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fluid management in icu patients

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https://www.readbyqxmd.com/read/28448605/vasopressor-use-following-traumatic-injury-a-single-center-retrospective-study
#1
Mathieu Hylands, Marie-Pier Godbout, Sandeep K Mayer, William D Fraser, Alain Vanasse, Marc-André Leclair, Alexis F Turgeon, François Lauzier, Emmanuel Charbonney, Vincent Trottier, Tarek S Razek, André Roy, Frédérick D'Aragon, Emilie Belley-Côté, Andrew G Day, Soazig Le Guillan, Robert Sabbagh, François Lamontagne
OBJECTIVES: Vasopressors are not recommended by current trauma guidelines, but recent reports indicate that they are commonly used. We aimed to describe the early hemodynamic management of trauma patients outside densely populated urban centers. METHODS: We conducted a single-center retrospective cohort study in a Canadian regional trauma center. All adult patients treated for traumatic injury in 2013 who died within 24 hours of admission or were transferred to the intensive care unit were included...
2017: PloS One
https://www.readbyqxmd.com/read/28446775/delivering-prolonged-intensive-care-to-a-non-human-primate-a-high-fidelity-animal-model-of-critical-illness
#2
P Guillaume Poliquin, Mia Biondi, Charlene Ranadheera, Mable Hagan, Alexander Bello, Trina Racine, Mark Allan, Duane Funk, Gregory Hansen, B J Hancock, Murray Kesselman, Todd Mortimer, Anand Kumar, Shane Jones, Anders Leung, Allen Grolla, Kaylie N Tran, Kevin Tierney, Xiangguo Qiu, Darwyn Kobasa, James E Strong
Critical care needs have been rising in recent decades as populations age and comorbidities increase. Sepsis-related admissions to critical care contribute up to 50% of volume and septic shock carries a 35-54% fatality rate. Improvements in sepsis-related care and mortality would have a significant impact of a resource-intensive area of health care delivery. Unfortunately, research has been hampered by the lack of an animal model that replicates the complex care provided to humans in an intensive care unit (ICU)...
April 26, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28439133/importance-of-pharmacy-involvement-in-the-treatment-of-sepsis
#3
Joseph B Cavanaugh, Jesse B Sullivan, Nicole East, Jessica N Nodzon
Purpose: A review of the impact of pharmacists on appropriate medication selection, timing of administration, and as members of a multidisciplinary sepsis response team. Summary: Early goal-directed therapy (EGDT), currently recommended by the 2013 Surviving Sepsis Campaign guidelines for the management of patients with sepsis, includes the administration of appropriate antibiotics in patients with septic shock within the first hour. Multidisciplinary teams containing pharmacists have been shown to decrease time to antibiotic delivery, time to antibiotic administration, and patient mortality...
March 2017: Hospital Pharmacy
https://www.readbyqxmd.com/read/28430760/resuscitative-endovascular-balloon-occlusion-of-the-aorta-or-resuscitative-thoracotomy-with-aortic-clamping-for-noncompressible-torso-hemorrhage-a-retrospective-nationwide-study
#4
Shotaro Aso, Hiroki Matsui, Kiyohide Fushimi, Hideo Yasunaga
BACKGROUND: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an emerging treatment for noncompressible torso hemorrhage. It remains unclear if REBOA is superior to resuscitative thoracotomy with aortic cross-clamping (RT) in terms of improving outcomes. This study compared in-hospital outcomes between REBOA and RT in trauma patients with uncontrolled hemorrhagic shock, using data from a national inpatient database in Japan. METHODS: Using the Diagnosis Procedure Combination database, we identified patients who received REBOA or RT within 1 day after admission from July 1, 2010, to March 31, 2014...
