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Decompensated Shock

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https://www.readbyqxmd.com/read/28225875/decompensated-chagasic-heart-failure-versus-non-chagasic-heart-failure-at-a-tertiary-care-hospital-clinical-characteristics-and-outcomes
#1
Luiza Nauane Borges Azevedo Dos Santos, Mário de Seixas Rocha, Eloina Nunes de Oliveira, Carlos Antônio Gusmão de Moura, Ayslan Jorge Santos de Araujo, Ítalo Magalhães Gusmão, Gilson Soares Feitosa-Filho, Constança Margarida Sampaio Cruz
OBJECTIVE: To evaluate clinical and epidemiological characteristics and clinical outcomes in patients hospitalized with decompensated heart failure (DHF), with a comparison between Chagas and non-Chagas disease. METHOD: This is a retrospective cohort study involving 136 patients consecutively admitted with DHF between January 1 and December 31, 2011, with the following outcomes: acute renal failure, cardiogenic shock, rehospitalization, and hospital death. Individuals aged ≥ 18 years with DHF were included while those with more than 10% of missing data regarding outcomes were excluded...
January 1, 2017: Revista da Associação Médica Brasileira
https://www.readbyqxmd.com/read/28213377/interventional-treatment-of-pulmonary-embolism
#2
David M Dudzinski, Jay Giri, Kenneth Rosenfield
Pulmonary embolism (PE) is a serious and prevalent cause of vascular disease. Nevertheless, optimal treatment for many phenotypes of PE remains uncertain. Treating PE requires appropriate risk stratification as a first step. For the highest-risk PE, presenting as shock or arrest, emergent systemic thrombolysis or embolectomy is reasonable, while for low-risk PE, anticoagulation alone is often chosen. Normotensive patients with PE but with indicia of right heart dysfunction (by biomarkers or imaging) constitute an intermediate-risk group for whom there is controversy on therapeutic strategy...
February 2017: Circulation. Cardiovascular Interventions
https://www.readbyqxmd.com/read/28208199/systemic-thrombolytic-therapy-for-acute-pulmonary-embolism-who-is-a-candidate
#3
Stavros V Konstantinides, Stefano Barco
Pulmonary embolism (PE) is a major cause of both acute and long-term morbidity for a large number of patients worldwide, and massive PE is frequently fatal. Right ventricular (RV) dysfunction is a key determinant of prognosis in the acute phase of PE. Patients with clinically overt RV failure, that is, with cardiogenic shock or persistent hypotension at presentation (acute high-risk PE), are clearly in need of immediate reperfusion treatment with systemic thrombolysis or, alternatively, surgical or catheter-directed techniques...
February 2017: Seminars in Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/28192257/anti-thrombotic-and-pro-fibrinolytic-effects-of-levosimendan-in-human-endothelial-cells-in-vitro
#4
Konstantin A Krychtiuk, Christoph Kaun, Philipp J Hohensinner, Stefan Stojkovic, Jacqueline Seigner, Stefan P Kastl, Andreas Zuckermann, Wolfgang Eppel, Sabine Rauscher, Rainer de Martin, Gerald Maurer, Kurt Huber, Johann Wojta, Walter S Speidl
AIMS: Levosimendan is an inodilator for the treatment of acute decompensated heart failure (HF). Data from clinical studies suggest that levosimendan is particularly effective in HF due to myocardial infarction. After acute revascularization, no reflow-phenomenon is a common complication that may lead to pump failure and cardiogenic shock. Our aim was to examine whether levosimendan interferes with the pro-thrombotic phenotype of activated endothelial cells in vitro. METHODS: Human heart microvascular endothelial cells (HHMEC) and human umbilical vein endothelial cells (HUVEC) were treated with interleukin-1β (IL-1β) (200U/mL) or thrombin (5U/mL) and co-treated with or without levosimendan (0...
