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Intensive unit care

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https://www.readbyqxmd.com/read/28645982/a-multicentre-randomised-controlled-non-inferiority-trial-comparing-nasal-high-flow-with-nasal-continuous-positive-airway-pressure-as-primary-support-for-newborn-infants-with-early-respiratory-distress-born-in-australian-non-tertiary-special-care-nurseries
#1
Brett J Manley, Calum T Roberts, Gaston R B Arnolda, Ian M R Wright, Louise S Owen, Kim M Dalziel, Jann P Foster, Peter G Davis, Adam G Buckmaster
INTRODUCTION: Nasal high-flow (nHF) therapy is a popular mode of respiratory support for newborn infants. Evidence for nHF use is predominantly from neonatal intensive care units (NICUs). There are no randomised trials of nHF use in non-tertiary special care nurseries (SCNs). We hypothesise that nHF is non-inferior to nasal continuous positive airway pressure (CPAP) as primary support for newborn infants with respiratory distress, in the population cared for in non-tertiary SCNs. METHODS AND ANALYSIS: The HUNTER trial is an unblinded Australian multicentre, randomised, non-inferiority trial...
June 23, 2017: BMJ Open
https://www.readbyqxmd.com/read/28645964/the-predictive-value-of-serial-changes-in-diaphragm-function-during-the-spontaneous-breathing-trial-for-weaning-outcome-a-study-protocol
#2
Pengmin Zhou, Zhongheng Zhang, Yucai Hong, Huabo Cai, Hui Zhao, Peifeng Xu, Yiming Zhao, Shengping Lin, Xuchang Qin, JiaWei Guo, Yun Pan, Junru Dai
INTRODUCTION: There is a variety of tools being used in clinical practice for the prediction of weaning success from mechanical ventilation. However, their diagnostic performances are less than satisfactory. The purpose of this study is to investigate the value of serial changes in diaphragm function measured by ultrasound during the spontaneous breathing trial (SBT) as a weaning predictor. METHODS AND ANALYSIS: This is a prospective observational study conducted in a 10-bed medical emergency intensive care unit (EICU) in a university-affiliated hospital...
June 23, 2017: BMJ Open
https://www.readbyqxmd.com/read/28645736/liver-transplantation-in-the-most-severely-ill-cirrhotic-patients-a-multicenter-study-in-acute-on-chronic-liver-failure-grade-3
#3
Florent Artru, Alexandre Louvet, Isaac Ruiz, Eric Levesque, Julien Labreuche, Jose Ursic-Bedoya, Guillaume Lassailly, Sebastien Dharancy, Emmanuel Boleslawski, Gilles Lebuffe, Eric Kipnis, Philippe Ichai, Audrey Coilly, Eleonora De Martin, Teresa Maria Antonini, Eric Vibert, Samir Jaber, Astrid Herrerro, Didier Samuel, Alain Duhamel, Georges-Philippe Pageaux, Philippe Mathurin, Faouzi Saliba
BACKGROUND & AIMS: Liver transplantation (LT) for the most severely ill patients with cirrhosis with dysfunction of several organs (accurately assessed by the acute-on-chronic liver failure (ACLF) classification) remains controversial. We aimed to report the results of LT in patients with ACL3 and to compare these patients to non-transplanted patients with cirrhosis and multiple organ dysfunction and to patients transplanted with lower ACLF grade. -Methods: All patients with ACLF3 transplanted in 3 liver ICU were retrospectively included...
June 20, 2017: Journal of Hepatology
https://www.readbyqxmd.com/read/28645517/glucose-control-diabetes-status-and-mortality-in-critically-ill-patients-the-continuum-from-intensive-care-unit-admission-to-hospital-discharge
#4
James S Krinsley, Paula Maurer, Sharon Holewinski, Roy Hayes, Douglas McComsey, Guillermo E Umpierrez, Stanley A Nasraway
OBJECTIVE: To describe the relationships among glycemic control, diabetes mellitus (DM) status, and mortality in critically ill patients from intensive care unit (ICU) admission to hospital discharge. PATIENTS AND METHODS: This is a retrospective investigation of 6387 ICU patients with 5 or more blood glucose (BG) tests and 4462 ICU survivors admitted to 2 academic medical centers from July 1, 2010, through December 31, 2014. We studied the relationships among mean BG level, hypoglycemia (BG level <70 mg/dL [to convert to mmol/L, multiply by 0...