May 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28420471/-mixed-venous-arterial-carbon-dioxide-difference-combined-with-passive-leg-raising-in-guiding-volume-management-for-patients-post-off-pump-coronary-artery-bypass-grafting
#5
Likun Huo, Peijun Li, Chang Xie, Chenglei Yan, Jie Li
OBJECTIVE: To investigate whether mixed venous-arterial carbon dioxide difference (Pv-aCO2) combined with passive leg raising (PLR) could better guide volume management for patients post off-pump coronary artery bypass grafting (OPCABG). METHODS: Eighty patients experienced OPCABG, and admitted to Tianjin Chest Hospital from June 1st to October 1st in 2016 were enrolled. They were randomly divided into two groups: observation group given Pv-aCO2 combined with PLR directed therapy and control group given central venous pressure (CVP) directed therapy, 40 cases in each group...
April 2017: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
https://www.readbyqxmd.com/read/28375472/enhanced-recovery-after-surgery-protocol-in-patients-undergoing-esophagectomy-for-cancer-a-single-center-experience
#6
S Giacopuzzi, J Weindelmayer, E Treppiedi, M Bencivenga, M Ceola, S Priolo, M Carlini, G de Manzoni
This article is about an emerging issue in esophageal surgery: enhanced recovery after surgery (ERAS) Few data are published in literature and its safety and feasibility is still debated. The focus of our paper is on the feasibility of an ERAS protocol for esophagectomy (including both the Ivor-Lewis and McKeown procedure) in a high volume center comparing to a standard perioperative protocol. We introduced a novelty item on this type of surgery: resume of oral feeding in the first postoperative day. We analyzed the dropout rate for each item and the postoperative morbidity...
April 1, 2017: Diseases of the Esophagus: Official Journal of the International Society for Diseases of the Esophagus
https://www.readbyqxmd.com/read/28372500/clinical-significance-of-bioimpedance-spectroscopy-in-critically-ill-patients
#7
Shang-Feng Yang, Ching-Min Tseng, I-Fan Liu, Shin-Hung Tsai, Wein-Shung Kuo, Tien-Ping Tsao
BACKGROUND: Early fluid resuscitation is a key aspect in the successful management of critically ill patients, but the optimal goal for volume control after the acute stage of critical illness remains unclear. This study aimed to evaluate the prognostic value of bioimpedance spectrometry for fluid management in critically ill patients. METHODS: In this prospective observational study, patients who consented to participate were screened within the first 24 hours of admission to a medical intensive care unit (ICU) from February 4, 2015, to January 31, 2016...
January 1, 2017: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/28366285/a-review-of-hemodynamic-monitoring-techniques-methods-and-devices-for-the-emergency-physician
#8
Abdullah E Laher, Matthew J Watermeyer, Sean K Buchanan, Nicole Dippenaar, Nelly Clotilde Tchouambou Simo, Feroza Motara, Muhammed Moolla
The emergency department (ED) is frequently the doorway to the intensive care unit (ICU) for a significant number of critically ill patients presenting to the hospital. Hemodynamic monitoring (HDM) which is a key component in the effective management of the critically ill patient presenting to the ED, is primarily concerned with assessing the performance of the cardiovascular system and determining the correct therapeutic intervention to optimise end-organ oxygen delivery. The spectrum of hemodynamic monitoring ranges from simple clinical assessment and routine bedside monitoring to point of care ultrasonography and various invasive monitoring devices...
March 18, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28341116/management-and-outcomes-of-acute-pancreatitis-patients-over-the-last-decade-a-us-tertiary-center-experience
#9
Efstratios Koutroumpakis, Adam Slivka, Alessandro Furlan, Anil K Dasyam, Anwar Dudekula, Julia B Greer, David C Whitcomb, Dhiraj Yadav, Georgios I Papachristou
BACKGROUND/OBJECTIVES: Acute pancreatitis (AP) management remains largely supportive and can be challenging in patients with severe disease. This study aims to describe a ten-year US tertiary-center experience in managing AP patients. METHODS: Clinical management and outcomes of 400 prospectively enrolled AP patients stratified by the Revised Atlanta Classification were analyzed; trends in management between early (2004-2008) and late enrollment phase (2009-2014) were assessed...
