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Critical care fluid management

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https://www.readbyqxmd.com/read/28187752/targeting-urine-output-and-30-day-mortality-in-goal-directed-therapy-a-systematic-review-with-meta-analysis-and-meta-regression
#1
Esther N van der Zee, Mohamud Egal, Diederik Gommers, A B Johan Groeneveld
BACKGROUND: Oliguria is associated with a decreased kidney- and organ perfusion, leading to organ damage and increased mortality. While the effects of correcting oliguria on renal outcome have been investigated frequently, whether urine output is a modifiable risk factor for mortality or simply an epiphenomenon remains unclear. We investigated whether targeting urine output, defined as achieving and maintaining urine output above a predefined threshold, in hemodynamic management protocols affects 30-day mortality in perioperative and critical care...
February 10, 2017: BMC Anesthesiology
https://www.readbyqxmd.com/read/28187026/an-algorithmic-approach-to-the-suspected-septic-wrist
#2
Jeffrey R Claiborne, Leslie G Branch, Michael Reynolds, Anthony J Defranzo
An acutely painful, erythematous wrist can be due to a variety of pathologic processes, including crystalline arthropathy, infection, trauma, osteoarthritis, and systemic disease. The broad differential diagnosis of the inflamed wrist and nonspecific clinical findings make accurate diagnosis challenging. There is no published clinical or laboratory criterion that reliably differentiates septic wrist arthritis from a sterile inflammatory arthropathy. For septic joint patients, long-term results are notably poorer in patients with a delay in treatment, therefore establishing evidenced-based guidelines deserves attention...
February 10, 2017: Annals of Plastic Surgery
https://www.readbyqxmd.com/read/28169966/perioperative-management-of-adult-patients-with-external-ventricular-and-lumbar-drains-guidelines-from-the-society-for-neuroscience-in-anesthesiology-and-critical-care
#3
Abhijit V Lele, Amie L Hoefnagel, Nina Schloemerkemper, David A Wyler, Nophanan Chaikittisilpa, Monica S Vavilala, Bhiken I Naik, James H Williams, Lakshmikumar Venkat Raghavan, Ines P Koerner
External ventricular drains and lumbar drains are commonly used to divert cerebrospinal fluid and to measure cerebrospinal fluid pressure. Although commonly encountered in the perioperative setting and critical for the care of neurosurgical patients, there are no guidelines regarding their management in the perioperative period. To address this gap in the literature, The Society for Neuroscience in Anesthesiology & Critical Care tasked an expert group to generate evidence-based guidelines. The document generated targets clinicians involved in perioperative care of patients with indwelling external ventricular and lumbar drains...
February 6, 2017: Journal of Neurosurgical Anesthesiology
https://www.readbyqxmd.com/read/28153190/acute-pd-evidence-guidelines-and-controversies-%C3%A2
#4
REVIEW
Daniela Ponce, Andre Balbi, Brett Cullis
Peritoneal dialysis (PD) may be a feasible, safe, and complementary alternative to hemodialysis not only in the chronic setting, but also in the acute setting. It previously was widely accepted for acute kidney injury (AKI) treatment, but its practice decreased in favor of other types of extracorporeal therapies. The interest in PD to manage AKI patients has been reignited and PD now frequently is used in developing countries because of its lower cost and minimal infrastructural requirements. Studies from these countries have shown that, with careful thought and planning, critically ill patients can be treated successfully using PD...
January 2017: Seminars in Nephrology
https://www.readbyqxmd.com/read/28149031/thoughts-on-the-current-management-of-acute-aluminum-phosphide-toxicity-and-proposals-for-therapy-an-evidence-based-review
#5
REVIEW
Maryam Vasheghani Farahani, Davood Soroosh, Sayed Mahdi Marashi
The majority of aluminum phosphide (ALP) toxicity cases are suicidal attempts. Despite advances in critical care medicine, the mortality rate of ALP remains very high. Unfortunately, knowledge on the toxicokinetics of ALP is very low. An obsolete idea was proposed that inhibition of complex IV of cytochrome C oxidase is responsible for multiorgan dysfunction. However, based on human studies, this effect might be insignificant. Thus, a novel idea proposes that the main mechanism might be vascular wall integrity disruption...
December 2016: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/28144779/focused-cardiac-ultrasound-in-the-early-resuscitation-of-severe-sepsis-and-septic-shock-a-prospective-pilot-study
#6
Hiroshi Sekiguchi, Yohei Harada, Hector R Villarraga, Sunil V Mankad, Ognjen Gajic
PURPOSE: Point-of-care ultrasonography has been increasingly used in the care of critically ill patients; however, reports on its use during active resuscitation are limited. The aim of this study was to investigate the true impact of focused cardiac ultrasound (FCU) during the management of sepsis with early (6-h) resuscitation. METHODS: A prospective pilot observational study was conducted at an academic medical center from March 2011 through July 2012. Patients undergoing resuscitation for severe sepsis or septic shock were prospectively enrolled at medical and combined medical-surgical intensive care units...
