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hemodynamic instability

Ryan J Anderson, Sayuri P Jinadasa, Leeyen Hsu, Tiffany Bita Ghafouri, Sanjeev Tyagi, Jisha Joshua, Ariel Mueller, Daniel Talmor, Rebecca E Sell, Jeremy R Beitler
BACKGROUND: Post-resuscitation hemodynamic instability following out-of-hospital cardiac arrest (OHCA) may occur from myocardial dysfunction underlying cardiogenic shock and/or inflammation-mediated distributive shock. Distinguishing the predominant shock subtype with widely available clinical metrics may have prognostic and therapeutic value. METHODS: A two-hospital cohort was assembled of patients in shock following OHCA. Left ventricular ejection fraction (LVEF) was assessed via echocardiography or cardiac ventriculography within 1 day post arrest and used to delineate shock physiology...
June 15, 2018: Critical Care: the Official Journal of the Critical Care Forum
Stefan Kleiser, Daniel Ostojic, Nassim Nasseri, Helene Isler, Hans Ulrich Bucher, Dirk Bassler, Martin Wolf, Felix Scholkmann, Tanja Karen
The aim was to determine the precision of a noninvasive near-infrared spectroscopy (NIRS)-based tissue oximeter (OxyPrem v1.3). Using a linear mixed-effects model, we quantified the variability for cerebral tissue oxygenation (StO2) measurements in 35 preterm neonates to be 2.64%, a value that meets the often-articulated clinicians' demand for a precise tissue oxygenation measurement. We showed that the variability of StO2 values measured was dominated by spontaneous systemic hemodynamic fluctuations during the measurement, meaning that precision of the instrument was actually even better...
June 2018: Journal of Biomedical Optics
George Samanidis, Charalampos Katselis, Constantinos Contrafouris, Georgios Georgiopoulos, Ioannis Kriaras, Theofani Antoniou, Konstantinos Perreas
INTRODUCTION: Hypothermic circulatory arrest is widely used for correction of acute type A aortic dissection pathology. We present our experience of 45 consecutive patients operated in our unit with bilateral antegrade cerebral perfusion and moderate hypothermic circulatory arrest. METHODS: Between January 2011 and April 2015, 45 consecutive patients were admitted for acute type A aortic dissection and operated emergently under moderate hypothermic circulatory arrest and bilateral antegrade cerebral perfusion...
March 2018: Brazilian Journal of Cardiovascular Surgery
Muhammad Aziz, Rawish Fatima, Lindsey N Douglass, Omar Abughanimeh, Shahzad Raza
Clostridium difficile infection (CDI) is a significant health burden now recognized as the leading cause of acquired diarrhea in patients receiving antibiotic therapy. Complications of infection with this pathogen include severe diarrhea causing electrolyte imbalances, dehydration, hemodynamic instability, toxic megacolon, shock and death, hence it is extremely paramount to stay updated on management options for this infection especially in cancer patients. This article presents an in-depth review of literature on the treatment modalities available for CDI in cancer patients...
June 11, 2018: Current Medical Research and Opinion
O Martinelli, C Fenelli, J Ben-Hamida, M Fresilli, F G Irace, V Picone, A Malaj, B Gossetti, L Irace
OBJECTIVE: Treatment of ruptured abdominal aortic aneurysms (rAAAs) is still burdened by high morbidity and mortality. Although endovascular aortic repair (EVAR) offers encouraging results in elective setting, its role as first line strategy to treat rAAA is still debated. Our aim was to compare early and late outcomes in patients undergoing open surgical repair (OSR) compared with those submitted to vs EVAR for rAAAs. METHODS: A retrospective review of data extracted from medical records identified 105 consecutive patients with rAAA who were submitted to open or endovascular repairs from 2008 to 2016...
June 6, 2018: Annals of Vascular Surgery
Kelly N Sawyer, Michael Mooney, Gregory Norris, Thomas Devlin, Justin Lundbye, Pratik B Doshi, Jonathan Kyle Hewett, Alan T Kono, Jesse P Jorgensen, Brian J O'Neil
Targeted temperature management (TTM) is recommended postcardiac arrest. The cooling method with the highest safety and efficacy is unknown. The COOL-ARREST pilot trial aimed to evaluate the safety and efficacy of the most contemporary ZOLL Thermogard XP Intravascular Temperature Management (IVTM) system for providing mild TTM postcardiac arrest. This multicenter, prospective, single-arm, observational pilot trial enrolled patients at eight U.S. hospitals between July 28, 2014, and July 24, 2015. Adult (≥18 years old), out-of-hospital cardiac arrest subjects of presumed cardiac etiology who achieved return of spontaneous circulation (ROSC) were considered for inclusion...
