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https://www.readbyqxmd.com/read/27907961/critical-care-management-of-the-patient-with-traumatic-brain-injury
#1
G Duemani Reddy, Shankar Gopinath, Claudia Robertson
The critical care management of patients with traumatic brain injury is complex. The primary goal is to minimize the effects of secondary injury that would otherwise serve to further worsen neurologic function. This requires an understanding of the abnormal brain physiology that is found in these patients. In this article the authors discuss this physiology and describe suggested treatment strategies for these patients based on evidence-based guidelines.
December 2016: Seminars in Neurology
https://www.readbyqxmd.com/read/27890495/critical-care-guidelines-more-science-less-art
#2
EDITORIAL
The Lancet Respiratory Medicine
No abstract text is available yet for this article.
December 2016: Lancet Respiratory Medicine
https://www.readbyqxmd.com/read/27876084/a-trial-to-determine-whether-septic-shock-reversal-is-quicker-in-pediatric-patients-randomized-to-an-early-goal-directed-fluid-sparing-strategy-versus-usual-care-squeeze-study-protocol-for-a-pilot-randomized-controlled-trial
#3
Melissa J Parker, Lehana Thabane, Alison Fox-Robichaud, Patricia Liaw, Karen Choong
BACKGROUND: Current pediatric septic shock resuscitation guidelines from the American College of Critical Care Medicine focus on the early and goal-directed administration of intravascular fluid followed by vasoactive medication infusions for persistent and fluid-refractory shock. However, accumulating adult and pediatric data suggest that excessive fluid administration is associated with worse patient outcomes and even increased risk of death. The optimal amount of intravascular fluid required in early pediatric septic shock resuscitation prior to the initiation of vasoactive support remains unanswered...
November 22, 2016: Trials
https://www.readbyqxmd.com/read/27868189/an-evaluation-of-inpatient-morbidity-and-critical-care-provision-in-zambia
#4
P J Dart, J Kinnear, M D Bould, S L Mwansa, Z Rakhda, D Snell
The aim of this study was to objectively measure demand for critical care services in a southern African tertiary referral centre. We carried out a point prevalence study of medical and surgical admissions over a 48-h period at the University Teaching Hospital, Lusaka, recording the following: age; sex; diagnosis; Human Immunodeficiency Virus (HIV) status and National Early Warning Score. One-hundred and twenty medical and surgical admissions were studied. Fifty-four patients (45%) had objective evidence of a requirement for critical care review and potential or probable admission to an intensive care unit, according to the Royal College of Physicians (UK) guidelines...
November 21, 2016: Anaesthesia
https://www.readbyqxmd.com/read/27858808/guideline-for-reversal-of-antithrombotics-in-intracranial-hemorrhage-executive-summary-a-statement-for-healthcare-professionals-from-the-neurocritical-care-society-and-the-society-of-critical-care-medicine
#5
Jennifer A Frontera, John J Lewin, Alejandro A Rabinstein, Imo P Aisiku, Anne W Alexandrov, Aaron M Cook, Gregory J Del Zoppo, Monisha Kumar, Ellinor I B Peerschke, Michael F Stiefel, Jeanne S Teitelbaum, Katja E Wartenberg, Cindy L Zerfoss
No abstract text is available yet for this article.
December 2016: Critical Care Medicine
https://www.readbyqxmd.com/read/27855228/the-devil-is-in-the-details-incomplete-reporting-in-preclinical-animal-research
#6
Marc T Avey, David Moher, Katrina J Sullivan, Dean Fergusson, Gilly Griffin, Jeremy M Grimshaw, Brian Hutton, Manoj M Lalu, Malcolm Macleod, John Marshall, Shirley H J Mei, Michael Rudnicki, Duncan J Stewart, Alexis F Turgeon, Lauralyn McIntyre
Incomplete reporting of study methods and results has become a focal point for failures in the reproducibility and translation of findings from preclinical research. Here we demonstrate that incomplete reporting of preclinical research is not limited to a few elements of research design, but rather is a broader problem that extends to the reporting of the methods and results. We evaluated 47 preclinical research studies from a systematic review of acute lung injury that use mesenchymal stem cells (MSCs) as a treatment...