January 31, 2017: Journal of Anesthesia
https://www.readbyqxmd.com/read/28139519/emergence-of-vancomycin-resistant-enterococci-at-a-teaching-hospital-saudi-arabia
#7
Fawzia E Alotaibi, Elham E Bukhari
BACKGROUND: Vancomycin-resistant enterococci (VRE) are a major and emerging hospital-acquired pathogen associated with high mortality, particularly among the critically ill and Intensive Care Units (ICUs) patients. This study aimed to determine the prevalence and demographic and clinical characteristics of VRE among patients admitted to a university hospital in Riyadh, Saudi Arabia. METHODS: A study was conducted during the period from September 2014 to November 2015 at King Khalid University Hospital, a tertiary care hospital in Riyadh, Saudi Arabia, including in-patients with VRE infection...
2017: Chinese Medical Journal
https://www.readbyqxmd.com/read/28124225/feasibility-of-automated-titration-of-vasopressor-infusions-using-a-novel-closed-loop-controller
#8
Joseph Rinehart, Michael Ma, Michael-David Calderon, Maxime Cannesson
Blood pressure management is a central concern in critical care patients. For a variety of reasons, titration of vasopressor infusions may be an ideal use-case for computer assistance. Using our previous experience gained in the bench-to-bedside development of a computer-assisted fluid management system, we have developed a novel controller for this purpose. The aim of this preliminary study was to assess the feasibility of using this controller in simulated patients to maintain a target blood pressure in both stable and variable blood-pressure scenarios...
January 25, 2017: Journal of Clinical Monitoring and Computing
https://www.readbyqxmd.com/read/28051046/typhoid-perforation-post-operative-intensive-care-unit-care-and-outcome
#9
Mukaila Oyegbade Akinwale, Arinola A Sanusi, Oluwaseun K Adebayo
BACKGROUND: Typhoid perforation ileitis is a serious complication of typhoid fever, a common and unfortunate health problem in a resource-poor country like Nigeria. Following bowel perforation, treatment is usually by simple closure or bowel resection and anastomosis after adequate aggressive fluid resuscitation and electrolyte correction. Postoperatively, some of these patients do require management in Intensive Care Unit (ICU) on account of sepsis or septic shock and to improve survival...
October 2016: African Journal of Paediatric Surgery: AJPS
https://www.readbyqxmd.com/read/27994358/retrospective-analysis-of-multiplex-polymerase-chain-reaction-based-molecular-diagnostics-ses-in-70-patients-with-suspected-central-nervous-system-infections-a-single-center-study
#10
Rama Krishnan Tiruppur Chinnappan Ramalingam, Dipanjan Chakraborty
BACKGROUND: Central nervous system (CNS) infections present a grave health care challenge due to high morbidity and mortality. Clinical findings and conventional laboratory assessments are not sufficiently distinct for specific etiologic diagnosis. Identification of pathogens is a key to appropriate therapy. AIM: In this retrospective observational study, we evaluated the efficacy and clinical utility of syndrome evaluation system (SES) for diagnosing clinically suspected CNS infections...
October 2016: Annals of Indian Academy of Neurology
https://www.readbyqxmd.com/read/27989360/complications-in-neonatal-surgery
#11
Mauricio A Escobar, Michael G Caty
Neonatal surgery is recognized as an independent discipline in general surgery, requiring the expertise of pediatric surgeons to optimize outcomes in infants with surgical conditions. Survival following neonatal surgery has improved dramatically in the past 60 years. Improvements in pediatric surgical outcomes are in part attributable to improved understanding of neonatal physiology, specialized pediatric anesthesia, neonatal critical care including sophisticated cardiopulmonary support, utilization of parenteral nutrition and adjustments in fluid management, refinement of surgical technique, and advances in surgical technology including minimally invasive options...
December 2016: Seminars in Pediatric Surgery
https://www.readbyqxmd.com/read/27965233/research-in-review-advancing-critical-care-practice
#12
Elizabeth Bridges, Margaret M McNeill, Nancy Munro
Research published in 2016 identified strategies to enhance acute and critical care, initiated discussions on professional roles and responsibilities, clarified complex care issues, and led to robust debate. Some of this important work addressed strategies to prevent delirium and pressure ulcers, considerations for pain management within the context of the opioid abuse crisis, strategies to guide fluid resuscitation in patients with sepsis and heart failure, and ways to enhance care for family members of intensive care patients...
December 2016: American Journal of Critical Care: An Official Publication, American Association of Critical-Care Nurses
https://www.readbyqxmd.com/read/27920421/a-missing-guide-wire-after-placement-of-peripherally-inserted-central-venous-catheter
#13
Muhammad Kashif, Hafiz Hashmi, Preeti Jadhav, Misbahuddin Khaja
BACKGROUND Central venous catheterization is a common tool used in critically ill patients to monitor central venous pressure and administer fluids and medications such as vasopressors. Here we present a case of a missing guide wire after placement of peripherally inserted central catheter (PICC), which was incidentally picked up by bedside ultrasound in the intensive care unit.  CASE REPORT A 50-year-old Hispanic male was admitted to the intensive care unit for alcohol intoxication. He was managed for septic shock and required placement of a peripherally inserted central line in his left upper extremity for antibiotics and vasopressor administration...
