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base excess intensive care

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https://www.readbyqxmd.com/read/28078858/use-of-lactated-ringer%C3%A2-s-solution-does-not-eliminate-the-risk-of-strong-ion-difference-related-metabolic-acidosis-following-on-pump-cardiac-surgery
#1
T Jovaisa, V Vicka, G Linkaitė, J Guseinovaitė, D Ringaitienė, I Norkienė
There is a growing interest in the effects of plasma sodium levels on postoperative outcomes. A trend of using balanced crystalloid solutions is based on the extensive data on chloride and the strong ion difference-related acidosis. However, effects of sodium are often overlooked in this context. The aim of the study was to establish the effects of the routine use of Lactated Ringer’s Solution (RL) on postoperative changes in sodium concentrations and whether these changes result in metabolic acidosis. We performed database analysis of 358 consecutive elective on-pump cardiac surgery cases in a tertiary referral university hospital...
October 2016: Journal of Biological Regulators and Homeostatic Agents
https://www.readbyqxmd.com/read/28074799/basic-arterial-blood-gas-biomarkers-as-a-predictor-of-mortality-in-tetralogy-of-fallot-patients
#2
Vandana Bhardwaj, Poonam Malhotra Kapoor, Kalpana Irpachi, Suruchi Ladha, Ujjwal Kumar Chowdhury
BACKGROUND: Serum lactate and base deficit have been shown to be a predictor of morbidity and mortality in critically ill patients. Poor preoperative oxygenation appears to be one of the significant factors that affects early mortality in tetralogy of Fallot (TOF). There is little published literature evaluating the utility of serum lactate, base excess (BE), and oxygen partial pressure (PO 2 ) as simple, widely available, prognostic markers in patients undergoing surgical repair of TOF...
January 2017: Annals of Cardiac Anaesthesia
https://www.readbyqxmd.com/read/28069712/an-evidence-based-medicine-approach-to-antihyperglycemic-therapy-in-diabetes-mellitus-to-overcome-overtreatment
#3
Anil N Makam, Oanh K Nguyen
Overtreatment is pervasive in medicine and leads to potential patient harms and excessive costs in health care. Although evidence-based medicine is often derided as practice by rote algorithmic medicine, the appropriate application of key evidence-based medicine principles in clinical decision making is fundamental to preventing overtreatment and promoting high-value, individualized patient-centered care. Specifically, this article discusses the importance of (1) using absolute rather than relative estimates of benefits to inform treatment decisions; (2) considering the time horizon to benefit of treatments; (3) balancing potential harms and benefits; and (4) using shared decision making by physicians to incorporate the patient's values and preferences into treatment decisions...
January 10, 2017: Circulation
https://www.readbyqxmd.com/read/28045915/alkalosis-in-critically-ill-patients-with-severe-sepsis-and-septic-shock
#4
Simon Kreü, Allan Jazrawi, Jan Miller, Amir Baigi, Michelle Chew
INTRODUCTION: Although metabolic alkalosis is a common occurrence in intensive care units (ICUs), no study has evaluated its prevalence or outcomes in patients with severe sepsis or septic shock. METHODS: This is a retrospective cohort study of critically ill patients suffering from severe sepsis and septic shock admitted to the ICUs of Halmstad and Varberg County hospitals. From 910 patient records, 627 patients met the inclusion criteria. We investigated the relationship between metabolic alkalosis and mortality...
2017: PloS One
https://www.readbyqxmd.com/read/28039606/development-of-a-physiologically-based-pharmacokinetic-modelling-approach-to-predict-the-pharmacokinetics-of-vancomycin-in-critically-ill-septic-patients
#5
Christian Radke, Dagmar Horn, Christian Lanckohr, Björn Ellger, Michaela Meyer, Thomas Eissing, Georg Hempel
BACKGROUND AND OBJECTIVES: Sepsis is characterised by an excessive release of inflammatory mediators substantially affecting body composition and physiology, which can be further affected by intensive care management. Consequently, drug pharmacokinetics can be substantially altered. This study aimed to extend a whole-body physiologically based pharmacokinetic (PBPK) model for healthy adults based on disease-related physiological changes of critically ill septic patients and to evaluate the accuracy of this PBPK model using vancomycin as a clinically relevant drug...