June 8, 2018: Therapeutic Hypothermia and Temperature Management
Makoto Nagoshi, Swayta Reddy, Marisa Bell, Allan Cresencia, Rebecca Margolis, Randall Wetzel, Patrick Ross
INTRODUCTION: Propofol is an effective sedative for magnetic resonance imaging. Nevertheless, it may cause hemodynamic and respiratory complications in a dose dependent fashion. We investigated the role of low-dose dexmedetomidine (0.5 μg/kg) as an adjuvant to propofol sedation for children undergoing magnetic resonance imaging. We hypothesized that dexmedetomidine would decrease the propofol dose required, airway complications, and hemodynamic instability. METHODS: We performed a retrospective chart review of patients' age of 1 month to 20 years...
June 7, 2018: Paediatric Anaesthesia
Nakul Katyal, Christopher R Newey, Pravin George, Premkumar Nattanamai, Jonathan M Beary, Agnieszka Ardelt, Anantha Vellipuram
Somatosensory evoked potentials (SSEPs) are a sensitive, minimally invasive technique used to localize dysfunction of myelinated peripheral and central axons in the nervous system. The utility of SSEPs in acutely assessing central nervous system function in brainstem herniation in the neuroscience intensive care unit (NICU) has not been well established. We discuss a case of an 18-year-old, postpartum female who presented with intermittent headache, diplopia, nausea/vomiting and cachexia following delivery two months prior...
April 6, 2018: Curēus
Amadou Magagi, Harissou Adamou, Ibrahim Amadou Magagi, Maazou Halidou, Oumarou Habou, Hassane Moussa Diongolé, Maman Sani Rabiou, Mahaman Boukari Baoua
This study decribes the treatment of a 37-year old female patient, with a history of poorly treated arterial hypertension (AH), referred to surgical consultation with right lower back pain, vertigo, headache, sweating and palpitations. During hospitalization, blood pressure (BP) ranged between 130/80 mm Hg and 190/120 mm Hg. The remainder of the clinical examination was normal. Thoracoabdominal scanner showed adrenal mass measuring 55x45x65 mm compressing the inferior vena cava and the right renal vein. The assay of urinary vanilmandelic acid (VMA) was 11...
2018: Pan African Medical Journal
Payal K Gurnani, Allison Bohlmann, Robert J March
BACKGROUND: Venoarterial extracorporeal membrane oxygenation (VA-ECMO) has been used as a bridge to cardiac recovery in patients following a major cardiac event. There is a lack of literature surrounding prolonged use of eptifibatide and optimal dosing during ECMO. This case report describes our experience with extended durations and standard dosing of eptifibatide in the setting of ECMO. CASE: A 40-year-old male with a history of Marfan's syndrome, aortic root and ascending aortic aneurysm status post a modified Bentall with a St...
June 1, 2018: Perfusion
Michael J Ewing, John F Eidt
The incidence of acute kidney injury (AKI) attributed to iodinated contrast has been over-estimated and this has led clinicians to withhold potentially life-saving diagnostic and therapeutic interventions. There is mounting evidence that iodinated contrast plays only a minor role in the development of AKI in comparison with more significant risk factors such as pre-existing renal dysfunction, hemodynamic instability and exposure to nephrotoxic drugs. We will present data which challenge the dogma of avoiding iodinated contrast in patients with reduced renal function...
June 3, 2018: Nephrology, Dialysis, Transplantation
D Martin, H Teixeira Farinha, N Dattner, S Rotman, N Demartines, M O Sauvain
The current case report is about spontaneous non-traumatic rupture of a splenic artery aneurysm (SAA) in a 53-year-old woman with no particular medical history. An emergent laparotomy with splenectomy was required, unfortunately without success as the patient died. SAA is the most common visceral artery aneurysm. Most of SAA remain asymptomatic and are discovered incidentally on imaging. The overall risk of rupture increases with the size of SAA, especially when above 2 cm. Initial presentation of SAA has been associated with acute rupture and hemodynamic instability leading to substantial perioperative morbidity and mortality...
May 2018: European Review for Medical and Pharmacological Sciences
Constance Rickelmann, Diane J Knoblauch
Historically, patients supported on extra corporeal membrane oxygenation were thought to be too unstable to engage in early mobility but are at increased risk for deconditioning from prolonged immobilization due to the nature of illness, numerous cannulas, equipment, and hemodynamic and respiratory instability along with heavy sedation/analgesia or paralysis. This article will discuss the specific considerations that should be employed to keep the patient and the staff safe while providing mobility to patients on extra corporeal membrane oxygenation...
