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"critical care" and "guidelines"

Abigail R Koch, Pamela T Roesch, Caitlin E Garland, Stacie E Geller
CONTEXT: Severe maternal morbidity (SMM) rates in the United States more than doubled between 1998 and 2010. Advanced maternal age and chronic comorbidities do not completely explain the increase in SMM or how to effectively address it. The Centers for Disease Control and Prevention and American College of Obstetricians and Gynecologists have called for facility-level multidisciplinary review of SMM for potential preventability and have issued implementation guidelines. IMPLEMENTATION: Within Illinois, SMM was identified as any intensive or critical care unit admission and/or 4 or more units of packed red blood cells transfused at any time from conception through 42 days postpartum...
March 7, 2018: Journal of Public Health Management and Practice: JPHMP
Christian J Wiedermann
Published articles may be retracted when their findings are no longer considered reliable due to honest error, publication misconduct or research misconduct. This article focuses on the case of a single serial violator of research and publication ethics in anesthesiology and critical care, which is widely publicized. A chain of events led to detection of misconduct that had substantial impact on the evidence base for the safety of hydroxyethyl starch, an intravenous artificial colloid solution, which is reflected in current guidelines on fluid management and volume resuscitation...
March 8, 2018: Accountability in Research
Wojciech Francuzik, Sabine Dölle, Margitta Worm
Patients experiencing anaphylaxis who do not recover after treatment with intramuscular adrenaline are regarded as suffering from refractory anaphylaxis. The incidence of refractory anaphylaxis is estimated to range between 3-5% of anaphylaxis cases. The risk factors for refractory anaphylaxis are unknown. Areas covered: In the present analysis, we aimed to evaluate the management and risk factors of refractory anaphylaxis to highlight possible clinical implications for updating current management algorithms...
March 7, 2018: Expert Review of Clinical Immunology
W A Werbel, M G Ison, M P Angarone, A Yang, V Stosor
BACKGROUND: Pneumocystis jirovecii pneumonia (PJP) affected 5-15% of solid organ transplant (SOT) recipients prior to universal prophylaxis, classically with trimethoprim-sulfamethoxazole (TMP-SMX). Guidelines generally recommend 6-12 months of prophylaxis post SOT, yet optimal duration and robust PJP risk stratification have not been established. METHODS: A retrospective, single-center, case-control study of PJP among SOT recipients from January 1998 to December 2013 was conducted...
March 7, 2018: Transplant Infectious Disease: An Official Journal of the Transplantation Society
Bethan Jenkins, Philip C Calder, Luise V Marino
BACKGROUND & AIMS: Critically ill adults have increased nutrition risk. Prior to procedures patients are often fasted, leading to nutritional deficits. The use of fasting guidelines may therefore help reduce deficits from accumulating. The aim of this work was to determine the impact on nutrition support delivery following the implementation of fasting guidelines in addition to characterizing staff knowledge of the guidelines. DESIGN: Retrospective data were collected on n = 74 patients at two different time points; prior to launch of fasting guidelines and post launch, with regards to estimated nutritional requirements, nutritional targets, volume of enteral nutrition (EN) delivered and periods of fasting...
February 15, 2018: Clinical Nutrition: Official Journal of the European Society of Parenteral and Enteral Nutrition
Micaela Carwell
Therapeutic hypothermia, also referred to as targeted temperature management, has been a component of the postcardiac arrest treatment guidelines since 2010. Although almost a decade has passed since its inclusion in the postarrest guidelines, many unanswered questions remain regarding selection of the appropriate patient population, optimal target temperature, ideal window of time in which to initiate therapy after arrest, most efficient, safe, and accurate equipment choice for inducing and maintaining hypothermia, most effective duration of treatment, and rate of cooling or rewarming...
April 2018: Critical Care Nursing Quarterly
Kamath Sriganesh, Jason W Busse, Harsha Shanthanna, Venkatapura J Ramesh
Background and Aims: There is a paucity of clinical practice guidelines for the ideal approach to airway management in patients with cervical spine instability (CSI). The aim of this survey was to evaluate preferences, perceptions and practices regarding airway management in patients with CSI among neuroanaesthesiologists practicing in India. Methods: A 25-item questionnaire was circulated for cross-sectional survey to 378 members of the Indian Society of Neuroanaesthesiology and Critical Care (ISNACC) by E-mail...