December 31, 2016: Clinical Pharmacokinetics
https://www.readbyqxmd.com/read/28033528/neuroblastoma-survivors-are-at-increased-risk-for-second-malignancies-a-report-from-the-international-neuroblastoma-risk-group-project
#6
Mark A Applebaum, Zalman Vaksman, Sang Mee Lee, Eric A Hungate, Tara O Henderson, Wendy B London, Navin Pinto, Samuel L Volchenboum, Julie R Park, Arlene Naranjo, Barbara Hero, Andrew D Pearson, Barbara E Stranger, Susan L Cohn, Sharon J Diskin
BACKGROUND: The incidence of second malignant neoplasm (SMN) within the first ten years of diagnosis in high-risk neuroblastoma patients treated with modern, intensive therapy is unknown. Further, the underlying germline genetics that contribute to SMN in these survivors are not known. METHODS: The International Neuroblastoma Risk Group (INRG) database of patients diagnosed from 1990 to 2010 was analysed. SMN risk was accessed by cumulative incidence, standardised incidence ratios (SIRs) and absolute excess risk...
December 26, 2016: European Journal of Cancer
https://www.readbyqxmd.com/read/27929527/durations-of-second-stage-of-labor-and-pushing-and-adverse-neonatal-outcomes-a-population-based-cohort-study
#7
A Sandström, M Altman, S Cnattingius, S Johansson, M Ahlberg, O Stephansson
OBJECTIVE: The associations between duration of second stage of labor, pushing time and risk of adverse neonatal outcomes are not fully established. Therefore, we aimed to examine such relationships. STUDY DESIGN: A population-based cohort study including 42 539 nulliparous women with singleton infants born in cephalic presentation at ⩾37 gestational weeks, using the Stockholm-Gotland Obstetric Cohort, Sweden, and the Swedish Neonatal Quality Register, 2008 to 2013...
December 8, 2016: Journal of Perinatology: Official Journal of the California Perinatal Association
https://www.readbyqxmd.com/read/27755508/sex-differences-in-inflammatory-response-and-acid-base-balance-in-prepubertal-children-with-severe-sepsis
#8
Nicolas Lefèvre, Benjamin Noyon, Dominique Biarent, Francis Corazza, Jean Duchateau, Georges Casimir
PURPOSE AND METHODS: The severity and prognosis of various acute inflammatory conditions, such as sepsis, differ between males and females. The mechanisms underlying these sex differences probably involve both hormonal and genetic factors. In order to evaluate a possible genetic influence, we reviewed clinical signs and biological inflammatory markers of prepubertal children with severe sepsis admitted to the pediatric intensive care unit (PICU). FINDINGS: A total of 142 prepubertal children, 66 girls and 76 boys, suffering from severe sepsis and admitted to the PICU were included...
October 17, 2016: Shock
https://www.readbyqxmd.com/read/27754290/br-08-2-cardiovascular-risk-assessment-in-hypertensives-with-ckd
#9
Jongha Park
Cardiovascular (CV) risk assessment is not easy in chronic kidney disease (CKD) patients. Age, male sex, race, family history of CV disease, smoking status and diabetes should be considered as CV risk factors as the general population. It is also accepted that hypertension (HTN) is associated with the greater risk of CV complications in this population. However, there are some concerns in this issue.First, supporting evidence for specific blood pressure (BP) targets in CKD is scarce. Many observational studies reported a J-shaped association between BP level and CV mortality unlike a linear association in the general population...
September 2016: Journal of Hypertension
https://www.readbyqxmd.com/read/27748700/acetazolamide-therapy-for-metabolic-alkalosis-in-pediatric-intensive-care-patients
#10
Carolina López, Andrés José Alcaraz, Blanca Toledo, Lucía Cortejoso, Maite Augusta Gil-Ruiz
OBJECTIVE: Patients in PICUs frequently present hypochloremic metabolic alkalosis secondary to loop diuretic treatment, especially those undergoing cardiac surgery. This study evaluates the effectiveness of acetazolamide therapy for metabolic alkalosis in PICU patients. DESIGN: Retrospective, observational study. SETTING: A tertiary care children's hospital PICU. PATIENTS: Children receiving at least a 2-day course of enteral acetazolamide...
