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Physical therapy in icu

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https://www.readbyqxmd.com/read/27907966/getting-rid-of-weakness-in-the-icu-an-updated-approach-to-the-acute-management-of-myasthenia-gravis-and-guillain-barr%C3%A3-syndrome
#1
Alexis A Lizarraga, Karlo J Lizarraga, Michael Benatar
After prompt diagnosis, severe myasthenia gravis and Guillain-Barré syndrome (GBS) usually require management in the intensive care unit. In the myasthenic patient, recognition of precipitating factors is paramount, and frequent monitoring of bulbar, upper airway, and/or respiratory muscle strength is needed to identify impending myasthenic crisis. Noninvasive ventilation can be attempted prior to intubation and mechanical ventilation in the setting of respiratory failure. Cholinesterase inhibitors should be discontinued, but resumed prior to extubation, and steroid dosage could be increased once the airway is secured...
December 2016: Seminars in Neurology
https://www.readbyqxmd.com/read/27881152/fitness-and-mobility-training-in-patients-with-intensive-care-unit-acquired-muscle-weakness-fitonicu-study-protocol-for-a-randomised-controlled-trial
#2
Jan Mehrholz, Simone Thomas, Jane H Burridge, André Schmidt, Bettina Scheffler, Ralph Schellin, Stefan Rückriem, Daniel Meißner, Katja Mehrholz, Wolfgang Sauter, Ulf Bodechtel, Bernhard Elsner
BACKGROUND: Critical illness myopathy (CIM) and polyneuropathy (CIP) are a common complication of critical illness. Both cause intensive-care-unit-acquired (ICU-acquired) muscle weakness (ICUAW) which increases morbidity and delays rehabilitation and recovery of activities of daily living such as walking ability. Focused physical rehabilitation of people with ICUAW is, therefore, of great importance at both an individual and a societal level. A recent systematic Cochrane review found no randomised controlled trials (RCT), and thus no supporting evidence, for physical rehabilitation interventions for people with defined CIP and CIM to improve activities of daily living...
November 24, 2016: Trials
https://www.readbyqxmd.com/read/27836209/-extracorporeal-co2-removal-as-life-support-system-for-a-severe-organizing-pneumonia
#3
G Rival, O Millet, G Capellier
INTRODUCTION: Acute lung injuries are usually found in intensive care unit. The diffuse alveolar damage (DAD) is the associated histological pattern and the most severe end-stage of the disease. Organizing pneumonia (OP), for which corticosteroids are the reference therapy, can mimic DAD. While postponing the response to treatment, to limit mechanical ventilation side effects, extracorporeal membrane oxygene can be proposed. We present a case of a severe OP for which extracorporeal CO2 removal (ECCO2R) is used as a bridge to recovery under corticosteroid therapy...
November 8, 2016: Revue de Pneumologie Clinique
https://www.readbyqxmd.com/read/27834785/physiological-effects-of-a%C3%A2-single-chest-physiotherapy-session-in-mechanically-ventilated-and-extubated-preterm-neonates
#4
Y Mehta, J Shetye, R Nanavati, A Mehta
OBJECTIVE: To assess the changes on various physiological cardio-respiratory parameters with a single chest physiotherapy session in mechanically ventilated and extubated preterm neonates with respiratory distress syndrome. STUDY DESIGN: This is a prospective observational study in neonatal intensive care unit setting. Sixty preterm neonates with respiratory distress syndrome, thirty mechanically ventilated and thirty extubated preterm neonates requiring chest physiotherapy were enrolled in the study...
November 9, 2016: Journal of Neonatal-perinatal Medicine
https://www.readbyqxmd.com/read/27832565/safety-of-nicotine-replacement-therapy-in-critically-ill-smokers-a-retrospective-cohort-study
#5
A Kerr, J T McVey, A M Wood, Fmp Van Haren
Nicotine replacement therapy (NRT) is a common first-line treatment to prevent nicotine withdrawal in smokers. However, available literature reports conflicting results regarding its efficacy and safety in critically ill patients. The objective of this study was to evaluate the relationship between NRT in smokers in the intensive care unit (ICU) and outcomes. This case-control study was conducted in a university-affiliated tertiary hospital ICU. Over a period of five years, 126 active smokers who received transdermal NRT were matched to 126 active smokers who did not receive NRT...