February 2018: Indian Journal of Anaesthesia
James J McCarthy, Brendan Carr, Comilla Sasson, Bentley J Bobrow, Clifton W Callaway, Robert W Neumar, Jose Maria E Ferrer, J Lee Garvey, Joseph P Ornato, Louis Gonzales, Christopher B Granger, Monica E Kleinman, Chris Bjerke, Graham Nichol
The American Heart Association previously recommended implementation of cardiac resuscitation systems of care that consist of interconnected community, emergency medical services, and hospital efforts to measure and improve the process of care and outcome for patients with cardiac arrest. In addition, the American Heart Association proposed a national process to develop and implement evidence-based guidelines for cardiac resuscitation systems of care. Significant experience has been gained with implementing these systems, and new evidence has accumulated...
February 26, 2018: Circulation
Sean Collins, Jennifer Martindale
PURPOSE OF REVIEW: In spite of advances in our understanding of acute heart failure (AHF) and its different phenotypic expressions, AHF management is still centered on volume removal with intravenous diuretics. This narrative review describes the pathophysiology underlying hypertensive AHF and appraises therapies targeting these mechanisms. RECENT FINDINGS: Vascular redistribution rather than volume overload may be the primary determinant of elevated cardiac filling pressures and subsequent pulmonary congestion in patients with hypertensive AHF; in these patients, vasodilators should be the predominant treatment...
February 24, 2018: Current Hypertension Reports
Djillali Annane, Stephen M Pastores, Bram Rochwerg, Wiebke Arlt, Robert A Balk, Albertus Beishuizen, Josef Briegel, Joseph Carcillo, Mirjam Christ-Crain, Mark S Cooper, Paul E Marik, Gianfranco Umberto Meduri, Keith M Olsen, Sophia Rodgers, James A Russell, Greet Van den Berghe
To update the 2008 consensus statements for the diagnosis and management of critical illness-related corticosteroid insufficiency (CIRCI) in adult and pediatric patients.
February 23, 2018: Intensive Care Medicine
F J Kranenburg, S A Willems, S Le Cessie, P J Marang-van de Mheen, J G van der Bom, M S Arbous
BACKGROUND AND OBJECTIVES: Most guidelines recommend a restrictive transfusion trigger of 7 g/dl. It is unclear whether this resulted in more uniform transfusion practices. The primary objective was to uncover the extent of variation in transfusion decisions within four scenarios of critically ill patients among critical care physicians in the Netherlands. MATERIALS AND METHODS: An online survey comprising four different hypothetical clinical scenarios was sent to all members of the Dutch Society of Intensive Care...
February 23, 2018: Vox Sanguinis
M G Gómez-Prieto, M R Míguez-Crespo, J R Jiménez-Del-Valle, M D González-Caro, I Marmesat-Ríos, J Garnacho-Montero
OBJECTIVE: To know organization, management and training in airway (AW) in Spanish Intensive Care Units (ICUs), with special interest in difficult airway (DAW). DESIGN: Descriptive cross-sectional study and χ2 subanalysis, conducted through a national survey from november 1th to december 15th, 2016. With the SEMICYUC's support, an online questionnaire of 27 items was sent to 179 ICUs. SETTING: ICUs of public, private centers, and consortia...
February 18, 2018: Medicina Intensiva
Takahiro Niimura, Yoshito Zamami, Toru Imai, Kanako Nagao, Masafumi Kayano, Hidenori Sagara, Mitsuhiro Goda, Naoto Okada, Masayuki Chuma, Kenshi Takechi, Masaki Imanishi, Toshihiro Koyama, Tadashi Koga, Hironori Nakura, Toshiaki Sendo, Keisuke Ishizawa
PURPOSE: Although the 2016 Japanese guidelines for the management of sepsis recommend de-escalation of treatment after identification of the causative pathogen, adherence to this practice remain unknown. The objective of this study was to evaluate the benefits of de-escalating treatment for sepsis patients at an advanced critical care and emergency medical centre. METHODS: Based on electronic patient information, 85 patients who were transported to the centre by ambulance, and diagnosed with sepsis between January 2008 and September 2013 were enrolled and evaluated...
2018: Journal of Pharmacy & Pharmaceutical Sciences: a Publication of the Canadian Society for Pharmaceutical Sciences
Mohamad-Hani A Temsah, Fahad M Al-Sohime, Fahad A Bashiri, Ayman A Al-Eyadhy, Gamal M Hasan, Ali A Alhaboob
OBJECTIVE: To explore therapeutic attitude of healthcare providers practicing in pediatric critical care in Saudi Arabia toward patients with Spinal Muscular Atroph (SMA) Type I, and to explore their awareness about the International Consensus statement for SMA care. METHODS: A cross-sectional survey was conducted in April 2015 during 6th Saudi Critical Care Conference, targeting physicians and respiratory therapists practicing in Pediatric Critical Care. RESULTS: Sixty participants accepted to participate in this survey...
