies in the absence of informative and specific clinical or biological signs leading to delayed management, resulting in a poorer prognosis, especially after cardiac surgery. The aim of the present series was to propose a simple scoring system based on biological data for the diagnosis of bowel ischemia...
April 18, 2018: Annals of Intensive Care
https://www.readbyqxmd.com/read/29667097/an-elevated-respiratory-quotient-predicts-complications-after-cardiac-surgery-under-extracorporeal-circulation-an-observational-pilot-study
#8
J Piot, A Hébrard, M Durand, J F Payen, P Albaladejo
Following cardiac surgery, hyperlactatemia due to anaerobic metabolism is associated with an increase in both morbidity and mortality. We previously found that an elevated respiratory quotient (RQ) predicts anaerobic metabolism. In the present study we aimed to demonstrate that it is also associated with poor outcome following cardiac surgery. This single institution, prospective, observational study includes all those patients that were consecutively admitted to the intensive care unit (ICU) after cardiac surgery with cardiopulmonary bypass, that had also been monitored using pulmonary artery catheter...
April 17, 2018: Journal of Clinical Monitoring and Computing
https://www.readbyqxmd.com/read/29664003/-pathogenesis-of-sepsis-induced-myocardial-dysfunction
#9
Yunpeng Lou, Zhaofen Lin
Sepsis is a common disease in intensive care units (ICU), and the resulted multi-organ dysfunction syndrome (MODS) is the main cause of death in patients with severe sepsis. The cardiovascular system is one of the most important target organ for sepsis. The severity of cardiac dysfunction is closely related to the clinical prognosis of patients with sepsis. Studies have reported that various cytokines are expressed during sepsis. They have influence on myocardial contractile function, mitochondrial function and self-regulation...
April 2018: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
https://www.readbyqxmd.com/read/29664000/-comparison-of-cardiopulmonary-resuscitation-by-bending-and-pressing-the-lower-extremities-with-standard-cardiopulmonary-resuscitation-a-prospective-multicenter-trial
#10
Xiang Li, Jianjun Liu, Rui Tian, Jianguo Tang, Ruilan Wang, Liuyun Wang, Tonghao Zhou, Hui Huang
OBJECTIVE: To compare the effects of cardiopulmonary resuscitation by bending and pressing the lower extremities (BPLE-CPR) with standard cardiopulmonary resuscitation (S-CPR). METHODS: A multicenter prospective nonrandomized controlled study was performed. Patients with cardiac arrest (CA) treated in the emergency departments and intensive care units (ICU) of seven hospitals in Eastern China from January 2013 to February 2017 were enrolled. BPLE-CPR or S-CPR was used for resuscitation according to the patient's condition...
April 2018: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
https://www.readbyqxmd.com/read/29663283/eeg-artifact-versus-subclinical-status-epilepticus-in-a-patient-following-cardiac-arrest
#11
Jean E Cibula, Daniel S Demos, Brenda G Fahy
BACKGROUND: A challenge in ICU EEG interpretation is identifying subclinical status epilepticus versus patterns on the ictal-interictal continuum versus other repetitive patterns. In the electrically noisy intensive care unit, identifying and eliminating interference and artifact allow accurate diagnoses from the EEG, avoiding unnecessary treatment or sedation. METHODS: We present a case during Impella (Abiomed Inc, Danvers, MA) continuous flow left ventricular assist device use where the EEG artifact was initially misinterpreted as seizure by the resident and treated as status epilepticus because of the "focal" sharply contoured repetitive pattern...
April 16, 2018: Neurocritical Care
https://www.readbyqxmd.com/read/29660009/critical-care-in-the-military-health-system-a-24-h-point-prevalence-study
#12
Raymond Fisher, Christopher J Colombo, Cristin A Mount, Elizabeth A Mann-Salinas, Adam W Bostick, Konrad Davis, James K Aden, Kevin K Chung, Mary S McCarthy, Jeremy C Pamplin
Background: Healthcare expenditures are a significant economic cost with critical care services constituting one of its largest components. The Military Health System (MHS) is the largest, global healthcare system of its kind. In this project, we sought to describe critical care services and the patients who receive them in the MHS. Methods: We surveyed 26 military treatment facilities (MTFs) representing 38 critical care services or intensive care units (ICUs)...
April 11, 2018: Military Medicine
https://www.readbyqxmd.com/read/29659415/functional-status-change-among-children-with-extracorporeal-membrane-oxygenation-to-support-cardiopulmonary-resuscitation-in-a-pediatric-cardiac-icu-a-single-institution-report
#13
Asaad G Beshish, Mathew R Baginski, Thomas J Johnson, Barry K Deatrick, Ryan P Barbaro, Gabe E Owens
OBJECTIVES: The purpose of this study is to describe the functional status of survivors from extracorporeal cardiopulmonary resuscitation instituted during in-hospital cardiac arrest using the Functional Status Scale. We aimed to determine risk factors leading to the development of new morbidity and unfavorable functional outcomes. DESIGN: This was a single-center retrospective chart review abstracting patient characteristics/demographic data, duration of cardiopulmonary resuscitation, duration of extracorporeal membrane oxygenation support, as well as maximum lactate levels within 2 hours before and after extracorporeal cardiopulmonary resuscitation...
April 13, 2018: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/29657374/methylene-blue-for-vasoplegic-syndrome-postcardiac-surgery
#14
Aly Makram Habib, Ahmed Galal Elsherbeny, Rayd Abdelaziz Almehizia
Objectives: cardiopulmonary bypass (CPB) can be complicated by vasoplegia that is refractory to vasopressors. Methylene blue (MB) represents an alternative in such cases. Patients and Methods: Retrospective observational historical control-matched study. From 2010 to 2015, all patients who received MB for vasoplegia post-CPB were included in this study. Historical controls from the period of 2004 to 2009 were matched. End-points were the time till improvement of vasoplegia (Ti), 30-day mortality, cardiac surgical Intensive Care Unit (CSICU) morbidity, and length of stay (LOS)...