November 2016: Anaesthesia and Intensive Care
https://www.readbyqxmd.com/read/27829093/postoperative-pulmonary-complications-early-mortality-and-hospital-stay-following-noncardiothoracic-surgery-a-multicenter-study-by-the-perioperative-research-network-investigators
#6
Ana Fernandez-Bustamante, Gyorgy Frendl, Juraj Sprung, Daryl J Kor, Bala Subramaniam, Ricardo Martinez Ruiz, Jae-Woo Lee, William G Henderson, Angela Moss, Nitin Mehdiratta, Megan M Colwell, Karsten Bartels, Kerstin Kolodzie, Jadelis Giquel, Marcos Francisco Vidal Melo
Importance: Postoperative pulmonary complications (PPCs), a leading cause of poor surgical outcomes, are heterogeneous in their pathophysiology, severity, and reporting accuracy. Objective: To prospectively study clinical and radiological PPCs and respiratory insufficiency therapies in a high-risk surgical population. Design, Setting, and Participants: We performed a multicenter prospective observational study in 7 US academic institutions...
November 9, 2016: JAMA Surgery
https://www.readbyqxmd.com/read/27822310/anaphylactic-shock-during-cement-implantation-of-a-total-hip-arthroplasty-in-a-patient-with-underlying-mastocytosis-case-report-of-a-rare-intraoperative-complication
#7
Anita Ten Hagen, Pieter Doldersum, Tom van Raaij
BACKGROUND: Cemented total hip arthroplasty (THA) is a safe and common procedure. In rare cases life threatening bone cement implantation syndrome (BCIS) may occur, which is commonly caused by pulmonary embolism (PE). CASE PRESENTATION: We describe the rare case of a 70-year old patient who underwent an elective total hip replacement. Before surgery he was diagnosed with underlying systemic indolent mastocytosis, a rare pathological disorder that may result in anaphylaxis after massive systemic mast cell activation...
2016: Patient Safety in Surgery
https://www.readbyqxmd.com/read/27806794/-follow-up-of-survived-children-supported-by-extracorporeal-membrane-oxygenation
#8
Y Cheng, Z J Lu, X G Yan, J He, G F Yan, X D Cai, W J Shen, A L Jin, G P Lu
Objective: To summarize the follow-up of children treated with venoarterial extracorporeal membrane oxygenation (ECMO) by incision of internal carotid artery-vein. Method: This was a retrospective study, 10 children in whom the conventional therapy failed, but survived after treatment with ECMO technique through right internal jugular artery-venous incision and ligation after ECMO in pediatric intensive care unit (PICU) of Fudan University were followed up from December 2011 to December 2015. Primary disease situation, neurological development, growth and development, quality of life and personality development were included...
November 2, 2016: Zhonghua Er Ke za Zhi. Chinese Journal of Pediatrics
https://www.readbyqxmd.com/read/27793165/surviving-critical-illness-what-is-next-an-expert-consensus-statement-on-physical-rehabilitation-after-hospital-discharge
#9
M E Major, R Kwakman, M E Kho, B Connolly, D McWilliams, L Denehy, S Hanekom, S Patman, R Gosselink, C Jones, F Nollet, D M Needham, R H H Engelbert, M van der Schaaf
BACKGROUND: The study objective was to obtain consensus on physical therapy (PT) in the rehabilitation of critical illness survivors after hospital discharge. Research questions were: what are PT goals, what are recommended measurement tools, and what constitutes an optimal PT intervention for survivors of critical illness? METHODS: A Delphi consensus study was conducted. Panelists were included based on relevant fields of expertise, years of clinical experience, and publication record...
October 29, 2016: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/27758794/severe-human-monocytic-ehrlichiosis-presenting-with-altered-mental-status-and-seizures
#10
Christian Geier, Jessica Davis, Marc Siegel
A previously healthy 66-year-old woman living in the Mid-Atlantic USA presented to the hospital with lethargy, ataxia and slurred speech. 2 weeks prior she had removed a tick from her right groin. She reported malaise, fevers, diarrhoea, cough and a rash. Physical examination revealed a maculopapular rash on her chest, and lung auscultation revealed bi-basilar rales. Laboratory tests were remarkable for hyponatraemia, leucopenia and thrombocytopenia. Chest X-ray demonstrated bilateral pleural effusions with pulmonary oedema...
October 6, 2016: BMJ Case Reports
https://www.readbyqxmd.com/read/27717931/problems-and-challenges-in-the-early-period-of-rehabilitating-patients-with-severe-hypothermia-treated-using-ecmo-support
#11
Dominika Batycka-Stachnik, Agnieszka Piwoda, Tomasz Darocha, Malgorzata Spiewak, Sylweriusz Kosinski, Anna Jarosz, Hubert Hymczak, Tomasz Sanak, Robert Galazkowski, Jacek Piatek, Janusz Konstanty-Kalandyk, Rafal Drwila
: The objectives: To show and discuss the most frequent functional problems encountered in patients who underwent extracorporeal membrane oxygenation (ECMO) treatment after severe hypothermia and point out appropriate physiotherapy procedures used in order to diminish the effects of hypothermia on the human organism. It is necessary to look for effective physiotherapeutic solutions, especially that the number of scientific publications on the subject is very limited. DESIGN: Retrospective analysis Setting: Severe Accidental Hypothermia Center ( medical intensive care unit of a university hospital) Patients or participants: Nineteen patients who were qualified for ECMO in Severe Accidental Hypothermia Center Intervention: At least three times a day rehabilitation session (physiotherapeutic procedures adequate to patient problems) and interventions in case of emergency...