December 2016: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/27688362/predicting-severe-pneumonia-outcomes-in-children
#11
Derek J Williams, Yuwei Zhu, Carlos G Grijalva, Wesley H Self, Frank E Harrell, Carrie Reed, Chris Stockmann, Sandra R Arnold, Krow K Ampofo, Evan J Anderson, Anna M Bramley, Richard G Wunderink, Jonathan A McCullers, Andrew T Pavia, Seema Jain, Kathryn M Edwards
BACKGROUND: Substantial morbidity and excessive care variation are seen with pediatric pneumonia. Accurate risk-stratification tools to guide clinical decision-making are needed. METHODS: We developed risk models to predict severe pneumonia outcomes in children (<18 years) by using data from the Etiology of Pneumonia in the Community Study, a prospective study of community-acquired pneumonia hospitalizations conducted in 3 US cities from January 2010 to June 2012...
October 2016: Pediatrics
https://www.readbyqxmd.com/read/27687720/prevention-of-critical-care-complications-in-the-coronary-intensive-care-unit-protocols-bundles-and-insights-from-intensive-care-studies
#12
REVIEW
Sean van Diepen, Wendy I Sligl, Jeffrey B Washam, Ian C Gilchrist, Rakesh C Arora, Jason N Katz
Over the past half century, coronary care units have expanded from specialized ischemia arrhythmia monitoring units into intensive care units (ICUs) for acutely ill and medically complex patients with a primary cardiac diagnosis. Patients admitted to contemporary coronary intensive care units (CICUs) are at risk for common and preventable critical care complications, yet many CICUs have not adopted standard-of-care prevention protocols and practices from general ICUs. In this article, we (1) review evidence-based interventions and care bundles that reduce the incidence of ventilator-associated pneumonia, excess sedation during mechanical ventilation, central line infections, stress ulcers, malnutrition, delirium, and medication errors and (2) recommend pragmatic adaptations for common conditions in critically ill patients with cardiac disease, and (3) provide example order sets and practical CICU protocol implementation strategies...
January 2017: Canadian Journal of Cardiology
https://www.readbyqxmd.com/read/27663930/estimating-the-excess-lifetime-risk-of-radiation-induced-secondary-malignancy-smn-in-pediatric-patients-treated-with-craniospinal-irradiation-csi-conventional-radiation-therapy-versus-helical-intensity-modulated-radiation-therapy
#13
Jordan A Holmes, Bhishamjit S Chera, David J Brenner, Igor Shuryak, Adam K Wilson, Misty Lehman-Davis, David V Fried, Vivek Somasundaram, Jun Lian, Tim Cullip, Lawrence B Marks
PURPOSE: To quantify the risk of radiation-induced second malignancies (SMN) in pediatric patients receiving craniospinal irradiation (CSI) either with 3-dimensional conformal radiation therapy (Conv CSI) or tomotherapy helical intensity modulated radiation therapy (Tomo CSI). METHODS AND MATERIALS: A novel predictive model that accounts for short- and long-term carcinogenesis was incorporated into our institutional treatment planning system to quantify the lifetime risk of SMN in incidentally irradiated organs...
January 2017: Practical Radiation Oncology
https://www.readbyqxmd.com/read/27644062/metabolic-acidosis-assessment-in-high-risk-surgeries-prognostic-importance
#14
João Manoel Silva, Amanda Maria Ribas Rosa de Oliveira, Fernando Augusto Mendes Nogueira, Pedro M M Vianna, Cristina Prata Amendola, Maria José Carvalho Carmona, Luiz M Sá Malbouisson
BACKGROUND: Metabolic acidosis frequently is present in surgical patients; however, different types of metabolic acidosis (hyperlactatemia, hyperchloremia, and others) may have different relationships to perioperative outcomes. We hypothesized that in postoperative surgical patients, distinctive types of metabolic acidosis would correlate differently with the outcomes of high-risk surgeries. METHODS: A prospective, multicenter observational study was performed in 3 different tertiary care hospitals...
November 2016: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/27643288/br-08-2-cardiovascular-risk-assessment-in-hypertensives-with-ckd
#15
Jongha Park
Cardiovascular (CV) risk assessment is not easy in chronic kidney disease (CKD) patients. Age, male sex, race, family history of CV disease, smoking status and diabetes should be considered as CV risk factors as the general population. It is also accepted that hypertension (HTN) is associated with the greater risk of CV complications in this population. However, there are some concerns in this issue.First, supporting evidence for specific blood pressure (BP) targets in CKD is scarce. Many observational studies reported a J-shaped association between BP level and CV mortality unlike a linear association in the general population...
