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David Macku, Pavel Hedvicak, John Quinn, Vladimir Bencko
Due to the hybrid warfare currently experienced by multiple NATO coalition and NATO partner nations, the tactical combat casualty care (TCCC) paradigm is greatly challenged. One of the major challenges to TCCC is the ad hoc extension phase in resource-poor environments, referred to as prolonged field care (PFC) and forward resuscitative care (FRC). The nuanced clinical skills with limited resources required by warfighters and auxiliary health care professionals to mitigate death on the battlefield and prevent morbidity and mortality in the PFC phase represent a balance that is still under review...
2018: Journal of Special Operations Medicine: a Peer Reviewed Journal for SOF Medical Professionals
Stacy Pelekhaty, Jay Menaker
Prader-Willi Syndrome (PWS) is a genetic condition that results in a constellation of symptoms and typically results in hyperphagia and obesity in adulthood. Critically ill adults with PWS present a unique challenge to the nutrition professional, particularly when they require support modalities such as extracorporeal membrane oxygenation (ECMO). The purpose of this case study is to review the nutrition care of a critically ill adult patient with PWS who required venovenous ECMO. The patient was successfully managed with a hypocaloric, high-protein approach, which did not result in the diagnosis of malnutrition during his hospitalization...
March 12, 2018: Nutrition in Clinical Practice
Taressa Bull, Amanda Corley, Danielle J Smyth, David J McMillan, Kimble R Dunster, John F Fraser
BACKGROUND: Extracorporeal membrane oxygenation (ECMO) delivers cardiac and/or respiratory support to critically ill patients who have failed conventional medical therapies. If the large-bore cannulas used to deliver ECMO become infected or dislodged, the patient consequences can be catastrophic. ECMO cannula-related infection has been reported to be double the rate of other vascular devices (7.1 vs 3.4 episodes/1000 ECMO days respectively). The aim of this study was to assess the ability of cyanoacrylate tissue adhesive (TA) to inhibit bacterial growth at the ECMO cannulation site, and the effectiveness of TA and securement devices in securing ECMO cannulas and tubing...
March 12, 2018: Intensive Care Medicine Experimental
Matthieu Schmidt, Hannah Wunsch, Daniel Brodie
No abstract text is available yet for this article.
March 12, 2018: Intensive Care Medicine
C Vignesh, Madhan Kumar, Ramesh Venkataraman, Senthilkumar Rajagopal, Nagarajan Ramakrishnan, Babu K Abraham
Overdose of cardiovascular medications such as beta blockers and calcium channel blockers cause impaired cardiac contractility, vasoplegia, and/or rhythm disturbances. In addition to conventional management of limiting absorption, increasing elimination and hemodynamic support intravenous (IV) calcium infusion, hyperinsulinemia-euglycemia therapy, glucagon infusion, and IV lipid emulsion have been tried. Extracorporeal circulatory assist device support has been reported as a rescue therapy in overdose refractory to maximal medical therapy...
February 2018: Indian Journal of Critical Care Medicine
Pelle Hanberg, Kristina Öbrink-Hansen, Anders Thorsted, Mats Bue, Mikkel Tøttrup, Lena E Friberg, Tore Forsingdal Hardlei, Kjeld Søballe, Jakob Gjedsted
The objectives of this study were to describe meropenem pharmacokinetics (PK) in plasma and/or subcutaneous adipose tissue (SCT) in critically ill patients receiving ECMO treatment, and to develop a population PK model to simulate alternative dosing regimens and modes of administration. We conducted a prospective observational study. Ten patients on ECMO treatment received meropenem (1 or 2 g) intravenously over 5 min every 8 hours. Serial SCT concentrations were determined using microdialysis and compared with plasma concentrations...