2016: Wiadomości Lekarskie: Organ Polskiego Towarzystwa Lekarskiego
https://www.readbyqxmd.com/read/27676786/healthcare-pathway-after-sever-traumatic-brain-injury-about-a-tunisian-population
#12
Soumaya Boudokhane, Amine Kalai, Aymen Haj Salah, Houda Migaou, Sana Salah, Anis Jellad, Mourad Gahbiche, Zohra Ben Salah Frih
OBJECTIVE: The aim of our study was to determine the demographic characteristics and the pathway of severe traumatic brain injury (STBI) victims in the Tunisian population. MATERIAL/PATIENTS AND METHODS: Our study included 26 patients victims of STBI hospitalized in intensive care unit, among 450 traumatic head injuries admitted to the Teaching Hospital of Fattouma Bourguiba in Monastir during the year 2014. The studied parameters were: demographic characteristics of the population, circumstances of the accident, transport modalities to the hospital, assessments of the injury types, duration of coma, length of hospitalization in the Intensive Care Unit (ICU) and finally the discharge mode after the ICU stay (transfer to neurosurgery ward, to rehabilitation unit, or home discharged)...
September 2016: Annals of Physical and Rehabilitation Medicine
https://www.readbyqxmd.com/read/27676408/lung-transplanation-after-125-days-on-ecmo-for-severe-refractory-hypoxemia-with-no-prior-lung-disease
#13
Shameen Salam, Robert Kotloff, Puneet Garcha, Sudhir Krishnan, Dhruv Joshi, Patrick Grady, Abhijit Duggal
Veno-venous extracorporeal membrane oxygenation (ECMO) has become a viable and increasingly utilized option for the treatment of refractory hypoxemia in severe acute respiratory distress syndrome (ARDS). However, options are limited for ARDS patients who fail to wean from ECMO. The high rates of infection, presence of extrapulmonary end organ damage, ICU-acquired weakness, and high short-term mortality associated with ARDS are all significant hurdles that make lung transplantation a difficult prospect to consider...
September 22, 2016: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
https://www.readbyqxmd.com/read/27661864/point-prevalence-study-of-mobilization-practices-for-acute-respiratory-failure-patients-in-the-united-states
#14
Sarah Elizabeth Jolley, Marc Moss, Dale M Needham, Ellen Caldwell, Peter E Morris, Russell R Miller, Nancy Ringwood, Megan Anders, Karen K Koo, Stephanie E Gundel, Selina M Parry, Catherine L Hough
OBJECTIVE: Early mobility in mechanically ventilated patients is safe, feasible, and may improve functional outcomes. We sought to determine the prevalence and character of mobility for ICU patients with acute respiratory failure in U.S. ICUs. DESIGN: Two-day cross-sectional point prevalence study. SETTING: Forty-two ICUs across 17 Acute Respiratory Distress Syndrome Network hospitals. PATIENTS: Adult patients (≥ 18 yr old) with acute respiratory failure requiring mechanical ventilation...
September 22, 2016: Critical Care Medicine
https://www.readbyqxmd.com/read/27649699/association-between-source-control-and-mortality-in-258-patients-with-intra-abdominal-candidiasis-a-retrospective-multi-centric-analysis-comparing-intensive-care-versus-surgical-wards-in-spain
#15
L Lagunes, A Rey-Pérez, M T Martín-Gómez, A Vena, V de Egea, P Muñoz, E Bouza, A Díaz-Martín, I Palacios-García, J Garnacho-Montero, M Campins, M Bassetti, J Rello
Early empiric therapy and adequate resuscitation have been identified as main predictors of outcome in patients with candidemia or bacteremia. Moreover, source control is a major determinant in infectious sites when feasible, as a main technique to reduce microbiological burden. A retrospective, multicenter, cohort study was performed at surgical wards and intensive care units (ICU) of three University Hospitals in Spain between 2010 and 2014, with the aim of improving understanding of the interaction between source control, early antifungal therapy, and use of vasoactives in patients with intra-abdominal candidiasis (IAC)...