December 6, 2016: American Journal of Case Reports
https://www.readbyqxmd.com/read/27910706/intravenous-oxygen-a-novel-method-of-oxygen-delivery-in-hypoxemic-respiratory-failure
#14
Jonathan A Gehlbach, Kyle J Rehder, Michael A Gentile, David A Turner, Daniel J Grady, Ira M Cheifetz
Hypoxemic respiratory failure is a common problem in critical care. Current management strategies, including mechanical ventilation and extracorporeal membranous oxygenation, can be efficacious but these therapies put patients at risk for toxicities associated with invasive forms of support. Areas covered: In this manuscript, we discuss intravenous oxygen (IVO2), a novel method to improve oxygen delivery that involves intravenous administration of a physiologic solution containing dissolved oxygen at hyperbaric concentrations...
January 2017: Expert Review of Respiratory Medicine
https://www.readbyqxmd.com/read/27891499/a-presumptive-case-of-human-rabies-a-rare-survived-case-in-rural-ghana
#15
Paschal Awingura Apanga, John Koku Awoonor-Williams, Michael Acheampong, Matthew Ayamba Adam
Rabies remains endemic in Ghana and continues to pose a major public health threat to humans and animals with a nearly 100% case fatality rate in humans. We report of a presumptive case of human rabies whose survival represents a rare occurrence in rural Ghana and worldwide. Lessons from this case study provide a critically needed focus in helping improve rabies surveillance and case management in Ghana. We report of the survival of a 36-year-old man who developed clinical rabies after he was bitten by his dog, while restraining the dog with a chain...
2016: Frontiers in Public Health
https://www.readbyqxmd.com/read/27887762/extracardiac-signs-of-fluid-overload-in-the-critically-ill-cardiac-patient-a-focused-evaluation-using-bedside-ultrasound
#16
REVIEW
William Beaubien-Souligny, Josée Bouchard, Georges Desjardins, Yoan Lamarche, Mark Liszkowski, Pierre Robillard, André Denault
Fluid balance management is of great importance in the critically ill cardiac patient. Although intravenous fluids are a cornerstone therapy in the management of unstable patients, excessive administration coupled with cardiac dysfunction leads to elevation in central venous pressure and end-organ venous congestion. Fluid overload is known to have a detrimental effect on organ function and is responsible for significant morbidity in critically ill patients. Multisystem bedside point of care ultrasound imaging can be used to assess signs of fluid overload and venous congestion in critically ill patients...
January 2017: Canadian Journal of Cardiology
https://www.readbyqxmd.com/read/27881286/renal-adaptive-changes-and-sodium-handling-in-the-fetal-to-newborn-transition
#17
REVIEW
Jeffrey L Segar
Appropriate fluid and electrolyte management is critical for optimal care of very low birth weight or sick infants. Delivery of such care requires an understanding of developmental changes in renal water and salt handling that occur with advancing gestational age as well as postnatal age. This review focuses on the principles of sodium homeostasis during fetal and postnatal life. The physiology of renal tubular transport mechanisms, as well as neurohumoral factors impacting renal tubular transport are highlighted...
November 20, 2016: Seminars in Fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/27873292/icu-management-based-on-picco-parameters-reduces-duration-of-mechanical-ventilation-and-icu-length-of-stay-in-patients-with-severe-thoracic-trauma-and-acute-respiratory-distress-syndrome
#18
Zhong Yuanbo, Wang Jin, Shi Fei, Long Liangong, Liu Xunfa, Xu Shihai, Shan Aijun
BACKGROUND: This study aimed to assess whether a management algorithm using data obtained with a PiCCO system can improve clinical outcomes in critically ill patients with acute respiratory distress syndrome (ARDS). RESULTS: The PaO2/FiO2 ratio increased over time in both groups, with a sharper increase in the PiCCO group. There was no difference in 28-day mortality (3.2 vs. 3.6%, P = 0.841). Days on mechanical ventilation (3 vs. 5 days, P = 0.002) and ICU length of stay (6 vs...
December 2016: Annals of Intensive Care
https://www.readbyqxmd.com/read/27870576/airway-management-strategies-for-brain-injured-patients-meeting-standard-criteria-to-consider-extubation-a-prospective-cohort-study
#19
Victoria A McCredie, Niall D Ferguson, Ruxandra L Pinto, Neill K J Adhikari, Robert A Fowler, Martin G Chapman, Althea Burrell, Andrew J Baker, Deborah J Cook, Maureen O Meade, Damon C Scales
RATIONALE: Patients with acute brain injury are frequently capable of breathing spontaneously with minimal ventilatory support despite persistent neurological impairment. OBJECTIVES: We sought to describe factors associated with extubation timing, success, and primary tracheostomy in these patients. METHODS: We conducted a prospective multicenter observational cohort study in three academic hospitals in Toronto, Canada. Consecutive brain-injured adults receiving mechanical ventilation for at least 24 hours in three intensive care units were screened by study personnel daily for extubation consideration criteria...
January 2017: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/27829710/early-norepinephrine-decreases-fluid-and-ventilatory-requirements-in-pediatric-vasodilatory-septic-shock
#20
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
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