March 2018: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/29657370/delirium-in-the-intensive-care-unit-incidence-risk-factors-and-impact-on-outcome
#15
Nejla Tilouche, Mohamed Fekih Hassen, Habiba Ben Sik Ali, Oussamma Jaoued, Rim Gharbi, S Souheil El Atrous
Background: The incidence and risk factors for delirium vary among studies. Objective: We aimed to determine the incidence, risk factors, and impact on outcome of delirium in a medical Intensive Care Unit (ICU) in Tunisia using a prospective observational study. Patients: All consecutive patients admitted to the ICU between May 2012 and April 2013 were included if they were aged more than 18 years and had an ICU stay of more than 24 h. Patients who had a cardiac arrest or have a history of dementia or psychosis were excluded...
March 2018: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/29657106/hyponatraemia-is-independently-associated-with-in-hospital-mortality-in-patients-with-pneumonia
#16
Martin Müller, Joerg C Schefold, Viviane Guignard, Aristomenis K Exadaktylos, Carmen A Pfortmueller
BACKGROUND: Hyponatraemia on hospital admission has been shown to be a risk factor for illness severity in critically ill patients. The aim of the present study was to investigate whether hyponatraemia on emergency department (ED) admission independently influences in-hospital mortality, ICU admission, and/or length of hospitalisation in patients with pneumonia. METHODS: 610 patients (64.4% male, median 66 years) diagnosed with pneumonia were identified by retrospective screening of electronic admission data (06/2011-06/2013)...
April 13, 2018: European Journal of Internal Medicine
https://www.readbyqxmd.com/read/29652752/practice-change-from-intermittent-medication-boluses-to-bolusing-from-a-continuous-infusion-in-pediatric-critical-care-a-quality-improvement-project
#17
Jessica L Hochstetler, A Jill Thompson, Natalie M Ball, Melissa C Evans, Shaun C Frame, A Lauren Haney, Amelia K Little, Jaime L O'Donnell, Bryna M Rickett, Elizabeth H Mack
OBJECTIVES: To determine whether implementing a guideline to bolus medications from continuous infusions in PICUs affects nursing satisfaction, patient safety, central line entries, medication utilization, or cost. DESIGN: This is a pre- and postimplementation quality improvement study. SETTING: An 11-bed ICU and 14-bed cardiac ICU in a university-affiliated children's hospital. PATIENTS: Patients less than 18 years old admitted to the PICU or pediatric cardiac ICU receiving a continuous infusion of dexmedetomidine, midazolam, fentanyl, morphine, vecuronium, or cisatracurium from May 2015 to May 2016, excluding November 2015 (washout period), were eligible for inclusion...
April 12, 2018: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/29652273/assessment-of-the-effect-of-two-regimens-of-milrinone-infusion-in-pediatric-patients-undergoing-fontan-procedure-a-randomized-study
#18
Rabie Soliman, Adel Ragheb
Objective: The aim of the study was to compare the effect of two different regimens of milrinone on hemodynamics and oxygen saturation in pediatric patients undergoing Fontan procedure. Design: This was a randomized study. Setting: Cardiac centers. Patients: This study included 116 patients undergoing Fontan procedure. Material and Methods: Group E: Milrinone was started as infusion 0.5 μg/kg/min without a loading dose at the beginning of cardiopulmonary bypass (CPB) followed by infusion 0...
April 2018: Annals of Cardiac Anaesthesia
https://www.readbyqxmd.com/read/29652271/prophylactic-preoperative-levosimendan-for-off-pump-coronary-artery-bypass-grafting-in-patients-with-left-ventricular-dysfunction-single-centered-randomized-prospective-study
#19
Pushkar Mahendra Desai, Manjula S Sarkar, Sanjeeta R Umbarkar
Background: Off-pump coronary artery bypass surgery (OPCAB) is often complicated by hemodynamic instability, especially in patients with prior left ventricular (LV) dysfunction and appropriate choice of inotrope plays a vital role in perioperative management of these patients. Aim and Objective: To study hemodynamic effects and immediate outcome of prophylactic infusion of levosimendan in patients with the LV dysfunction undergoing OPCAB surgery and whether this strategy helps in successful conduct of OPCAB surgery...
April 2018: Annals of Cardiac Anaesthesia
https://www.readbyqxmd.com/read/29642928/diagnostic-and-management-of-life-threatening-adult-onset-still-disease-a-french-nationwide-multicenter-study-and-systematic-literature-review
#20
Antoine Néel, Anaïs Wahbi, Benoit Tessoulin, Julien Boileau, Dorothée Carpentier, Olivier Decaux, Laurence Fardet, Guillaume Geri, Pascal Godmer, Cécile Goujard, Hervé Maisonneuve, Arnaud Mari, Jacques Pouchot, Jean-Marc Ziza, Cédric Bretonnière, Mohamed Hamidou
BACKGROUND: Adult-onset Still disease (AOSD) is a rare systemic inflammatory disorder. A few patients develop organ complications that can be life-threatening. Our objectives were to describe the disease course and phenotype of life-threatening AOSD, including response to therapy and long-term outcome. METHODS: A multicenter case series of intensive care medicine (ICU) patients with life-threatening AOSD and a systematic literature review. RESULTS: Twenty patients were included...
April 11, 2018: Critical Care: the Official Journal of the Critical Care Forum
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