September 21, 2016: European Journal of Clinical Microbiology & Infectious Diseases
https://www.readbyqxmd.com/read/27642739/-an-unexpected-cause-of-dyspnea-and-degradation-of-performance
#16
Peter Seizer, Michaela Rockenstiehl, Suzanne Fateh-Moghadam, Susanne Haen, Ferruh Artunc, Martin R Müller, Azadeh Ebrahimi, Reimer Riessen, Meinrad Gawaz, Falko Fend, Michael Haap
HISTORY AND ADMISSION FINDINGS: A 55-year old man suffers from progressive, distinctive dyspnoea and physical weakness since 5 days. Due to ST-segment changes in the ECG and a positive troponin-test, the primary care physician initiates an hospitalization. INVESTIGATIONS: After admission, the laboratory tests confirm the elevated troponin-values, and show additionally elevated pro-brain-natriuric-peptide-values. The coronary angiography presents a highly reduced left ventricular function, an aortic insufficiency III° and a coronary heart disease...
September 2016: Deutsche Medizinische Wochenschrift
https://www.readbyqxmd.com/read/27642150/-pulmonary-complications-of-sickle-cell-disease-in-children
#17
T Pincez, L Calamy, Z Germont, A Lemoine, A-A Lopes, A Massiot, J Tencer, C Thivent, A Hadchouel
Acute and chronic pulmonary complications are frequent in sickle cell disease (SCD), with different spectrum and characteristics in children and adults. Chronic hypoxia is frequent and plays a role in several respiratory complications in SCD. Furthermore, hypoxia has been associated with a higher risk of cerebral ischemia. Despite differing oxygen affinity between hemoglobin A and S, standard pulse oximetry was shown to be accurate in diagnosing hypoxia in SCD patients. Whereas acute hypoxia management is similar to non-SCD patients, chronic hypoxia treatment is mainly based on a transfusion program rather than long-term oxygen therapy...
October 2016: Archives de Pédiatrie: Organe Officiel de la Sociéte Française de Pédiatrie
https://www.readbyqxmd.com/read/27641755/addition-of-adjuvant-progesterone-to-physical-exam-indicated-cervical-cerclage-to-prevent-preterm-birth
#18
Eun Young Jung, Kyung Joon Oh, Joon-Seok Hong, Bo Ryoung Han, Jung Kyung Joo
AIM: The aim of this study was to assess the effect of vaginal progesterone as an adjuvant therapy to physical-exam-indicated cervical cerclage (PEICC). METHODS: This retrospective cohort study included 53 consecutive singleton women who underwent PEICC because of acute cervical insufficiency at 17-24 gestational weeks. The study population was divided into two groups: the adjuvant progesterone group (n = 18) and the non-adjuvant group (n = 35). A 200-mg dose of vaginal micronized natural progesterone was administered after cerclage in the adjuvant progesterone group...
September 19, 2016: Journal of Obstetrics and Gynaecology Research
https://www.readbyqxmd.com/read/27618376/progressive-mobility-protocol-reduces-venous-thromboembolism-rate-in-trauma-intensive-care-patients-a-quality-improvement-project
#19
Kathryn Booth, Josh Rivet, Richelle Flici, Ellen Harvey, Mark Hamill, Douglas Hundley, Katelyn Holland, Sandra Hubbard, Apurva Trivedi, Bryan Collier
The intensive care unit (ICU) trauma population is at high risk for complications associated with immobility. The purpose of this project was to compare ICU trauma patient outcomes before and after implementation of a structured progressive mobility (PM) protocol. Outcomes included hospital and ICU stays, ventilator days, falls, respiratory failure, pneumonia, or venous thromboembolism (VTE). In the preintervention cohort, physical therapy (PT) consults were placed 53% of the time. This rose to more than 90% during the postintervention period...
September 2016: Journal of Trauma Nursing: the Official Journal of the Society of Trauma Nurses
https://www.readbyqxmd.com/read/27600938/-algorithms-for-early-mobilization-in-intensive-care-units
#20
P Nydahl, R Dubb, S Filipovic, C Hermes, F Jüttner, A Kaltwasser, S Klarmann, H Mende, S Nessizius, C Rottensteiner
Immobility of patients in intensive care units (ICU) can lead to long-lasting physical and cognitive decline. During the last few years, bundles for rehabilitation were developed, including early mobilization. The German guideline for positioning therapy and mobilization, in general, recommends the development of ICU-specific protocols. The aim of this narrative review is to provide guidance when developing a best practice protocol in one's own field of work. It is recommended to a) implement early mobilization as part of a bundle, including screening and management of patient's awareness, pain, anxiety, stress, delirium and family's presence, b) develop a traffic-light system of specific in- and exclusion criteria in an interprofessional process, c) use checklists to assess risks and preparation of mobilization, d) use the ICU Mobility Scale for targeting and documentation of mobilization, e) use relative safety criteria for hemodynamic and respiratory changes, and Borg Scale for subjective evaluation, f) document and evaluate systematically mobilization levels, barriers, unwanted safety events and other parameters...
September 6, 2016: Medizinische Klinik, Intensivmedizin und Notfallmedizin
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