2016: PloS One
https://www.readbyqxmd.com/read/27852357/a-multifaceted-approach-to-reduction-of-catheter-associated-urinary-tract-infections-in-the-intensive-care-unit-with-an-emphasis-on-stewardship-of-culturing
#7
Katherine M Mullin, Christopher S Kovacs, Cynthia Fatica, Colette Einloth, Elizabeth A Neuner, Jorge A Guzman, Eric Kaiser, Venu Menon, Leticia Castillo, Marc J Popovich, Edward M Manno, Steven M Gordon, Thomas G Fraser
BACKGROUND Catheter-associated urinary tract infections (CAUTIs) are among the most common hospital-acquired infections (HAIs). Reducing CAUTI rates has become a major focus of attention due to increasing public health concerns and reimbursement implications. OBJECTIVE To implement and describe a multifaceted intervention to decrease CAUTIs in our ICUs with an emphasis on indications for obtaining a urine culture. METHODS A project team composed of all critical care disciplines was assembled to address an institutional goal of decreasing CAUTIs...
November 17, 2016: Infection Control and Hospital Epidemiology
https://www.readbyqxmd.com/read/27849676/platelet-transfusion-in-critical-care-and-surgery-evidence-based-review-of-contemporary-practice-and-future-directions
#8
Eric W Etchill, Sara P Myers, Jay S Raval, Adnan Hassoune, Anirban SenGupta, Matthew D Neal
Thrombocytopenia is prevalent in critical care, surgical, and trauma settings. Despite the fact that a significant proportion of these patients receive platelet transfusion during their hospital course, much work remains to be done with regard to development of platelet transfusion guidelines. Given the wide variety of platelet transfusion practices and the frequency with which patients present with thrombocytopenia, it is paramount to understand standards of care and to identify deficiencies that may exist...
November 15, 2016: Shock
https://www.readbyqxmd.com/read/27829710/early-norepinephrine-decreases-fluid-and-ventilatory-requirements-in-pediatric-vasodilatory-septic-shock
#9
Suchitra Ranjit, Rajeswari Natraj, Sathish Kumar Kandath, Niranjan Kissoon, Balasubramaniam Ramakrishnan, Paul E Marik
AIMS: We previously reported that vasodilatation was common in pediatric septic shock, regardless of whether they were warm or cold, providing a rationale for early norepinephrine (NE) to increase venous return (VR) and arterial tone. Our primary aim was to evaluate the effect of smaller fluid bolus plus early-NE versus the American College of Critical Care Medicine (ACCM) approach to more liberal fluid boluses and vasoactive-inotropic agents on fluid balance, shock resolution, ventilator support and mortality in children with septic shock...
October 2016: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/27818334/neuromuscular-blockade-in-the-21-st-century-management-of-the-critically-ill-patient
#10
REVIEW
Julian deBacker, Nicholas Hart, Eddy Fan
Neuromuscular blockings agents (NMBAs) have a controversial role in the ventilatory and medical management of critical illness. The clinical concern surrounding NMBA-induced complications stems from evidence presented in the 2002 clinical practice guidelines, but new evidence from subsequent randomized trials and studies provides a more optimistic outlook about the application of NMBAs in the intensive care unit (ICU). Furthermore, changes in the delivery of critical care such as protocolized care pathways, minimizing or interrupting sedation, increased monitoring techniques, and overall improvements in reducing immobility have created a modern, 21st century ICU environment whereby NMBAs may be administered safely...
November 3, 2016: Chest
https://www.readbyqxmd.com/read/27818329/liberation-from-mechanical-ventilation-in-critically-ill-adults-executive-summary-of-an-official-american-college-of-chest-physicians-american-thoracic-society-clinical-practice-guideline
#11
Gregory A Schmidt, Timothy D Girard, John P Kress, Peter E Morris, Daniel R Ouellette, Waleed Alhazzani, Suzanne M Burns, Scott K Epstein, Andres Esteban, Eddy Fan, Miguel Ferrer, Gilles L Fraser, Michelle Gong, Catherine L Hough, Sangeeta Mehta, Rahul Nanchal, Sheena Patel, Amy J Pawlik, Curtis N Sessler, William Schweickert, Thomas Strøm, Kevin C Wilson, Jonathon D Truwit
BACKGROUND: This clinical practice guideline addresses six questions related to liberation from mechanical ventilation in critically ill adults. It is the result of a collaborative effort between the American Thoracic Society (ATS) and American College of Chest Physicians (CHEST). METHODS: A multi-disciplinary panel posed six clinical questions in a Population, Intervention, Comparator and Outcomes (PICO) format. A comprehensive literature search and evidence synthesis was performed for each question, which included appraising the quality of evidence using the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach...
