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https://www.readbyqxmd.com/read/28938387/critical-sized-bone-defects-sequence-and-planning
#1
Paul Toogood, Theodore Miclau
Bone defects associated with open fractures require a careful approach and planning. At initial presentation, an emergent irrigation and debridement is required. Immediate definitive fixation is frequently safe, with the exception of those injuries that normally require staged management or very severe type IIIB and IIIC injuries. Traumatic wounds that can be approximated primarily should be closed at the time of initial presentation. Wounds that cannot be closed should have a negative pressure wound therapy dressing applied...
October 2017: Journal of Orthopaedic Trauma
https://www.readbyqxmd.com/read/28938306/different-clinical-course-and-complications-in-interagency-registry-for-mechanically-assisted-circulatory-support-1-patients-managed-with-or-without-extracorporeal-membrane-oxygenation
#2
Jason J Han, Jennifer Chung, Carol W Chen, Ann C Gaffey, Alex Sotolongo, Christyna Justice, Alyse E Ameer, J Eduardo Rame, Christian Bermudez, Michael A Acker, Pavan Atluri
Extracorporeal membrane oxygenation (ECMO) as a bridge to left ventricular assist device (LVAD) implantation has shown promise in improving end-organ function and optimizing outcomes in some critically ill patients, but the practice remains controversial. Retrospective review of patients who received LVADs from May 2008 to September 2016 at a high-volume, tertiary care cardiovascular center was performed. Subjects were Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) class 1 patients divided into ECMO bridge and non-ECMO bridge cohorts...
September 21, 2017: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
https://www.readbyqxmd.com/read/28938302/anesthesia-information-management-clinical-decision-support
#3
Robert E Freundlich, Jesse M Ehrenfeld
PURPOSE OF REVIEW: Perioperative informatics tools continue to be developed at a rapid pace and offer clinicians the potential to greatly enhance clinical decision making. The goal of this review is to bring the reader updates on perioperative information management and discuss future research directions in the field. RECENT FINDINGS: Clinical decision support tools become more timely, accurate, and, in some instances, have been shown to improve patient outcomes...
September 21, 2017: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/28938253/guidelines-for-the-diagnosis-and-management-of-critical-illness-related-corticosteroid-insufficiency-circi-in-critically-ill-patients-part-i-society-of-critical-care-medicine-sccm-and-european-society-of-intensive-care-medicine-esicm-2017
#4
Djillali Annane, Stephen M Pastores, Bram Rochwerg, Wiebke Arlt, Robert A Balk, Albertus Beishuizen, Josef Briegel, Joseph Carcillo, Mirjam Christ-Crain, Mark S Cooper, Paul E Marik, Gianfranco Umberto Meduri, Keith M Olsen, Sophia C Rodgers, James A Russell, Greet Van den Berghe
OBJECTIVE: To update the 2008 consensus statements for the diagnosis and management of critical illness-related corticosteroid insufficiency (CIRCI) in adult and pediatric patients. PARTICIPANTS: A multispecialty task force of 16 international experts in critical care medicine, endocrinology, and guideline methods, all of them members of the Society of Critical Care Medicine and/or the European Society of Intensive Care Medicine. DESIGN/METHODS: The recommendations were based on the summarized evidence from the 2008 document in addition to more recent findings from an updated systematic review of relevant studies from 2008 to 2017 and were formulated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology...
September 21, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28938251/critical-illness-related-corticosteroid-insufficiency-circi-a-narrative-review-from-a-multispecialty-task-force-of-the-society-of-critical-care-medicine-sccm-and-the-european-society-of-intensive-care-medicine-esicm
#5
Djillali Annane, Stephen M Pastores, Wiebke Arlt, Robert A Balk, Albertus Beishuizen, Josef Briegel, Joseph Carcillo, Mirjam Christ-Crain, Mark S Cooper, Paul E Marik, Gianfranco Umberto Meduri, Keith M Olsen, Bram Rochwerg, Sophia C Rodgers, James A Russell, Greet Van den Berghe
OBJECTIVE: To provide a narrative review of the latest concepts and understanding of the pathophysiology of critical illness-related corticosteroid insufficiency (CIRCI). PARTICIPANTS: A multi-specialty task force of international experts in critical care medicine and endocrinology and members of the Society of Critical Care Medicine and the European Society of Intensive Care Medicine. DATA SOURCES: Medline, Database of Abstracts of Reviews of Effects (DARE), Cochrane Central Register of Controlled Trials (CENTRAL) and the Cochrane Database of Systematic Reviews...