June 7, 2017: Mayo Clinic Proceedings
https://www.readbyqxmd.com/read/28645516/the-search-continues-for-optimal-intensive-care-unit-glucose-management-and-measurement
#5
EDITORIAL
Micah T Long, Ann M Sheehy, Douglas B Coursin
No abstract text is available yet for this article.
June 7, 2017: Mayo Clinic Proceedings
https://www.readbyqxmd.com/read/28645462/analgosedation-practices-and-the-impact-of-sedation-depth-on-clinical-outcomes-among-patients-requiring-mechanical-ventilation-in-the-emergency-department-a-cohort-study
#6
Robert J Stephens, Enyo Ablordeppey, Anne M Drewry, Christopher Palmer, Brian T Wessman, Nicholas M Mohr, Brian W Roberts, Stephen Y Liang, Marin H Kollef, Brian M Fuller
BACKGROUND: Analgesia and sedation are cornerstone therapies for mechanically ventilated patients. Despite data showing that early deep sedation in the intensive care unit influences outcome, this has not been investigated in the emergency department (ED). Therefore, ED-based sedation practices, and their influence on outcome, remain incompletely defined. This study's objectives were to describe ED sedation practices in mechanically ventilated patients, and to test the hypothesis that ED sedation depth is associated with worse outcomes METHODS: This was a cohort study on a prospectively compiled ED registry of adult, mechanically ventilated patients at a single academic medical center...
June 20, 2017: Chest
https://www.readbyqxmd.com/read/28645302/untangling-glycaemia-and-mortality-in-critical-care
#7
Vincent Uyttendaele, Jennifer L Dickson, Geoffrey M Shaw, Thomas Desaive, J Geoffrey Chase
BACKGROUND: Hyperglycaemia is associated with adverse outcomes in the intensive care unit, and initial studies suggested outcome benefits of glycaemic control (GC). However, subsequent studies often failed to replicate these results, and they were often unable to achieve consistent, safe control, raising questions about the benefit or harm of GC as well as the nature of the association of glycaemia with mortality and clinical outcomes. In this study, we evaluated if non-survivors are harder to control than survivors and determined if glycaemic outcome is a function of patient condition and eventual outcome or of the glycaemic control provided...
June 24, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/28645181/the-clinical-benefits-of-perioperative-antioxidant-vitamin-therapy-in-patients-undergoing-cardiac-surgery-a-meta-analysis
#8
Jun Geng, Ju Qian, Weijun Si, Hao Cheng, Fuhai Ji, Zhenya Shen
The clinical benefits of perioperative antioxidant vitamin therapy in cardiac patients remain controversial. Here, we conducted a meta-analysis to determine the strength of the evidence supporting the perioperative use of antioxidant vitamins in patients undergoing cardiac surgery. We searched 4 databases (PubMed, EMBASE, Science Citation Index and Cochrane Library) for randomized controlled trials that reported the effects of antioxidant vitamin therapy on patients undergoing cardiac surgery until 6 June 2016...
June 22, 2017: Interactive Cardiovascular and Thoracic Surgery
https://www.readbyqxmd.com/read/28644831/inflammatory-and-vascular-placental-lesions-are-associated-with-neonatal-amplitude-integrated-eeg-recording-in-early-premature-neonates
#9
Dorit Paz-Levy, Letizia Schreiber, Offer Erez, Sharon Goshen, Justin Richardson, VIadimir Drunov, Orna Staretz Chacham, Eilon Shany
INTRODUCTION: Placental histologic examination can assist in revealing the mechanism leading to preterm birth. Accumulating evidence suggests an association between intrauterine pathological processes, morbidity and mortality of premature infants, and their long term outcome. Neonatal brain activity is increasingly monitored in neonatal intensive care units by amplitude integrated EEG (aEEG) and indices of background activity and sleep cycling patterns were correlated with long term outcome...