March 12, 2018: Antimicrobial Agents and Chemotherapy
Marian Urban, Karen Booth, John O'Sullivan, John Dark
We present a case of young female patient with end stage lung failure due to pulmonary arterial hypertension who was failing maximal medical therapy and was listed for a single sequential lung transplantation. The challenge of the case was a concomitant presence of a large atrial septal defect (ASD). The novelty of our approach was a device closure of ASD before performing a transplant with the use of intraoperative venoarterial extracorporeal membrane oxygenation (ECMO).
March 9, 2018: Annals of Thoracic Surgery
Kate M Richmond, Katharine G Warburton, Simon J Finney, Sachin Shah, Benjamin A J Reddi
INTRODUCTION: Comprehensive clinical examination can be compromised in patients on veno-venous extracorporeal membrane oxygenation (VV-ECMO). Adjunctive diagnostic imaging strategies range from bedside imaging only to routine computed tomography (CT). The risk-benefit of either approach remains to be evaluated. Patients retrieved to the Royal Brompton Hospital (RBH) on VV-ECMO routinely undergo admission CT imaging of head, chest, abdomen and pelvis. This study aimed to identify how frequently changes in therapy or adverse events could be attributed to routine CT scanning...
March 1, 2018: Perfusion
Matthieu Glorion, Olaf Mercier, Delphine Mitilian, Alexandra De Lemos, Lilia Lamrani, Séverine Feuillet, Pauline Pradere, Jérôme Lepavec, Daniel Lehouerou, François Stephan, Laurent Savale, Dominique Fabre, Sacha Mussot, Elie Fadel
OBJECTIVES: Extracorporeal membrane oxygenation (ECMO) has become the standard of cardiopulmonary support during a sequential double lung transplant for pulmonary hypertension. Whether central or peripheral cannulation is the best strategy for these patients remains unknown. Our goal was to determine which is the best strategy by comparing 2 populations of patients. METHODS: We performed a single-centre retrospective study based on an institutional prospective lung transplant database...
March 8, 2018: European Journal of Cardio-thoracic Surgery
Todd C Carpenter, John P Kinsella
No abstract text is available yet for this article.
March 9, 2018: American Journal of Respiratory and Critical Care Medicine
Jason J Han, JaBaris D Swain
No abstract text is available yet for this article.
March 13, 2018: Journal of the American College of Cardiology
Whittney A Warren, Domingo Franco-Palacios, Christopher S King, Oksana A Shlobin, Steven D Nathan, Shalika B Katugaha, Haresh Mani, A Whitney Brown
A 24-year-old woman with ΔF508/Y1092X cystic fibrosis (CF) complicated by severe obstructive lung disease (FEV1 of 30% predicted) was admitted for IV antibiotics for planned sinus surgery resulting from severe chronic sinusitis causing frequent exacerbations and declining lung function. She had persistent airway infection with multidrug-resistant Pseudomonas aeruginosa, methicillin-resistant Staphylococcus aureus, and growth of a fungus presumed to be an airway colonizer, identified as Stephanoascus ciferrii 1 year before presentation...
March 2018: Chest
Dirk W Donker, Daniel Brodie, José P S Henriques, Michael Broomé
Veno-arterial extracorporeal membrane oxygenation (VA ECMO) is widely used in cardiogenic shock. It provides systemic perfusion, but left ventricular (LV) unloading is suboptimal. Using a closed-loop, real-time computer model of the human cardiovascular system, cardiogenic shock supported by peripheral VA ECMO was simulated and effects of various adjunct LV unloading interventions were quantified. After VA ECMO initiation (4 L/min) in cardiogenic shock (baseline), hemodynamics improved (mean arterial pressure (MAP) increased to 85 mmHg), while LV overload occurred (10% increase in end-diastolic volume (EDV), and 5 mmHg increase in pulmonary capillary wedge pressure (PCWP))...