September 2016: Journal of Hypertension
https://www.readbyqxmd.com/read/27604335/a-multicentre-randomised-controlled-pilot-study-of-fluid-resuscitation-with-saline-or-plasma-lyte-148-in-critically-ill-patients
#16
Brij Verma, Nora Luethi, Luca Cioccari, Patryck Lloyd-Donald, Marco Crisman, Glenn Eastwood, Neil Orford, Craig French, Rinaldo Bellomo, Johan Martensson
BACKGROUND: Normal saline (NS) is the most commonly used crystalloid solution worldwide but contains an excess of chloride and may cause metabolic acidosis and hyperchloraemia. Such abnormalities may be attenuated by the use of a balanced solution such as Plasma-Lyte 148 (PL-148). OBJECTIVE: To assess the feasibility, safety and biochemical and physiological effects of resuscitation with NS versus PL-148 in critically ill patients. DESIGN, SETTING AND PARTICIPANTS: An exploratory, multicentre, doubleblind, randomised controlled trial involving patients aged ≥ 18 years who were prescribed crystalloid fluid resuscitation by the treating clinician between 16 July and 22 October 2015, in three multidisciplinary intensive care units in Melbourne, Victoria, Australia...
September 2016: Critical Care and Resuscitation: Journal of the Australasian Academy of Critical Care Medicine
https://www.readbyqxmd.com/read/27595791/individual-participant-data-meta-analyses-compared-with-meta-analyses-based-on-aggregate-data
#17
Catrin Tudur Smith, Maura Marcucci, Sarah J Nolan, Alfonso Iorio, Maria Sudell, Richard Riley, Maroeska M Rovers, Paula R Williamson
BACKGROUND: Meta-analyses based on individual participant data (IPD-MAs) allow more powerful and uniformly consistent analyses as well as better characterisation of subgroups and outcomes, compared to those which are based on aggregate data (AD-MAs) extracted from published trial reports. However, IPD-MAs are a larger undertaking requiring greater resources than AD-MAs. Researchers have compared results from IPD-MA against results obtained from AD-MA and reported conflicting findings...
September 6, 2016: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/27510178/identifying-the-position-of-the-right-atrium-to-align-pressure-transducer-for-cvp-spirit-level-or-3d-electromagnetic-positioning
#18
S Avellan, I Uhr, D McKelvey, Soren Sondergaard
The central venous pressure, CVP, is an important variable in the management of selected perioperative and intensive care cases and in clinical decision support systems, CDSS. In current routine, when measuring CVP the health care provider may use anatomical landmarks and a spirit level, SL, to adjust the pressure transducer to the level of the tricuspid valve, i.e. the phlebostatic axis. The aim of the study was to assess the agreement in the postoperative setting between the SL method and electromagnetic 3D positioning (EM)...
August 10, 2016: Journal of Clinical Monitoring and Computing
https://www.readbyqxmd.com/read/27366324/a-comparison-of-prognostic-significance-of-strong-ion-gap-sig-with-other-acid-base-markers-in-the-critically-ill-a-cohort-study
#19
Kwok M Ho, Norris S H Lan, Teresa A Williams, Yusra Harahsheh, Andrew R Chapman, Geoffrey J Dobb, Sheldon Magder
BACKGROUND: This cohort study compared the prognostic significance of strong ion gap (SIG) with other acid-base markers in the critically ill. METHODS: The relationships between SIG, lactate, anion gap (AG), anion gap albumin-corrected (AG-corrected), base excess or strong ion difference-effective (SIDe), all obtained within the first hour of intensive care unit (ICU) admission, and the hospital mortality of 6878 patients were analysed. The prognostic significance of each acid-base marker, both alone and in combination with the Admission Mortality Prediction Model (MPM0 III) predicted mortality, were assessed by the area under the receiver operating characteristic curve (AUROC)...
2016: Journal of Intensive Care
https://www.readbyqxmd.com/read/27352175/a-comparison-between-two-dilute-citrate-solutions-15-vs-18-mmol-l-in-continuous-renal-replacement-therapy-the-base-excess-and-renal-substitution-solution-study
#20
Chris Anstey, Victoria Campbell, Alexander Richardson
BACKGROUND/AIMS: The study aimed to compare the changes in biochemistry occurring in patients undergoing continuous renal replacement therapy (CRRT) using 2 trisodium citrate solutions, Baxter hemofiltration fluid containing 18 mmol/l (C18) and Baxter NamSol, a custom manufactured solution containing 15 mmol/l (C15), both delivered as regional citrate anticoagulation (RCA) predilution fluids for hemofiltration. METHODS: This is a prospective randomized control trial conducted in a major regional adult intensive care unit...
2016: Blood Purification
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