September 21, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28938179/does-simulation-enhance-nurses-ability-to-assess-deteriorating-patients
#6
Maria Bliss, Leanne M Aitken
Recognising and responding to patient deterioration has been identified as a key skill in nursing care to ensure that care is escalated for prompt, efficient management of the potentially critically ill patient. Simulation is one teaching strategy that has been established in nurse education as a method for enhancing skills. The objective was to explore the experiences of registered nurses to ascertain whether they perceived that simulation enhanced their skills in recognising the deteriorating patient. An exploratory qualitative design was used...
September 12, 2017: Nurse Education in Practice
https://www.readbyqxmd.com/read/28937573/committee-opinion-no-721-smoking-cessation-during-pregnancy
#7
(no author information available yet)
Smoking is the one of the most important modifiable causes of poor pregnancy outcomes in the United States, and is associated with maternal, fetal, and infant morbidity and mortality. The physical and psychologic addiction to cigarettes is powerful; however, the compassionate intervention of the obstetrician-gynecologist can be the critical element in prenatal smoking cessation. An office-based protocol that systematically identifies pregnant women who smoke and offers treatment or referral has been proved to increase quit rates...
October 2017: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28937568/committee-opinion-no-721-summary-smoking-cessation-during-pregnancy
#8
(no author information available yet)
Smoking is the one of the most important modifiable causes of poor pregnancy outcomes in the United States, and is associated with maternal, fetal, and infant morbidity and mortality. The physical and psychologic addiction to cigarettes is powerful; however, the compassionate intervention of the obstetrician-gynecologist can be the critical element in prenatal smoking cessation. An office-based protocol that systematically identifies pregnant women who smoke and offers treatment or referral has been proved to increase quit rates...
October 2017: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28936996/caregiver-perceptions-on-intensive-care-a-qualitative-study-from-southern-india
#9
Shuba Kumar, Jony Christina, Anna Revathi Jagadish, John Victor Peter, Kurien Thomas, Thambu David Sudarsanam
BACKGROUND: Admission of a patient to an intensive care unit (ICU) can result in tremendous stress to family caregivers not only because of the need to provide physical and emotional support to the sick relative, but also due to the burden of decision-making on behalf of the critically ill person. We enquired about family caregivers' perspectives on intensive care, the challenges they faced with decision-making and their perceptions on the nature of their interactions with healthcare providers...
May 2017: National Medical Journal of India
https://www.readbyqxmd.com/read/28936968/-progress-of-pain-assessment-and-analgesia-strategy-for-mechanical-ventilation-patients
#10
Qingdong Li, Xianyao Wan
Standardized pain assessment is a precondition of appropriate analgesia for mechanical ventilation patients. However, routine pain assessment rates remain very low in intensive care unit (ICU). Behavioral pain scale (BPS) and critical-care pain observation tool (CPOT) can be used to assess pain in mechanical ventilation patients who are unable to report pain by themselves. No matter what strategy we taken, analgesia-first sedation should be used in priority. Meanwhile, patient-centered and goal-directed sedation strategy should be adopted based on the individual condition...
September 2017: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
https://www.readbyqxmd.com/read/28936967/-effect-of-sedation-on-respiratory-function-of-patients-undergoing-mechanical-ventilation
#11
Jie Yang, Yan Kang
Sedation and analgesia for ventilated patients is an important treatment in intensive care unit (ICU). Patients receiving mechanical ventilation therapy comfortably and safely can improve patient-ventilator synchrony, reduce ventilation-related lung injury (VILI), improve compliance, decrease oxygen consumption and stress, prevent accidents, and reduce the incidence of complications and mortality in critical patients. Although sedation may protect lung function, it also has a greater impact on respiratory function...
