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https://www.readbyqxmd.com/read/29766326/the-change-in-management-of-bronchiolitis-in-the-intensive-care-unit-between-2000-and-2015
#1
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/29761216/low-dose-corticosteroids-for-adult-patients-with-septic-shock-a-systematic-review-with-meta-analysis-and-trial-sequential-analysis
#2
Sofie Louise Rygård, Ethan Butler, Anders Granholm, Morten Hylander Møller, Jeremy Cohen, Simon Finfer, Anders Perner, John Myburgh, Balasubramanian Venkatesh, Anthony Delaney
PURPOSE: To assess the effect of low dose corticosteroids on outcomes in adults with septic shock. METHODS: We systematically reviewed randomised clinical trials (RCTs) comparing low-dose corticosteroids to placebo in adults with septic shock. Trial selection, data abstraction and risk of bias assessment were performed in duplicate. The primary outcome was short-term mortality. Secondary and tertiary outcomes included longer-term mortality, adverse events, quality of life, and duration of shock, mechanical ventilation and ICU stay...
May 14, 2018: Intensive Care Medicine
https://www.readbyqxmd.com/read/29745620/non-ventilatory-therapies-for-acute-respiratory-distress-syndrome
#3
Jérémy Bourenne, Sami Hraiech, Romain Rambaud, Jean-Marie Forel, Nicolas Persico, Christophe Guervilly, Laurent Papazian
Acute respiratory distress syndrome (ARDS) commonly affects intensive care unit patients and is associated with high mortality. In addition to etiologic treatment and protective ventilation, non-ventilatory therapies represent a significant part of ARDS care. Pharmacological treatments, extra corporeal devices and prone positioning are commonly grouped under this term. Studies have evaluated the individual effects of some of these non- ventilatory therapies in large randomized controlled trials. Recent advances concerning the beneficial use of neuromuscular blocking agents and prone positioning deserve attention...
May 9, 2018: Minerva Anestesiologica
https://www.readbyqxmd.com/read/29705221/early-corticosteroids-for-pneumocystis-pneumonia-in-adults-without-hiv-are-not-associated-with-better-outcome
#4
Patrick M Wieruszewski, Jason N Barreto, Erin Frazee, Craig E Daniels, Pritish K Tosh, Ross A Dierkhising, Kristin C Mara, Andrew H Limper
BACKGROUND: Evidence supporting adjunctive corticosteroids during the treatment of Pneumocystis pneumonia (PcP) in adults without human immunodeficiency virus (HIV) is minimal and controversial. METHODS: This retrospective cohort study included PcP-positive, hospitalized patients without HIV admitted to Mayo Clinic from 2006 to 2016. Change from baseline in the respiratory component of the Sequential Organ Failure Assessment score (SOFAresp ) at day 5 was compared between early (within 48 hours) steroid recipients and non-recipients utilizing multivariable logistic regression and in a propensity-matched analysis...
April 26, 2018: Chest
https://www.readbyqxmd.com/read/29690685/-current-status-of-diagnosis-and-treatment-of-community-acquired-pneumonia-in-shanghai-revealed-by-a-questionnaire-analysis
#5
J Liu, J Zhang, Q J Cheng, J F Xu, Z J Jie, Y Jiao, Y Huang, J M Qu
Objective: To understand the current status of diagnosis and treatment of community-acquired pneumonia (CAP) among doctors in various hospitals across Shanghai, for the purpose of promoting the 2016 clinical practice guidelines for adult CAP of China. Methods: A questionnaire was designed to address the common questions in CAP management. The responses were collected via WeChat and the data were analyzed. Results: A total of 1 254 valid questionnaires were received, 46.1% from tertiary , 26.4% from secondary and 27...