July 2018: Critical Care Nursing Quarterly
Daniel Hurtado-Sierra, Juan Calderón-Colmenero, Pedro Curi-Curi, Jorge Cervantes-Salazar, Juan Pablo Sandoval, José Antonio García-Montes, Antonio Benita-Bordes, Samuel Ramírez-Marroquin
Background: Delayed sternal closure (DSC) after cardiac surgery is a therapeutic option in the treatment of the severely impaired heart in pediatric cardiac surgery. Methods: A single-center retrospective review of all bypass surgeries performed over a 10-year period (2003-2012). Results: Of a total of 2325 patients registered in our database, the DSC group included 259 cases (11%), and the remaining 2066 cases (89%) constituted the control group (PSC)...
2018: BioMed Research International
Vaia D Raikou, Despina Kyriaki
Background: Intradialytic hypertension was associated with a high mortality risk. We examined the relationship between intradialytic hypertension and metabolic disorders in hemodialysis treatment patients. Methods: We studied 76 patients in online hemodiafiltration. Dialysis adequacy was defined by Kt / V for urea. Normalized protein catabolic rate (nPCR), as a marker of protein intake, was calculated. Sodium removal was determined as percent sodium removal. Metabolic acidosis was determined by serum bicarbonate less than 22 mmol/L...
2018: International Journal of Hypertension
Günes Dogan, Jasmin Hanke, Jakob Puntigam, Axel Haverich, Jan D Schmitto
PURPOSE: Giant-cell myocarditis represents a rare and often fatal autoimmune disorder. Despite extracorporeal life support being a valid treatment option, alternatives to control the underlying inflammatory response remain sparse. A new hemoadsorption device (CytoSorb) has recently been introduced to treat patients with an excessive inflammatory response. METHODS: A 57-year-old patient developed fulminant right heart failure, respiratory insufficiency, hemodynamic instability, and oliguric-anuric renal failure...
May 1, 2018: International Journal of Artificial Organs
M J Rodríguez-Castaño, B Iglesias, L Arruza
BACKGROUND: Complications of intravenous lipid administration are relatively uncommon. However, inadvertent rapid infusion of intravenous fat emulsion (IVFE) is an inherent risk when fats are infused separately from the dextrose-amino acid solution. CASE REPORT: Extremely preterm infant, born at 25 weeks and 6 days of gestational age weighing 920 g, who inadvertently received a massive overdose of IVFE due to a device failure. He developed lethargy, apnea, metabolic acidosis and hemodynamic instability requiring mechanical ventilation and inotropic support...
May 23, 2018: Journal of Neonatal-perinatal Medicine
Sara Moura-Ferreira, Ricardo Ladeiras-Lopes, Domingas MBala, Alberto Rodrigues, Pedro Braga, Vasco Gama
Percutaneous coronary intervention (PCI) has been increasingly performed in patients with severely depressed left ventricular function and complex coronary lesions, including multivessel disease. Mechanical ventricular assist devices play an increasingly important role in high-risk PCI. Impella CP® (Abiomed, Inc.) is a new percutaneous left ventricular assist device, designed for short-term circulatory support. It is a promising option for hemodynamic support in high-risk procedures and can potentially reduce PCI-related complications...
May 25, 2018: Portuguese Journal of Cardiology: An Official Journal of the Portuguese Society of Cardiology
Eham Arora, Saurabh Gandhi, Ajay Bhandarwar, Abdul Haque M Quraishi, Amol Wagh, Amarjeet Tandur, Dhansagar Wakle
BACKGROUND: Evisceration of umbilical hernias is an uncommon occurrence whereby the hernial contents break through the skin overlying the sac and skin. Irrespective of cause, sudden evisceration of an umbilical hernia is associated with deterioration and a poor outcome. CASE REPORTS: Our first case was a 42-year-old woman who presented with sudden outpouring of fluid from the umbilicus with omental evisceration. Further evaluation revealed hepatic decompensation caused by hepatitis C infection belonging to Child-Turcotte-Pugh class C...
May 21, 2018: Journal of Emergency Medicine
Shu-Ju Lu, Shiao-Pei Wang
Acute respiratory distress syndrome (ARDS) is a life-threatening disease, as acute inflammation in the lungs typically leads to hypoxia and symptoms of dyspnea. The treatment modalities of ARDS include mechanical ventilation, corticosteroid, extracorporeal membranous oxygenation, inhaled nitrogen oxide, and the prone position. Among these, the prone position is supported by evidence showing significantly reduced mortality in patients that adopt this modality. Lying in the prone position reduces atelectatic lung volumes by recruitment of dependent parts and facilitates normal regulation of alveolar ventilation, giving better-matched ventilation perfusion and, thus, improved oxygenation...
June 2018: Hu Li za Zhi the Journal of Nursing
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