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fluid management in icu patients

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https://www.readbyqxmd.com/read/28735155/impact-of-restrictive-fluid-protocol-on-hypoxemia-after-aneurysmal-subarachnoid-hemorrhage
#1
Claire-Marie Drevet, Nicolas Opprecht, Abdelouaïd Nadji, Sebastien Mirek, Serge Aho, Frederic Ricolfi, Claude Girard, Bélaïd Bouhemad
PURPOSE: In patients with aneurysmal subarachnoid hemorrhage (aSAH), acute cardiac dysfunction and triple-H-therapy, can lead to hypoxemia. Our aim was to assess impact of a protocoled fluid restrictive approach on hypoxemia in these patients. METHODS: We included prospectively ICU patients with aSAH admitted within 24h after the bleed. The study was divided into 2 phases. The first phase, from January to December 2012, was designated as control group (group C)...
July 17, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/28729904/impact-of-a-sepsis-bundle-in-wards-of-a-tertiary-hospital
#2
F Teles, W G Rodrigues, M G T C Alves, C F T Albuquerque, S M O Bastos, M F A Mota, E S Mota, F J L Silva
BACKGROUND: Sepsis is a prevalent disease worldwide and still exhibits high rates of mortality. In the last years, many interventions aiming a positive impact on sepsis evolution have been studied. One of the main is the use of managed care protocols (sepsis bundles), which consist in systematization of diagnosis and treatment, such as standardization of antibiotics, collection of specific tests (cultures, lactate), and fluid replacement. Some studies have shown a reduction in hospital costs and lower mortality with the use of these tools...
2017: Journal of Intensive Care
https://www.readbyqxmd.com/read/28729005/influence-of-late-fluid-management-on-the-outcomes-of-severe-trauma-patients-a-retrospective-analysis-of-294-severely-injured-patients
#3
Mehdi Mezidi, Mehdi Ould-Chikh, Pauline Deras, Camille Maury, Orianne Martinez, Xavier Capdevila, Jonathan Charbit
BACKGROUND: Liberal late fluid management (LFM) is associated with higher morbi-mortality in critically ill populations. The aim of the study was to assess the association between LFM and duration of mechanical ventilation in a severe trauma population. METHODS: A retrospective analysis of consecutive patients with an ISS≥16 and a length of stay in the intensive care unit (ICU)≥7 days was performed. The conservative LFM group included patients with at least 2 consecutive days with a negative fluid balance between day 3 and day 7; other patients were allocated to the liberal LFM group...
June 15, 2017: Injury
https://www.readbyqxmd.com/read/28710563/an-observational-study-examining-the-effects-of-a-surgically-induced-inflammatory-response-on-the-distribution-of-morphine-and-its-metabolites-into-cerebrospinal-fluid
#4
Yan Wang, Kerry B Goralski, Derek J Roberts, Kathryn Landry, Mark E Issa, Lekha Sleno, Lisa C Julien, Jeremy Wood, Richard I Hall
PURPOSE: Morphine is administered intravenously for pain management in the perioperative period. The effect of the inflammatory response to surgery on morphine distribution across the blood-brain barrier (BBB) in humans was investigated. We hypothesized that a graded surgically induced, systemic inflammatory response alters cerebrospinal fluid (CSF) levels of morphine, morphine-3-glucuronide (M3G), and morphine-6-glucuronide (M6G) through a temporary reduction in BBB drug efflux transporter function...
July 14, 2017: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
https://www.readbyqxmd.com/read/28698756/treatment-of-decubitis-ulcer-stage-iv-in-the-patient-with-polytrauma-and-vertical-share-pelvic-fracture-diagnosed-entherocollitis-and-deep-wound-infection-with-clostridium-difficile-with-combined-negative-pressure-wound-therapy-npwt-and-faecal-management-system
#5
Slavcho Stojmenski, Igor Merdzanovski, Andrej Gavrilovski, Sofija Pejkova, Gjorge Dzokic, Smilja Tudzarova
AIM: The aim of this paper was to present a case with the successful treatment of decubitis ulcer stage IV in the patient with polytrauma and vertical share pelvic fracture and diagnosed entherocollitis combined with deep wound infection with Clostridium difficile treated with combined Negative Pressure Wound Therapy (NPWT) and faecal management system. CASE REPORT: Patient D.S.1967 treated on Traumatology Clinic after tentamen suicide on 9.2.2015 with diagnosis: brain contusion; contusion of thoracal space; vertical share pelvic fracture; open fracture type II of the right calcaneus; fracture of the left calcaneus; fracture on the typical place of the left radius; fracture of the right radius with dislocation...