April 12, 2018: Chinese Journal of Tuberculosis and Respiratory Diseases
https://www.readbyqxmd.com/read/29681180/amniocentesis-compared-with-antenatal-corticosteroids-prior-to-early-term-scheduled-cesarean-delivery
#6
Kelly B Zafman, Nathan S Fox
OBJECTIVE: There are a variety of maternal or fetal conditions that require late preterm or early term delivery. In cases where early delivery is indicated, optimal management is not always clear. Historically, obstetricians used amniocentesis to document fetal lung maturity, but recently, many have transitioned to administration of antenatal corticosteroids (ACS). The objective of this study was to compare neonatal outcomes between women undergoing amniocentesis or receiving ACS prior to scheduled cesarean delivery (CD) less than 39 weeks...
April 22, 2018: Journal of Maternal-fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/29679046/impact-of-antenatal-corticosteroids-in-preterm-neonates-based-on-maternal-body-mass-index
#7
Maheer Faden, Sarah D McDonald, Prakeshkumar S Shah, Amit Mukerji
OBJECTIVE: Impact of antenatal corticosteroid (ACS) in context of maternal body mass index (BMI) as it relates to neonatal outcomes remains unclear. We sought to evaluate effects of ACS on clinical outcomes of preterm infants based on maternal BMI. METHODS: We performed a retrospective cohort study among neonates 23-33 weeks' GA at a tertiary neonatal intensive care unit from 2011 to 2015. Outcomes of neonates exposed to any ACS and pre-pregnancy maternal BMI ≥ 25 (N = 491) were compared with maternal BMI < 25 (N = 484)...
April 20, 2018: Journal of Perinatology: Official Journal of the California Perinatal Association
https://www.readbyqxmd.com/read/29650049/variation-in-general-supportive-and-preventive-intensive-care-management-of-traumatic-brain-injury-a-survey-in-66-neurotrauma-centers-participating-in-the-collaborative-european-neurotrauma-effectiveness-research-in-traumatic-brain-injury-center-tbi-study
#8
Jilske A Huijben, Victor Volovici, Maryse C Cnossen, Iain K Haitsma, Nino Stocchetti, Andrew I R Maas, David K Menon, Ari Ercole, Giuseppe Citerio, David Nelson, Suzanne Polinder, Ewout W Steyerberg, Hester F Lingsma, Mathieu van der Jagt
BACKGROUND: General supportive and preventive measures in the intensive care management of traumatic brain injury (TBI) aim to prevent or limit secondary brain injury and optimize recovery. The aim of this survey was to assess and quantify variation in perceptions on intensive care unit (ICU) management of patients with TBI in European neurotrauma centers. METHODS: We performed a survey as part of the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study...
April 13, 2018: Critical Care: the Official Journal of the Critical Care Forum
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
#9
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
https://www.readbyqxmd.com/read/29629405/evaluation-of-systemic-corticosteroids-in-patients-with-an-acute-exacerbation-of-copd-and-a-diagnosis-of-pneumonia
#10
Tyler Scholl, Tyree H Kiser, Sheryl F Vondracek
Background: Chronic obstructive pulmonary disease (COPD) and pneumonia are leading causes of morbidity and mortality and are frequently comorbid. Studies of systemic corticosteroids in pneumonia have shown conflicting outcomes, whereas studies in acute exacerbations of COPD (AECOPD) have shown significant benefits. No studies have evaluated systemic corticosteroids in patients with both an AECOPD and pneumonia. Purpose: To evaluate the use of systemic corticosteroids in patients with both an AECOPD and pneumonia...
January 24, 2018: Chronic Obstructive Pulmonary Diseases: Journal of the COPD Foundation
https://www.readbyqxmd.com/read/29588066/life-threatening-everolimus-associated-pneumonitis-a-case-report-and-a-review-of-the-literature
#11
F Almeida, S Amorim, A Sarmento, L Santos
INTRODUCTION: Noninfective pneumonitis is a class-related effect within mammalian target of rapamycin (mTOR) inhibitors, including everolimus, and can occasionally be severe. CASE REPORT: A 62-year-old man, medicated with everolimus due to a heart transplantation 17 years previously and with chronic kidney disease, was admitted to the intensive care unit (ICU) with acute respiratory failure, cardiovascular shock, and impaired renal function requiring dialysis. Computed tomography (CT) scan revealed right upper lobe consolidation...