September 2017: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
https://www.readbyqxmd.com/read/28936963/-application-of-self-made-guidance-for-difficult-gastric-tube-placement-in-patients-with-artificial-airway
#12
Xiaojie Chen, Jinchao Zhang, Wenxiu Li, Yiqing Jiang, Lingzhi Lin
OBJECTIVE: To use evidence-based nursing on patients with artificial airway to the practice of stomach tube, and to evaluate the self made guidance for difficult gastric tube placement in patients with artificial airway. METHODS: Forty patients with artificial airway and were difficult to put the tube, and admitted to Department of Critical Care Medicine of Harrison International Peace Hospital Affiliated to Hebei Medical University from April to December in 2016 were enrolled as observation group...
September 2017: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
https://www.readbyqxmd.com/read/28936951/-preliminary-evaluation-of-sequential-therapy-by-high-flow-nasal-cannula-oxygen-therapy-following-endotracheal-tube-extubation-in-mechanically-ventilated-patients
#13
Zhengfang Zhu, Yuhao Liu, Qixing Wang, Sheng Wang
OBJECTIVE: To evaluate the feasibility and effect of sequential treatment by the heated humidified high flow nasal cannula oxygen therapy (HFNC) in mechanically ventilated patients following endotracheal tube extubation. METHODS: A prospective randomized controlled trial was conducted. Forty-nine patients with the sequential treatment after tracheal intubation extraction admitted to Department of Critical Care Medicine of Shanghai Tenth People's Hospital from January 1st to December 31st 2016 were enrolled...
September 2017: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
https://www.readbyqxmd.com/read/28936887/interpretation-of-correlations-in-clinical-research
#14
Man Hung, Jerry Bounsanga, Maren Wright Voss
BACKGROUND: Critically analyzing research is a key skill in evidence-based practice and requires knowledge of research methods, results interpretation, and applications, all of which rely on a foundation based in statistics. Evidence-based practice makes high demands on trained medical professionals to interpret an ever-expanding array of research evidence. OBJECTIVE: As clinical training emphasizes medical care rather than statistics, it is useful to review the basics of statistical methods and what they mean for interpreting clinical studies...
September 22, 2017: Postgraduate Medicine
https://www.readbyqxmd.com/read/28936698/recommendations-for-mechanical-ventilation-of-critically-ill-children-from-the-paediatric-mechanical-ventilation-consensus-conference-pemvecc
#15
Martin C J Kneyber, Daniele de Luca, Edoardo Calderini, Pierre-Henri Jarreau, Etienne Javouhey, Jesus Lopez-Herce, Jürg Hammer, Duncan Macrae, Dick G Markhorst, Alberto Medina, Marti Pons-Odena, Fabrizio Racca, Gerhard Wolf, Paolo Biban, Joe Brierley, Peter C Rimensberger
PURPOSE: Much of the common practice in paediatric mechanical ventilation is based on personal experiences and what paediatric critical care practitioners have adopted from adult and neonatal experience. This presents a barrier to planning and interpretation of clinical trials on the use of specific and targeted interventions. We aim to establish a European consensus guideline on mechanical ventilation of critically children. METHODS: The European Society for Paediatric and Neonatal Intensive Care initiated a consensus conference of international European experts in paediatric mechanical ventilation to provide recommendations using the Research and Development/University of California, Los Angeles, appropriateness method...
September 22, 2017: Intensive Care Medicine
https://www.readbyqxmd.com/read/28936695/early-application-of-airway-pressure-release-ventilation-may-reduce-the-duration-of-mechanical-ventilation-in-acute-respiratory-distress-syndrome
#16
Yongfang Zhou, Xiaodong Jin, Yinxia Lv, Peng Wang, Yunqing Yang, Guopeng Liang, Bo Wang, Yan Kang
PURPOSE: Experimental animal models of acute respiratory distress syndrome (ARDS) have shown that the updated airway pressure release ventilation (APRV) methodologies may significantly improve oxygenation, maximize lung recruitment, and attenuate lung injury, without circulatory depression. This led us to hypothesize that early application of APRV in patients with ARDS would allow pulmonary function to recover faster and would reduce the duration of mechanical ventilation as compared with low tidal volume lung protective ventilation (LTV)...