January 2017: Pancreatology: Official Journal of the International Association of Pancreatology (IAP) ... [et Al.]
https://www.readbyqxmd.com/read/28338247/impact-of-diabetic-ketoacidosis-management-in-the-medical-intensive-care-unit-after-order-set-implementation
#10
Benjamin Laliberte, Siu Yan Amy Yeung, Jeffrey P Gonzales
OBJECTIVE: To determine the rate of compliance to the 2006 and 2009 ADA DKA guidelines in the medical intensive care unit (MICU) at a large academic medical centre after the implementation of a computerised DKA order set and protocol. METHODS: Retrospective chart review of adult patients with DKA admitted to the MICU. Results of pre-order set (PRE) were compared to those of data post-order set (POST). The primary outcome was a composite administration of intravenous fluid resuscitation in the first 24 h, insulin bolus and initial insulin infusion rate...
March 24, 2017: International Journal of Pharmacy Practice
https://www.readbyqxmd.com/read/28241247/peritoneal-dialysis-vs-furosemide-for-prevention-of-fluid-overload-in-infants-after-cardiac-surgery-a-randomized-clinical-trial
#11
David M Kwiatkowski, Stuart L Goldstein, David S Cooper, David P Nelson, David L S Morales, Catherine D Krawczeski
Importance: Fluid overload after congenital heart surgery is frequent and a major cause of morbidity and mortality among infants. Many programs have adopted the use of peritoneal dialysis (PD) for fluid management; however, its benefits compared with those of traditional diuretic administration are unknown. Objective: To determine whether infants randomized to PD vs furosemide for the treatment of oliguria have a higher incidence of negative fluid balance on postoperative day 1, as well as avoidance of 10% fluid overload; shorter duration of mechanical ventilation, intensive care unit stay, and inotrope use; and fewer electrolyte abnormalities...
April 1, 2017: JAMA Pediatrics
https://www.readbyqxmd.com/read/28236396/challenges-in-sepsis-care-new-sepsis-definitions-and-fluid-resuscitation-beyond-the-central-venous-pressure
#12
REVIEW
Maureen A Seckel, Thomas Ahrens
There are two important recent changes in sepsis care. The first key change is the 2016 Sepsis-3 definitions from the recent consensus workgroup with new sepsis and septic shock definitions. Useful tools for assessing patients that have a greater risk of mortality include Sequential Organ Failure Assessment (SOFA) in intensive care units and quick SOFA outside intensive care units. The second change involves management of fluid resuscitation and measures of volume responsiveness. Measures such as blood pressure and central venous pressure are not reliable...
December 2016: Critical Care Nursing Clinics of North America
https://www.readbyqxmd.com/read/28219399/noninvasive-detection-of-alarming-intracranial-pressure-changes-by-auditory-monitoring-in-early-management-of-brain-injury-a-prospective-invasive-versus-noninvasive-study
#13
Fabrice Giraudet, François Longeras, Aurélien Mulliez, Aurélie Thalamy, Bruno Pereira, Paul Avan, Laurent Sakka
BACKGROUND: In brain-injured patients intracranial pressure (ICP) is monitored invasively by a ventricular or intraparenchymal transducer. The procedure requires specific expertise and exposes the patient to complications such as malposition, hemorrhage or infection. As inner-ear fluid compartments are connected to the cerebrospinal fluid space, ICP changes elicit subtle changes in the physiology of the inner ear. Notably, we previously demonstrated that the phase of cochlear microphonic potential (CM) generated by sound stimuli rotates with ICP...
February 21, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/28203407/thoracoabdominal-aortic-replacement-for-crawford-extent-ii-aneurysm-after-thoracic-endovascular-aortic-repair
#14
Haiou Hu, Tie Zheng, Junming Zhu, Yongmin Liu, Ruidong Qi, Lizhong Sun
BACKGROUND: The surgical treatment of Crawford extent II aneurysms after thoracic endovascular aortic repair (TEVAR) remains challenging, because of the need to remove the failed endograft and the complexity of the aortic reconstruction. We retrospectively reviewed our experience with surgical management of Crawford extent II aneurysms after TEVAR using thoracoabdominal aortic replacement (TAAR). METHODS: Eleven patients (10 males, 1 female) with Crawford extent II aneurysm after TEVAR were treated with TAAR between August 2012 and May 2015...