March 24, 2018: Transplantation Proceedings
https://www.readbyqxmd.com/read/29568696/aplastic-anemia-secondary-to-nivolumab-and-ipilimumab-in-a-patient-with-metastatic-melanoma-a-case-report
#12
D E Meyers, W F Hill, A Suo, V Jimenez-Zepeda, T Cheng, N A Nixon
Background: Immune checkpoint blockade (ICB) is becoming an increasingly prevalent strategy in the clinical realm of cancer therapeutics. With more patients being administered ICB for a host of tumor types, the scope of adverse events associated with these drugs will likely grow. Here we report a case of aplastic anemia (AA) in a patient with metastatic melanoma secondary to dual ICB therapy. To our knowledge, this is only the second case of AA secondary to dual ICB in the literature, and the first to have a positive patient outcome...
2018: Experimental Hematology & Oncology
https://www.readbyqxmd.com/read/29559173/patients-with-influenza-a-h1n1-pdm09-admitted-to-the-icu-impact-of-the-recommendations-of-the-semicyuc
#13
J Marin-Corral, C Climent, R Muñoz, M Samper, I Dot, C Vilà, J R Masclans, A Rodriguez, I Martin-Loeches, F Álvarez-Lerma
OBJECTIVES: To evaluate the impact of the recommendations of the SEMICYUC (2012) on severe influenza A. DESIGN: A prospective multicenter observational study was carried out. SETTING: ICU. PATIENTS: Patients infected with severe influenza A (H1N1) from the GETGAG/SEMICYUC registry. INTERVENTIONS: Analysis of 2 groups according to the epidemic period of the diagnosis (2009-2011; 2013-2015). VARIABLES: Demographic, temporal, comorbidities, severity, treatments, mortality, late diagnosis and place of acquisition...
March 17, 2018: Medicina Intensiva
https://www.readbyqxmd.com/read/29557596/severe-asthma-in-pediatrics-outcomes-of-the-implementation-of-a-special-health-care-protocol
#14
Verónica Giubergia, María J Ramirez Farías, Verónica Pérez, Adriana González, Nancy Crespi, Nora Fridman, Claudio Castaños
INTRODUCTION: Severe asthma accounts for 5-7% of all asthma cases. The World Health Organization proposed a follow-up protocol to classify cases into severe, treatment-resistant asthma (STRA) or severe, difficult-to-control asthma (SDCA). OBJECTIVE: To analyze the clinical, functional, and therapeutic characteristics of patients with STRA or SDCA. METHODS: Cross-sectional, observational, and analytical study to assess the diagnosis, the extent of control (clinical and functional), comorbidities, treatment adherence, inhalation technique, and environmental factors in patients with severe asthma...
April 1, 2018: Archivos Argentinos de Pediatría
https://www.readbyqxmd.com/read/29545274/acute-respiratory-distress-syndrome-in-mechanically-ventilated-patients-with-community-acquired-pneumonia
#15
Catia Cilloniz, Miquel Ferrer, Adamanthia Liapikou, Carolina Garcia-Vidal, Albert Gabarrus, Adrian Ceccato, Jorge Puig de La Bellacasa, Francesco Blasi, Antoni Torres
Our aim was to assess the incidence, characteristics, aetiology, risk factors and mortality of acute respiratory distress syndrome (ARDS) in intensive care unit (ICU) patients with community-acquired pneumonia (CAP) using the Berlin definition.We prospectively enrolled consecutive mechanically ventilated adult ICU patients with CAP over 20 years, and compared them with mechanically ventilated patients without ARDS. The main outcome was 30-day mortality.Among 5334 patients hospitalised with CAP, 930 (17%) were admitted to the ICU and 432 required mechanical ventilation; 125 (29%) cases met the Berlin ARDS criteria...