2017: PloS One
https://www.readbyqxmd.com/read/28644785/what-should-physicians-do-when-they-disagree-clinically-and-ethically-with-a-surrogate-s-wishes
#10
Terri Traudt, Joan Liaschenko
When patients' surrogates and physicians disagree about the appropriateness of aggressive treatment in intensive care units (ICUs), physicians can experience surrogates' demands as sources of moral distress. This article addresses the virtues and communication strategies needed to respond appropriately in such situations. Specifically, we offer a framework and language that rely on moral community to facilitate common ground and alleviate moral distress.
June 1, 2017: AMA Journal of Ethics
https://www.readbyqxmd.com/read/28644698/sleep-disturbance-after-hospitalization-and-critical-illness-a-systematic-review
#11
Marcus T Altman, Melissa P Knauert, Margaret A Pisani
BACKGROUND: Sleep disturbance during intensive care unit (ICU) admission is common and severe. Sleep disturbance has been observed in survivors of critical illness even after transfer out of the ICU. Not only is sleep important to overall health and well-being, but patients after critical illness are also in a physiologically vulnerable state. Understanding how sleep disturbance impacts recovery from critical illness after hospital discharge is therefore clinically meaningful. OBJECTIVE: This systematic review aimed to summarize studies that identify the prevalence of and risk factors for sleep disturbance after hospital discharge for critical illness survivors...
June 23, 2017: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/28644335/practice-bulletin-number-179-breast-cancer-risk-assessment-and-screening-in-average-risk-women
#12
(no author information available yet)
Breast cancer is the most commonly diagnosed cancer in women in the United States and the second leading cause of cancer death in American women (1). Regular screening mammography starting at age 40 years reduces breast cancer mortality in average-risk women (2). Screening, however, also exposes women to harm through false-positive test results and overdiagnosis of biologically indolent lesions. Differences in balancing benefits and harms have led to differences among major guidelines about what age to start, what age to stop, and how frequently to recommend mammography screening in average-risk women (2-4)...
July 2017: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28644328/practice-bulletin-no-179-summary-breast-cancer-risk-assessment-and-screening-in-average-risk-women
#13
(no author information available yet)
Breast cancer is the most commonly diagnosed cancer in women in the United States and the second leading cause of cancer death in American women (1). Regular screening mammography starting at age 40 years reduces breast cancer mortality in average-risk women (2). Screening, however, also exposes women to harm through false-positive test results and overdiagnosis of biologically indolent lesions. Differences in balancing benefits and harms have led to differences among major guidelines about what age to start, what age to stop, and how frequently to recommend mammography screening in average-risk women (2-4)...
July 2017: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28644313/unique-clinical-features-of-los-angeles-grade-d-esophagitis-suggest-that-factors-other-than-gastroesophageal-reflux-contribute-to-its-pathogenesis
#14
Anh D Nguyen, Stuart J Spechler, Monique N Shuler, Rhonda F Souza, Kerry B Dunbar
BACKGROUND: The Los Angeles (LA) grade of reflux esophagitis (A to D) is assumed to reflect severity of the underlying gastroesophageal reflux disease (GERD). Thus, LA-D esophagitis patients might be expected to have the most conditions predisposing to GERD (eg, obesity, hiatal hernia), and the highest frequency of GERD symptoms. GOALS: The main goal of this study is to compare clinical features of patients with the most severe (LA-D) and mildest (LA-A) grades of esophagitis...
June 21, 2017: Journal of Clinical Gastroenterology
https://www.readbyqxmd.com/read/28644310/predictors-of-mortality-in-cirrhosis-inpatients-with-clostridium-difficile-infection
#15
Elliot Z Smith, Patrick G Northup, Curtis K Argo
BACKGROUND: Clostridium difficile is a bacterial pathogen associated with significant morbidity and mortality in patients with cirrhosis. GOALS: Our primary aim is to identify variables that are predictive of poor outcomes in cirrhosis patients with C. difficile infection (CDI). We also aim to further characterize the risk factors for developing CDI and risk of mortality in this patient population. STUDY: A total of 200 subjects with a diagnosis of cirrhosis and CDI were matched to 200 cirrhosis inpatients without CDI...