November 3, 2016: Chest
https://www.readbyqxmd.com/read/27818327/an-educational-intervention-optimizes-the-utilization-of-arterial-blood-gases-across-intensive-care-units-from-different-specialties-a-quality-improvement-study
#12
Carlos D Martínez-Balzano, Paulo Oliveira, Michelle O'Rourke, Luanne Hills, Andrés F Sosa
BACKGROUND: Arterial blood gas (ABG) overutilization leads to increased costs, inefficient use of staff work-hours, patient discomfort and blood loss. We developed guidelines to optimize ABG utilization in the intensive care unit (ICU). METHODS: ABG utilization guidelines were implemented on all adult ICUs in our institution: three medical, two trauma-surgery, one cardiovascular and one neurosurgical ICU. While relying on pulse oximetry, we encouraged the utilization of ABGs after an acute respiratory event or for a rational clinical concern, and discouraged obtaining ABGs for routine surveillance, after planned changes of PEEP or FiO2 on the mechanical ventilator, for spontaneous breathing trials, or when a disorder was not suspected...
November 3, 2016: Chest
https://www.readbyqxmd.com/read/27816128/surgical-critical-care-for-the-patient-with-sepsis-and-multiple-organ-dysfunction
#13
REVIEW
Gary J Kaml, Kimberly A Davis
Sepsis and multiple organ dysfunction syndrome (MODS) is common in the surgical intensive care unit. Sepsis involves infection and the patient's immune response. Timely recognition of sepsis and swift application of evidence-based interventions is critical to the success of therapy. This article reviews the nature of the septic process, existing definitions of sepsis, and current evidence-based treatment strategies for sepsis and MODS. An improved understanding of the process of sepsis and its relation to MODS has resulted in clinical definitions and scoring systems that allow for the quantification of disease severity and guidelines for treatment...
December 2016: Anesthesiology Clinics
https://www.readbyqxmd.com/read/27804108/tracheal-extubation-of-the-adult-intensive-care-patient-with-a-predicted-difficult-airway-a-narrative-review
#14
REVIEW
D J Sturgess, K B Greenland, S Senthuran, F A Ajvadi, A van Zundert, M G Irwin
Management of the difficult airway is an important, but as yet poorly-studied, component of intensive care management. Although there has been a strong emphasis on prediction and intubation of the difficult airway, safe extubation of the patient with a potentially difficult airway has not received the same attention. Extubation is a particularly vulnerable time for the critically ill patient and, because of the risks involved and the consequences of failure, it warrants specific consideration. The Royal College of Anaesthetists 4th National Audit Project highlighted differences in the incidence and consequences of major complications during airway management between the operating room and the critical care environment...
November 2, 2016: Anaesthesia
https://www.readbyqxmd.com/read/27800290/antibiogram-of-medical-intensive-care-unit-at-tertiary-care-hospital-setting-of-pakistan
#15
Aayesha Qadeer, Aftab Akhtar, Qurat Ul Ain, Shoab Saadat, Salman Mansoor, Salman Assad, Wasib Ishtiaq, Abid Ilyas, Ali Y Khan, Yousaf Ajam
OBJECTIVE:  To determine the frequency of micro-organisms causing sepsis as well as to determine the antibiotic susceptibility and resistance of microorganisms isolated in a medical intensive care unit. MATERIALS AND METHODS:  This is a cross-sectional analysis of 802 patients from a medical intensive care unit (ICU) of Shifa International Hospital, Islamabad, Pakistan over a one-year period from August 2015 to August 2016. Specimens collected were from blood, urine, endotracheal secretions, catheter tips, tissue, pus swabs, cerebrospinal fluid, ascites, bronchoalveolar lavage (BAL), and pleural fluid...