January 2018: Neurosciences: the Official Journal of the Pan Arab Union of Neurological Sciences
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
Howieda Fouly, Fayza Ahmed Abdou, Ahmed M Abbas, Ayat Masoud Omar
Maternal deaths remain high, numbers at the facility level are relatively low. AIM: To evaluate effect of management guidelines on occurrence of maternal near miss in Women's Health Hospital. DESIGN: A cross-sectional study. SETTING: ICU of Women's Health Hospital's at Assiut Main University Hospital and Al-fayoum University Hospital. SUBJECTS: Convenient sample of 93 maternal near-miss cases including (Pregnancy or postpartum complications)...
February 2018: Applied Nursing Research: ANR
Lucia Rivera-Lara, Andres Zorrilla-Vaca, Ryan J Healy, Wendy Ziai, Charles Hogue, Romergryko Geocadin, Batya Radzik, Caitlin Palmisano, Marek A Mirski
OBJECTIVE: Critical care guidelines recommend a single target value for mean arterial blood pressure in critically ill patients. However, growing evidence regarding cerebral autoregulation challenges this concept and supports individualizing mean arterial blood pressure targets to prevent brain and kidney hypo- or hyperperfusion. Regional cerebral oxygen saturation derived from near-infrared spectroscopy is an acceptable surrogate for cerebral blood flow and has been validated to measure cerebral autoregulation...
February 6, 2018: Critical Care Medicine
Barbara S Gordon, Maggie Keogh, Zachary Davidson, Stephen Griffiths, Vanshdeep Sharma, Deborah Marin, Stephan A Mayer, Neha S Dangayach
OBJECTIVES: The purpose of this review is to provide an overview of research on spirituality and religiosity in the intensive care setting that has been published since the 2004-2005 American College of Critical Care Medicine (ACCM) Clinical Practice Guidelines for the Support of Family in the Patient-Centered Intensive Care Unit with an emphasis on its application beyond palliative and end-of-life care. MATERIALS AND METHODS: ACCM 2004-2005 guidelines emphasized the importance of spiritual and religious support in the form of four specific recommendations: [1] assessment and incorporation of spiritual needs in ICU care plan; [2] spiritual care training for doctors and nurses; [3] physician review of interdisciplinary spiritual need assessments; and [4] honoring the requests of patients to pray with them...
January 31, 2018: Journal of Critical Care
F Chaves, J Garnacho-Montero, J L Del Pozo, E Bouza, J A Capdevila, M de Cueto, M Á Domínguez, J Esteban, N Fernández-Hidalgo, M Fernández Sampedro, J Fortún, M Guembe, L Lorente, J R Paño, P Ramírez, M Salavert, M Sánchez, J Vallés
Catheter-related bloodstream infections (CRBSI) constitute an important cause of hospital-acquired infection associated with morbidity, mortality, and cost. The aim of these guidelines is to provide updated recommendations for the diagnosis and management of CRBSI in adults. Prevention of CRBSI is excluded. Experts in the field were designated by the two participating Societies (the Spanish Society of Infectious Diseases and Clinical Microbiology and [SEIMC] and the Spanish Society of Spanish Society of Intensive and Critical Care Medicine and Coronary Units [SEMICYUC])...
January 2018: Medicina Intensiva
Aayush Gabrani, Taiki Kojima, Ronald C Sanders, Asha Shenoi, Vicki Montgomery, Simon J Parsons, Sandeep Gangadharan, Sholeen Nett, Natalie Napolitano, Keiko Tarquinio, Dennis W Simon, Anthony Lee, Guillaume Emeriaud, Michelle Adu-Darko, John S Giuliano, Keith Meyer, Ana Lia Graciano, David A Turner, Conrad Krawiec, Adnan M Bakar, Lee A Polikoff, Margaret Parker, Ilana Harwayne-Gidansky, Benjamin Crulli, Paula Vanderford, Ryan K Breuer, Eleanor Gradidge, Aline Branca, Lily B Grater-Welt, David Tellez, Lisa V Wright, Matthew Pinto, Vinay Nadkarni, Akira Nishisaki
OBJECTIVES: As of July 2013, pediatric resident trainee guidelines in the United States no longer require proficiency in nonneonatal tracheal intubation. We hypothesized that laryngoscopy by pediatric residents has decreased over time, with a more pronounced decrease after this guideline change. DESIGN: Prospective cohort study. SETTING: Twenty-five PICUs at various children's hospitals across the United States. PATIENTS: Tracheal intubations performed in PICUs from July 2010 to June 2016 in the multicenter tracheal intubation database (National Emergency Airway Registry for Children)...
February 5, 2018: Pediatric Critical Care Medicine
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