June 15, 2017: Open Access Macedonian Journal of Medical Sciences
https://www.readbyqxmd.com/read/28692675/cardio-haemodynamic-assessment-and-venous-lactate-in-severe-dengue-relationship-with-recurrent-shock-and-respiratory-distress
#6
Sophie Yacoub, Trieu Huynh Trung, Phung Khanh Lam, Vuong Huynh Ngoc Thien, Duong Ha Thi Hai, Tu Qui Phan, Oanh Pham Kieu Nguyet, Nguyen Than Ha Quyen, Cameron Paul Simmons, Christopher Broyd, Gavin Robert Screaton, Bridget Wills
BACKGROUND: Dengue can cause plasma leakage that may lead to dengue shock syndrome (DSS). In approximately 30% of DSS cases, recurrent episodes of shock occur. These patients have a higher risk of fluid overload, respiratory distress and poor outcomes. We investigated the association of echocardiographically-derived cardiac function and intravascular volume parameters plus lactate levels, with the outcomes of recurrent shock and respiratory distress in severe dengue. METHODS/PRINCIPLE FINDINGS: We performed a prospective observational study in Paediatric and adult ICU, at the Hospital for Tropical Diseases (HTD), Ho Chi Minh City, Vietnam...
July 2017: PLoS Neglected Tropical Diseases
https://www.readbyqxmd.com/read/28673224/fluid-resuscitation-in-critically-ill-patients-timing-and-dose-matters
#7
K Lall, G Roberts, U Buehner
Fluid management is a complex subject in healthcare, particularly when pertaining to critically ill patients. Following a literature search on international recommendations regarding fluid administration for shocked patients, an audit was undertaken at Rotorua Public Hospital, New Zealand, to assess how the local fluid resuscitation strategy could be improved. The first part of the audit looked at the fluid resuscitation approach used to treat shocked patients admitted to the ICU of Rotorua Hospital in 2014 and changes required to achieve best practice recommendations...
July 2017: Anaesthesia and Intensive Care
https://www.readbyqxmd.com/read/28666929/fluid-responsiveness-after-cardiac-surgery-fracas-a-prospective-observational-study-using-peripheral-near-infrared-spectroscopy
#8
Ethan Butler, John Nguyen, Sajeev Mahendran, Anders Aneman
OBJECTIVES: To describe tissue oxygen saturation (StO2) in response to a vascular occlusion test using thenar eminence and forearm near-infrared spectroscopy (NIRS) and the association with volume responsiveness after cardiac surgery. DESIGN: Single-center, prospective, observational cohort study. SETTING: Cardiothoracic intensive care unit. PARTICIPANTS: Seventy-six post-cardiac surgical adults. INTERVENTIONS: Immediately before and 10 minutes after a 250-to-500 mL fluid bolus, StO2 was measured in response to a vascular occlusion test to calculate tissue deoxygenation (Rdes) and reoxygenation (Rres) rates...
March 18, 2017: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/28642988/development-of-pulmonary-hypertension-during-treatment-with-diazoxide-a-case-series-and-literature-review
#9
Matthew R Timlin, Alexander B Black, Heather M Delaney, Renée I Matos, Candace S Percival
Congenital hyperinsulinism (CHI) is the most common cause of persistent hypoglycemia in infancy. The mainstay of medical management for CHI is diazoxide. Diazoxide inhibits insulin release from the pancreas, but also causes smooth muscle relaxation and fluid retention so it is typically given with chlorothiazide. In July 2015, the FDA issued a drug safety communication warning that pulmonary hypertension (PH) had been reported in 11 infants being treated with diazoxide and that the PH resolved with withdrawal of diazoxide...
June 22, 2017: Pediatric Cardiology
https://www.readbyqxmd.com/read/28625165/transpulmonary-thermodilution-advantages-and-limits
#10
REVIEW
Xavier Monnet, Jean-Louis Teboul
BACKGROUND: For complex patients in the intensive care unit or in the operating room, many questions regarding their haemodynamic management cannot be answered with simple clinical examination. In particular, arterial pressure allows only a rough estimation of cardiac output. Transpulmonary thermodilution is a technique that provides a full haemodynamic assessment through cardiac output and other indices. MAIN BODY: Through the analysis of the thermodilution curve recorded at the tip of an arterial catheter after the injection of a cold bolus in the venous circulation, transpulmonary thermodilution intermittently measures cardiac output...