March 2018: European Respiratory Journal: Official Journal of the European Society for Clinical Respiratory Physiology
https://www.readbyqxmd.com/read/29543593/effect-of-pre-pregnancy-body-mass-index-on-respiratory-related-neonatal-outcomes-in-women-undergoing-elective-cesarean-prior-to-39-weeks
#16
Sophie Vincent, Nicholas Czuzoj-Shulman, Andrea R Spence, Haim A Abenhaim
OBJECTIVE: To examine the association between pre-pregnancy body mass index (BMI) and neonatal respiratory-related outcomes among women who underwent an elective cesarean section (CS). METHODS: A retrospective cohort study was conducted using the Centers for Disease Control and Prevention (CDC)'s 2009-2013 period linked birth/infant death dataset. Women who had elective CSs at term were categorized by their pre-pregnancy BMI as normal, overweight, obese or morbidly obese...
March 15, 2018: Journal of Perinatal Medicine
https://www.readbyqxmd.com/read/29521713/open-lung-biopsy-in-nonresolving-acute-respiratory-distress-syndrome-commonly-identifies-corticosteroid-sensitive-pathologies-associated-with-better-outcome
#17
Ludovic Gerard, Thomas Bidoul, Diego Castanares-Zapatero, Xavier Wittebole, Valérie Lacroix, Antoine Froidure, Delphine Hoton, Pierre-François Laterre
OBJECTIVES: Approximately half of the patients undergoing lung biopsy for nonresolving acute respiratory distress syndrome exhibit another histologic pattern than diffuse alveolar damage, with some of the pathologies characterized by a potential response to corticosteroids. This study aimed to assess whether open lung biopsy performed in the ICU for nonresolving acute respiratory distress syndrome was able to identify steroid-sensitive diseases and whether patients with a steroid-sensitive pathology experienced different clinical courses and outcomes...
June 2018: Critical Care Medicine
https://www.readbyqxmd.com/read/29511951/predictors-of-response-to-fixed-dose-vasopressin-in-adult-patients-with-septic-shock
#18
Gretchen L Sacha, Simon W Lam, Abhijit Duggal, Heather Torbic, Stephanie N Bass, Sarah C Welch, Robert S Butler, Seth R Bauer
BACKGROUND: Vasopressin is often utilized for hemodynamic support in patients with septic shock. However, the most appropriate patient to initiate therapy in is unknown. This study was conducted to determine factors associated with hemodynamic response to fixed-dose vasopressin in patients with septic shock. METHODS: Single-center, retrospective cohort of patients receiving fixed-dose vasopressin for septic shock for at least 6 h with concomitant catecholamines in the medical, surgical, or neurosciences intensive care unit (ICU) at a tertiary care center...
March 6, 2018: Annals of Intensive Care
https://www.readbyqxmd.com/read/29501285/impact-and-safety-of-open-lung-biopsy-in-patients-with-acute-respiratory-distress-syndrome-ards
#19
G Ortiz, M Garay, D Mendoza, P Cardinal-Fernández
INTRODUCTION: Acute respiratory distress syndrome (ARDS) is an inflammatory lung disorder, and its pathological hallmark is diffuse alveolar damage (DAD). Given that open lung biopsy (OLB) can sometimes result in severe side effects, it is rarely performed in patients with ARDS. AIM: The aims of this study were to describe: (a) the rate of treatment change associated with the histological result; and (b) the incidence of side effects induced by OLB. DESIGN AND PATIENTS: A retrospective, single-center, descriptive observational study was carried out in Hospital Santa Clara (Bogotá, Colombia) from February 2007 to January 2014...
February 28, 2018: Medicina Intensiva
https://www.readbyqxmd.com/read/29432350/an-exploratory-reanalysis-of-the-randomized-trial-on-efficacy-of-corticosteroids-as-rescue-therapy-for-the-late-phase-of-acute-respiratory-distress-syndrome
#20
G Umberto Meduri, Lisa Bridges, Reed A C Siemieniuk, Mehmet Kocak
OBJECTIVES: In the Acute Respiratory Distress Syndrome Network randomized controlled trial, methylprednisolone treatment was associated with increased return to mechanical ventilation with partial loss of early improvements. We hypothesize a causal relationship between protocol-driven rapid discontinuation of methylprednisolone post extubation and return to mechanical ventilation. To explore this possibility, we investigated the timing that events occurred in each treatment arm during active treatment intervention (efficacy) and after stopping therapy...
June 2018: Critical Care Medicine
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