March 6, 2018: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
Nicolas Allou, Hugo Lo Pinto, Romain Persichini, Bruno Bouchet, Eric Braunberger, Nathalie Lugagne, Olivier Belmonte, Olivier Martinet, Benjamin Delmas, Laurence Dangers, Jérôme Allyn
Little is known about cannula-related infection (CRI) in patients supported by extracorporeal membrane oxygenation (ECMO). The aim of this study was to assess the incidence, the risk factors, prognosis, and microbiological characteristics of CRI in patients supported by ECMO. This retrospective cohort study was conducted in one intensive care unit (ICU). Among 220 consecutive patients with peripheral ECMO, 39 (17.7%) developed CRI. The incidence of CRI was 17.2 per 1,000 ECMO days. The main isolated microorganisms were Enterobacteriaceae (38%), Staphylococcus spp...
March 5, 2018: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
Matteo DI Nardo, Fabio S Taccone, Justyna Swol, Leen Vercaemst, Mirko Belliato
No abstract text is available yet for this article.
March 7, 2018: Minerva Anestesiologica
Sheila Sivam, Ruth Dentice, Nazmeen Reddy, Carmel Moriarty, Veronica Yozghatlian, Craig Mellis, Paul Torzillo, Allan Glanville, David Gattas, Peter Bye
Extracorporeal membrane oxygenation (ECMO) support is used in selected patients with cystic fibrosis (CF) as a bridge to transplantation. Our aim was to describe briefly treatment and outcomes of six CF patients who received ECMO. One patient received a lung transplant and another recovered from acute respiratory failure. Four died despite ECMO support. Lack of timely availability of suitable donor lungs and patient selection are contributing factors.
March 2018: Internal Medicine Journal
Axel Rand, Peter K Zahn, Thomas A Schildhauer, Christian Waydhas, Uwe Hamsen
BACKGROUND: Inhalative sedation is an emerging method for long-term sedation in intensive care therapy. There is evidence that it is easy to control and may be beneficial compared to intravenous sedation. Yet little is known about the use in patients with compromised lung function. In this retrospective analysis, we searched files of patients receiving inhalative sedation under venovenous extracorporeal membrane oxygenator (vv-ECMO) support due to lung failure. METHODS: After ethical approval, we performed a retrospective analysis of patients receiving vv-ECMO support and inhalative sedation in the surgical ICU in 2015...
March 5, 2018: Journal of Artificial Organs: the Official Journal of the Japanese Society for Artificial Organs
Martin Chen, Adam Evans, Jacob Gutsche
No abstract text is available yet for this article.
December 26, 2017: Journal of Cardiothoracic and Vascular Anesthesia
Pilar Anton-Martin, Michael Papacostas, Elisabeth Lee, Paul A Nakonezny, Michael L Green
BACKGROUND: Malnutrition is associated with an increased risk of mortality in patients admitted to the intensive care unit. Children requiring extracorporeal membrane oxygenation (ECMO) support represent an extremely ill subset of this population. There is a lack of data on the impact of nutrition state on survival in this cohort. We examined the association between being underweight and in-hospital mortality among children supported with ECMO. MATERIALS AND METHODS: This article reports on an observational retrospective cohort study performed among neonatal and pediatric patients supported with ECMO in a tertiary children's hospital from May 1996 through June 2013...
January 2018: JPEN. Journal of Parenteral and Enteral Nutrition
Kristin C Greathouse, Kelly T Sakellaris, Dmitry Tumin, Jacob Katsnelson, Joseph D Tobias, Don Hayes, Andrew R Yates
INTRODUCTION: Pediatric data related to safety, tolerance, and outcomes of enteral nutrition (EN) for patients requiring extracorporeal membrane oxygenation (ECMO) are lacking. The objectives of this study were to evaluate early nutrition status and timing of EN initiation on survival during pediatric ECMO. METHODS: A single center institutional review board-approved retrospective chart review was performed on all pediatric patients requiring ECMO from October 2008 through December 2013...
January 2018: JPEN. Journal of Parenteral and Enteral Nutrition
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