June 19, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/28622216/the-clinical-picture-of-severe-systemic-capillary-leak-syndrome-episodes-requiring-icu-admission
#11
Marc Pineton de Chambrun, Charles-Edouard Luyt, François Beloncle, Marie Gousseff, Wladimir Mauhin, Laurent Argaud, Stanislas Ledochowski, Anne-Sophie Moreau, Romain Sonneville, Bruno Verdière, Sybille Merceron, Nathalie Zappella, Mickael Landais, Damien Contou, Alexandre Demoule, Sylvie Paulus, Bertrand Souweine, Bernard Lecomte, Antoine Vieillard-Baron, Nicolas Terzi, Elie Azoulay, Raymond Friolet, Marc Puidupin, Jérôme Devaquet, Jean-Marc Mazou, Yannick Fedun, Jean-Paul Mira, Jean-Herlé Raphalen, Alain Combes, Zahir Amoura
OBJECTIVE: Systemic capillary-leak syndrome is a very rare cause of recurrent hypovolemic shock. Few data are available on its clinical manifestations, laboratory findings, and outcomes of those patients requiring ICU admission. This study was undertaken to describe the clinical pictures and ICU management of severe systemic capillary-leak syndrome episodes. DESIGN, SETTING, PATIENTS: This multicenter retrospective analysis concerned patients entered in the European Clarkson's disease (EurêClark) Registry and admitted to ICUs between May 1992 and February 2016...
July 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28610957/effectiveness-of-heart-rate-control-on-hemodynamics-in-critically-ill-patients-with-atrial-tachyarrhythmias-managed-by-amiodarone
#12
Joe-Elie Salem, Pauline Dureau, Christian Funck-Brentano, Jean-Sébastien Hulot, Maria El-Aissaoui, Nadia Aissaoui, Saik Urien, Christophe Faisy
Atrial tachyarrhythmias (AT) are common in intensive care unit (ICU) patients and might contribute to hemodynamic instability if heart rate (HR) is persistently too rapid. We aimed to assess if HR control below 115 or 130bpm with amiodarone improves hemodynamics in ICU patients with AT. This observational study included 73 ICU patients with disabling AT receiving amiodarone for HR control. A total of 525 changes (mainly within 4-8h) in mean arterial pressure (MAP) and 167 changes in plasma lactate in response to HR variations above 115 or 130bpm were analyzed...
June 10, 2017: Pharmacological Research: the Official Journal of the Italian Pharmacological Society
https://www.readbyqxmd.com/read/28562384/personalized-hemodynamic-management
#13
Bernd Saugel, Jean-Louis Vincent, Julia Y Wagner
PURPOSE OF REVIEW: To describe personalized hemodynamic management of critically ill patients in the operating room and the ICU. RECENT FINDINGS: Several recent clinical studies have investigated different strategies for optimizing blood pressure (BP) and flow in the operating room and in the ICU. In the past, (early) goal-directed hemodynamic treatment strategies often used predefined fixed population-based 'normal' values as hemodynamic targets. Most hemodynamic variables, however, have large interindividual variability and are dependent on several biometric factors...
August 2017: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/28561253/obstetric-disorders-in-the-icu
#14
Daniela N Vasquez, Lauren Plante, María N Basualdo, Gustavo G Plotnikow
Pregnant and postpartum patients represent a challenge to critical care physicians, as two patients in one have to be cared for and because specific obstetric disorders, not universally covered in formal critical care training, need to be managed. Pregnancy also alters physiologic norms, so that the critical care physician may either fail to recognize a value as abnormal in pregnancy or mistakenly identify as abnormal a value within the normal range for a pregnant woman. In this article, we will review the most frequent obstetric causes of admission of pregnant/postpartum patients to the intensive care unit (hypertensive disease of pregnancy, obstetric hemorrhage, and obstetric sepsis) along with their diagnostic criteria, clinical presentation, and recommended treatment...
April 2017: Seminars in Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/28542848/change-of-transfusion-and-treatment-paradigm-in-major-trauma-patients
#15
P Stein, A Kaserer, K Sprengel, G A Wanner, B Seifert, O M Theusinger, D R Spahn
Trauma promotes trauma-induced coagulopathy, which requires urgent treatment with fixed-ratio transfusions of red blood cells, fresh frozen plasma and platelet concentrates, or goal-directed administration of coagulation factors based on viscoelastic testing. This retrospective observational study compared two time periods before (2005-2007) and after (2012-2014) the implementation of changes in trauma management protocols which included: use of goal-directed coagulation management; admission of patients to designated trauma centres; whole-body computed tomography scanning on admission; damage control surgery; permissive hypotension; restrictive fluid resuscitation; and administration of tranexamic acid...