June 21, 2017: Journal of Clinical Gastroenterology
https://www.readbyqxmd.com/read/28644120/a-process-improvement-evaluation-of-sequential-compression-device-compliance-and-effects-of-provider-intervention
#16
Jason A Beachler, Chad A Krueger, Anthony E Johnson
This process improvement study sought to evaluate the compliance in orthopaedic patients with sequential compression devices and to monitor any improvement in compliance following an educational intervention. All non-intensive care unit orthopaedic primary patients were evaluated at random times and their compliance with sequential compression devices was monitored and recorded. Following a 2-week period of data collection, an educational flyer was displayed in every patient's room and nursing staff held an in-service training event focusing on the importance of sequential compression device use in the surgical patient...
2017: Journal of Surgical Orthopaedic Advances
https://www.readbyqxmd.com/read/28644101/safety-and-cost-efficiency-of-a-restrictive-transfusion-protocol-in-patients-with-traumatic-brain-injury
#17
Laura B Ngwenya, Catherine G Suen, Phiroz E Tarapore, Geoffrey T Manley, Michael C Huang
OBJECTIVE Blood loss and moderate anemia are common in patients with traumatic brain injury (TBI). However, despite evidence of the ill effects and expense of the transfusion of packed red blood cells, restrictive transfusion practices have not been universally adopted for patients with TBI. At a Level I trauma center, the authors compared patients with TBI who were managed with a restrictive (target hemoglobin level > 7 g/dl) versus a liberal (target hemoglobin level > 10 g/dl) transfusion protocol. This study evaluated the safety and cost-efficiency of a hospital-wide change to a restrictive transfusion protocol...
June 23, 2017: Journal of Neurosurgery
https://www.readbyqxmd.com/read/28643999/dexmedetomidine-and-general-anesthesia-a-narrative-literature-review-of-its-major-indications-for-use-in-adults-undergoing-non-cardiac-surgery
#18
Arthur Davy, Julien Fessler, Marc Fischler, Morgan le Guen
BACKGROUND: In Europe, dexmedetomidine has marketing approval only for sedation in intensive care units. However, its use during general anesthesia has been widely reported. The aim of this narrative review is to draw a picture of potential indications in anesthesia. METHODS: We searched in MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials using the keywords "Dexmedetomidine, Dexdor, Precedex and Dexdomitor". The research ended in December 2016...
June 22, 2017: Minerva Anestesiologica
https://www.readbyqxmd.com/read/28643996/age-related-outcome-of-patients-after-traumatic-brain-injury-a-single-centre-observation
#19
Rolf Erlebach, Alberto Pagnamenta, Stephanie Klinzing, Federica Stretti, Silvia Cottini, Reto Schüpbach, Peter Steiger, Giovanna Brandi
BACKGROUND: Study-purpose is to analyze clinical features of patients with traumatic brain injury (TBI), their age-related outcomes and determinants of long- term outcome. METHODS: This retrospective cohort study was conducted in a level I University Swiss trauma center. Consecutive patients with moderate to severe TBI admitted for more than 48 hours to the Intensive Care Unit were included. Patients' and trauma characteristics, management during ICU-stay, prognostic scores and long- term outcomes were analyzed...
June 22, 2017: Minerva Anestesiologica
https://www.readbyqxmd.com/read/28643577/an-assessment-of-advance-relatives-approach-for-brain-death-organ-donation
#20
Carine Michaut, Antoine Baumann, Hélène Gregoire, Corinne Laviale, Gérard Audibert, Xavier Ducrocq
BACKGROUND: Advance announcement of forthcoming brain death has developed to enable intensivists and organ procurement organisation coordinators to more appropriately, and separately from each other, explain to relatives brain death and the subsequent post-mortem organ donation opportunity. Research aim: The aim was to assess how potentially involved healthcare professionals perceived ethical issues surrounding the strategy of advance approach. RESEARCH DESIGN: A multi-centre opinion survey using an anonymous self-administered questionnaire was conducted in the six-member hospitals of the publicly funded East of France regional organ and tissue procurement network called 'Prélor'...
January 1, 2017: Nursing Ethics
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