September 22, 2017: Intensive Care Medicine
https://www.readbyqxmd.com/read/28936678/biomarker-based-strategy-for-early-discontinuation-of-empirical-antifungal-treatment-in-critically-ill-patients-a-randomized-controlled-trial
#17
Anahita Rouzé, Séverine Loridant, Julien Poissy, Benoit Dervaux, Boualem Sendid, Marjorie Cornu, Saad Nseir
PURPOSE: The aim of this study was to determine the impact of a biomarker-based strategy on early discontinuation of empirical antifungal treatment. METHODS: Prospective randomized controlled single-center unblinded study, performed in a mixed ICU. A total of 110 patients were randomly assigned to a strategy in which empirical antifungal treatment duration was determined by (1,3)-β-D-glucan, mannan, and anti-mannan serum assays, performed on day 0 and day 4; or to a routine care strategy, based on international guidelines, which recommend 14 days of treatment...
September 22, 2017: Intensive Care Medicine
https://www.readbyqxmd.com/read/28936675/reconnection-to-mechanical-ventilation-for-1%C3%A2-h-after-a-successful-spontaneous-breathing-trial-reduces-reintubation-in-critically-ill-patients-a-multicenter-randomized-controlled-trial
#18
M Mar Fernandez, Alejandro González-Castro, Monica Magret, M Teresa Bouza, Marcos Ibañez, Carolina García, Begoña Balerdi, Arantxa Mas, Vanesa Arauzo, José M Añón, Francisco Ruiz, José Ferreres, Roser Tomás, Marta Alabert, Ana Isabel Tizón, Susana Altaba, Noemi Llamas, Rafael Fernandez
BACKGROUND: Spontaneous breathing trials (SBT) can be exhausting, but the preventive role of rest has never been studied. This study aimed to evaluate whether reconnection to mechanical ventilation (MV) for 1 h after the effort of a successful SBT could reduce the need for reintubation in critically ill patients. METHODS: Randomized multicenter trial conducted in 17 Spanish medical-surgical intensive care units (Oct 2013-Jan 2015). Patients under MV for longer than 12 h who fulfilled criteria for planned extubation were randomly allocated after a successful SBT to direct extubation (control group) or reconnection to the ventilator for a 1-h rest before extubation (rest group)...
September 22, 2017: Intensive Care Medicine
https://www.readbyqxmd.com/read/28936626/the-impact-of-frailty-on-icu-and-30-day-mortality-and-the-level-of-care-in-very-elderly-patients-%C3%A2-%C3%A2-80%C3%A2-years
#19
Hans Flaatten, Dylan W De Lange, Alessandro Morandi, Finn H Andersen, Antonio Artigas, Guido Bertolini, Ariane Boumendil, Maurizio Cecconi, Steffen Christensen, Loredana Faraldi, Jesper Fjølner, Christian Jung, Brian Marsh, Rui Moreno, Sandra Oeyen, Christina Agwald Öhman, Bernardo Bollen Pinto, Ivo W Soliman, Wojciech Szczeklik, Andreas Valentin, Ximena Watson, Tilemachos Zaferidis, Bertrand Guidet
PURPOSE: Very old critical ill patients are a rapid expanding group in the ICU. Indications for admission, triage criteria and level of care are frequently discussed for such patients. However, most relevant outcome studies in this group frequently find an increased mortality and a reduced quality of life in survivors. The main objective was to study the impact of frailty compared with other variables with regards to short-term outcome in the very old ICU population. METHODS: A transnational prospective cohort study from October 2016 to May 2017 with 30 days follow-up was set up by the European Society of Intensive Care Medicine...
September 21, 2017: Intensive Care Medicine
https://www.readbyqxmd.com/read/28936495/the-accuracy-of-nurses-predictions-for-clinical-outcomes-in-the-chronically-critically-ill
#20
Amy R Lipson, Sarah J Miano, Barbara J Daly, Sara L Douglas
BACKGROUND: Accurately predicting survivorship of patients in the intensive care unit is known to be difficult. Previous research has shown that nurses are more likely to recognize futile medical care than other disciplines. The purpose of this study was to describe the accuracy of nurse's predictions for survival of patients who are chronically critically ill (CCI). METHODS: Using a secondary data analysis from a longitudinal, descriptive study, we evaluated nurses' predictions for survival at admission and until ICU discharge or patient death...
September 2017: Research & Reviews: Journal of Nursing and Health Sciences
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