May 23, 2017: Anaesthesia
https://www.readbyqxmd.com/read/28529913/critical-care-management-and-intensive-care-unit-outcomes-following-cytoreductive-surgery-with-hyperthermic-intraperitoneal-chemotherapy
#16
Sumit Kapoor, Adel Bassily-Marcus, Rafael Alba Yunen, Parissa Tabrizian, Sabrine Semoin, Joseph Blankush, Daniel Labow, John Oropello, Anthony Manasia, Roopa Kohli-Seth
AIM: To study the early postoperative intensive care unit (ICU) management and complications in the first 2 wk of patients undergoing cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). METHODS: Our study is a retrospective, observational study performed at Icahn School of Medicine at Mount Sinai, quaternary care hospital in New York City. All adult patients who underwent CRS and HIPEC between January 1, 2007 and December 31, 2012 and admitted to ICU postoperatively were studied...
May 4, 2017: World Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/28527880/intensive-monitoring-of-urine-output-is-associated-with-increased-detection-of-acute-kidney-injury-and-improved-outcomes
#17
Kui Jin, Raghavan Murugan, Florentina E Sileanu, Emily Foldes, Priyanka Priyanka, Gilles Clermont, John A Kellum
BACKGROUND: Urine output (UO) is a vital sign for critically ill patients, but standards for monitoring and reporting vary widely between ICUs. Careful monitoring of UO could lead to earlier recognition of acute kidney injury (AKI) and better fluid management. We sought to determine if the intensity of UO monitoring is associated with outcomes in patients with and those without AKI. METHODS: This was a retrospective cohort study including 15,724 adults admitted to ICUs from 2000 to 2008...
May 17, 2017: Chest
https://www.readbyqxmd.com/read/28474097/advanced-hemodynamic-monitoring-in-intensive-care-medicine-a%C3%A2-german-web-based-survey-study
#18
B Saugel, P C Reese, J Y Wagner, M Buerke, W Huber, S Kluge, R Prondzinsky
BACKGROUND: Advanced hemodynamic monitoring is recommended in patients with complex circulatory shock. OBJECTIVES: To evaluate the current attitudes and beliefs among German intensivists, regarding advanced hemodynamic monitoring, the actual hemodynamic management in clinical practice, and the barriers to using it. MATERIALS AND METHODS: Web-based survey among members of the German Society of Medical Intensive Care and Emergency Medicine. RESULTS: Of 284 respondents, 249 (87%) agreed that further hemodynamic assessment is needed to determine the type of circulatory shock if no clear clinical diagnosis can be made...
May 4, 2017: Medizinische Klinik, Intensivmedizin und Notfallmedizin
https://www.readbyqxmd.com/read/28457316/emergent-laparotomy-and-temporary-abdominal-closure-for-the-cirrhotic-patient
#19
Tyler J Loftus, Janeen R Jordan, Chasen A Croft, R Stephen Smith, Philip A Efron, Frederick A Moore, Alicia M Mohr, Scott C Brakenridge
BACKGROUND: Temporary abdominal closure (TAC) may be performed for cirrhotic patients undergoing emergent laparotomy. The effects of cirrhosis on physiologic parameters, resuscitation requirements, and outcomes following TAC are unknown. We hypothesized that cirrhotic TAC patients would have different resuscitation requirements and worse outcomes than noncirrhotic patients. METHODS: We performed a 3-year retrospective cohort analysis of 231 patients managed with TAC following emergent laparotomy for sepsis, trauma, or abdominal compartment syndrome...
April 2017: Journal of Surgical Research
https://www.readbyqxmd.com/read/28452888/the-impact-of-patient-weight-on-burn-resuscitation
#20
Nehemiah T Liu, Craig A Fenrich, Maria L Serio-Melvin, Wylan C Peterson, Leopoldo C Cancio, José Salinas
BACKGROUND: Optimal fluid resuscitation of burn patients with burns greater than 20% total body surface area is critical to prevent burn shock during the initial 24 hours to 48 hours postburn. Currently, most resuscitation formulas incorporate the patient's weight when estimating 24-hour fluid requirements. The objective of this study was to determine the impact of weight on fluid resuscitation requirements and outcomes during the initial 24 hours after admission. METHODS: We performed a retrospective review of patients admitted to our burn intensive care unit from December 2007 to April 2013, resuscitated with a computerized decision support system...
July 2017: Journal of Trauma and Acute Care Surgery
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