January 2017: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/28187809/management-of-bacterial-central-nervous-system-infections
#15
REVIEW
M C Brouwer, D van de Beek
Bacterial infections of the central nervous system present as a medical emergency, thus requiring rapid diagnosis and immediate treatment. The most prevalent bacterial infections seen in the intensive care unit can be summarized as acute bacterial meningitis, subdural empyema, intracerebral abscess, and ventriculitis, which all commonly involve the brain parenchyma. The infections can either be community-acquired or hospital-acquired, e.g., after neurosurgical intervention, as a complication of severe neurotrauma or related to indwelling cerebrospinal fluid drains...
2017: Handbook of Clinical Neurology
https://www.readbyqxmd.com/read/28180121/hemodynamic-changes-following-routine-fluid-resuscitation-in-patients-with-blunt-trauma
#16
Shahram Paydar, Hamed Kabiri, Maryam Barhaghtalab, Fariborz Ghaffarpasand, Saeed Safari, Alireza Baratloo
BACKGROUND: The management of trauma patients is often difficult. The American college of surgeons suggests using advanced trauma life support (ATLS) measures. ATLS is regarded as the gold standard for the resuscitation of cases with acute life threatening injuries. OBJECTIVES: To assess the change in base excess (BE) values and central venous pressure (CVP) one and six hours after injection of 1000 cc normal saline in trauma patients admitted to the ICU. PATIENTS AND METHODS: According to the inclusion and exclusion criteria, patients were randomly selected to participate in the project...
September 2016: Trauma Monthly
https://www.readbyqxmd.com/read/28167592/patient-characteristics-management-and-predictors-of-outcome-from-severe-community-onset-staphylococcal-sepsis-in-northeast-thailand-a-prospective-multicenter-study
#17
T Eoin West, Chanthiwa Wikraiphat, Sarunporn Tandhavanant, Pitchayanant Ariyaprasert, Pornpan Suntornsut, Shawna Okamoto, Weera Mahavanakul, Pramot Srisamang, Sunchai Phiphitaporn, Jirasak Anukunananchai, Ploenchan Chetchotisakd, Sharon J Peacock, Narisara Chantratita
Staphylococcus aureus infection is a persistent threat in resource-restricted settings in southeast Asia but informative data about this disease remain limited. We analyzed characteristics, management, and predictors of outcome in severely septic patients with community-onset S. aureus infection in northeast Thailand. We performed a prospective, multicenter observational cohort study of community-onset S. aureus sepsis in four referral hospitals recruiting patients at least 14 years of age admitted between March 2010 and December 2013...
February 6, 2017: American Journal of Tropical Medicine and Hygiene
https://www.readbyqxmd.com/read/28159011/fluids-and-sepsis-changing-the-paradigm-of-fluid-therapy-a-case-report
#18
Hori Hariyanto, Corry Quando Yahya, Monika Widiastuti, Primartanto Wibowo, Oloan Eduard Tampubolon
BACKGROUND: Over the past 16 years, sepsis management has been guided by large-volume fluid administration to achieve certain hemodynamic optimization as advocated in the Rivers protocol. However, the safety of such practice has been questioned because large-volume fluid administration is associated with fluid overload and carries the worst outcome in patients with sepsis. Researchers in multiple studies have declared that using less fluid leads to increased survival, but they did not describe how to administer fluids in a timely and appropriate manner...
February 4, 2017: Journal of Medical Case Reports
https://www.readbyqxmd.com/read/28156637/complications-of-intrathecal-pump-therapy-in-malignancy-related-pain
#19
Egidio Del Fabbro
102 Background: Intrathecal pumps (ITP) are used to manage severe malignancy related pain by delivering analgesics directly into the cerebrospinal fluid, in theory allowing for a reduced opioid dose and fewer complications. Although there is literature to support efficacy in patients with cancer, including improved survival, this mode of drug delivery also carries a risk of serious complications. Reports of complications in non-malignant pain suggest the risks and mortality related to ITP may be under-appreciated and that injury and liability occur with both ITP placement and ITP maintenance...
October 9, 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28144779/focused-cardiac-ultrasound-in-the-early-resuscitation-of-severe-sepsis-and-septic-shock-a-prospective-pilot-study
#20
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
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