September 29, 2016: Curēus
https://www.readbyqxmd.com/read/27790429/act-fast-as-time-is-less-high-faecal-carriage-of-carbapenem-resistant-enterobacteriaceae-in-critical-care-patients
#16
Sanjith Saseedharan, Manisa Sahu, Edwin Joseph Pathrose, Sarita Shivdas
INTRODUCTION: Carbapenem-resistant Enterobacteriaceae (CRE) are drug-resistant Gram-negative bacteria that are present in the community as well as in hospitals. Their infection and colonisation puts critically ill patients at high risk due to the drug-resistant nature of the strains and possible spreading of these organisms, even in a hospital environment. AIM: To examine the presence and types of Enterobacteriaceae species in patients admitted directly from the community...
September 2016: Journal of Clinical and Diagnostic Research: JCDR
https://www.readbyqxmd.com/read/27790273/clinical-practice-guideline-of-acute-respiratory-distress-syndrome
#17
REVIEW
Young-Jae Cho, Jae Young Moon, Ein-Soon Shin, Je Hyeong Kim, Hoon Jung, So Young Park, Ho Cheol Kim, Yun Su Sim, Chin Kook Rhee, Jaemin Lim, Seok Jeong Lee, Won-Yeon Lee, Hyun Jeong Lee, Sang Hyun Kwak, Eun Kyeong Kang, Kyung Soo Chung, Won-Il Choi
There is no well-stated practical guideline for mechanically ventilated patients with or without acute respiratory distress syndrome (ARDS). We generate strong (1) and weak (2) grade of recommendations based on high (A), moderate (B) and low (C) grade in the quality of evidence. In patients with ARDS, we recommend low tidal volume ventilation (1A) and prone position if it is not contraindicated (1B) to reduce their mortality. However, we did not support high-frequency oscillatory ventilation (1B) and inhaled nitric oxide (1A) as a standard treatment...
October 2016: Tuberculosis and Respiratory Diseases
https://www.readbyqxmd.com/read/27769084/pulmonary-embolism-response-teams
#18
Alison S Witkin, Savanah Harshbarger, Christopher Kabrhel
Pulmonary embolism is a common and often life-threatening event. Treatment options include anticoagulation alone, catheter-directed therapies, and surgical thromboembolectomy. While guidelines exist, there is often controversy over which treatment is most appropriate, particularly for intermediate-risk patients. The traditional care model, in which the primary team is responsible for consulting the appropriate specialists, may be inadequate and inefficient for emergent situations, as ensuring coordination and communication between various consulting services can be a time consuming and confusing process...
November 2016: Seminars in Thrombosis and Hemostasis
https://www.readbyqxmd.com/read/27767984/the-optimum-hematocrit
#19
Walter H Reinhart
The hematocrit (Hct) determines the oxygen carrying capacity of blood, but also increases blood viscosity and thus flow resistance. From this dual role the concept of an optimum Hct for tissue oxygenation has been derived. Viscometric studies using the ratio Hct/blood viscosity at high shear rate showed an optimum Hct of 50-60% for red blood cell (RBC) suspensions in plasma. For the perfusion of an artificial microvascular network with 5-70μm channels the optimum Hct was 60-70% for high driving pressures. With lower shear rates or driving pressures the optimum Hct shifted towards lower values...
October 21, 2016: Clinical Hemorheology and Microcirculation
https://www.readbyqxmd.com/read/27765400/failure-rate-of-single-unit-restorations-on-posterior-vital-teeth-a-systematic-review
#20
Kelvin I Afrashtehfar, Elham Emami, Motahareh Ahmadi, Samer Abi-Nader, Faleh Tamimi
STATEMENT OF PROBLEM: No knowledge synthesis exists concerning when to use a direct restoration versus a complete-coverage indirect restoration in posterior vital teeth. PURPOSE: The purpose of this systematic review was to identify the failure rate of conventional single-unit tooth-supported restorations in posterior permanent vital teeth as a function of remaining tooth structure. MATERIAL AND METHODS: Four databases were searched electronically, and 8 selected journals were searched manually up to February 2015...
October 17, 2016: Journal of Prosthetic Dentistry
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