February 10, 2017: Vascular Pharmacology
https://www.readbyqxmd.com/read/28154601/cardiac-resynchronization-therapy-device-implantation-in-a-patient-with-cardiogenic-shock-under-percutaneous-mechanical-circulatory-support
#5
Kyunghee Lim, Jin-Oh Choi, Jeong Hoon Yang, Seung-Jung Park, Sun Hwa Kim, Jiseok Kang, Hyun Sung Joh, Sun Hye Shin
65-year-old woman was admitted to our hospital with acute decompensated heart failure with reduced left ventricular ejection fraction and severe mitral regurgitation. Electrocardiography revealed a typical left bundle branch block and atrial fibrillation. Her condition deteriorated despite administering high-doses of inotropes and vasopressors. Pending a decision to therapy, venoarterial extracorporeal membrane oxygenation (ECMO) was performed when the patient underwent a cardiogenic shock. Although the hemodynamic status stabilized with ECMO support, weaning the patient from ECMO was not possible...
January 2017: Korean Circulation Journal
https://www.readbyqxmd.com/read/28153551/current-and-future-percutaneous-strategies-for-the-treatment-of-acute-and-chronic-heart-failure
#6
Ignacio J Amat-Santos, Luis H Varela-Falcón, William T Abraham
The prevalence of heart failure (HF) has risen in parallel with improved survival in patients after a myocardial infarction and an aging population worldwide. In recent years, new percutaneous therapies have been developed to complement current established treatments for acute/decompensated and chronic HF and minimize risks. In acute presentations, the failure of medical treatment is no longer the end of the road in refractory circulatory shock; the use of mechanical circulatory support devices may be the next milestone in well-resourced health settings...
January 30, 2017: Revista Española de Cardiología
https://www.readbyqxmd.com/read/28132131/evaluation-of-a-novel-5-group-classification-system-of-sepsis-by-vasopressor-use-and-initial-serum-lactate-in-the-emergency-department
#7
Kai E Swenson, James D Dziura, Ani Aydin, Jesse Reynolds, Charles R Wira
Prognostication in sepsis is limited by disease heterogeneity, and measures to risk-stratify patients in the proximal phases of care lack simplicity and accuracy. Hyperlactatemia and vasopressor dependence are easily identifiable risk factors for poor outcomes. This study compares incidence and hospital outcomes in sepsis based on initial serum lactate level and vasopressor use in the emergency department (ED). In a retrospective analysis of a prospectively identified dual-center ED registry, patients with sepsis were categorized by ED vasopressor use and initial serum lactate level...
January 28, 2017: Internal and Emergency Medicine
https://www.readbyqxmd.com/read/28009388/acute-gastrointestinal-haemorrhage-on-board-a-cruise-ship-in-the-antarctic-peninsula
#8
Mathieu Carron, Peter Globokar, Bruno A Sicard
Antarctic tourism on board cruise ships has expanded since the 1990s, essentially in the Antarctic Peninsula. Due to remoteness, medical cases may evolve into life threatening conditions as emergency medical evacuations are challenging. We discuss the case of a young crew member who suddenly fainted with an epigastric pain and abundant rectal bleeding while on board a cruise ship heading to the Deception Island (62°57.6 South, 60°29.5 West), 44 h away from Ushuaia by sea. A medical evacuation was necessary to save the patient whose haemoglobin level rapidly decreased from 11 g/dL to 8...
2016: International Maritime Health
https://www.readbyqxmd.com/read/27974893/recoverable-record-high-lactic-acidosis-in-a-patient-with-glycogen-storage-disease-type-1-a-mixed-type-a-and-type-b-lactate-disorder
#9
Yonatan Oster, Isaiah D Wexler, Samuel N Heyman, Elchanan Fried
A 17-year-old patient with GSD type 1a (von Gierke disease) was hospitalized with an extremely elevated serum lactate following an intercurrent infection and interruption of his frequent intake of carbohydrates. The patient developed shock, oliguric renal failure, and cardiorespiratory failure requiring mechanical ventilation and inotropes. At the peak of metabolic decompensation and clinical instability, serum lactate reached a level of 47.6 mmol/L which was accompanied by a severe anion gap metabolic acidosis with a pH of 6...
2016: Case Reports in Medicine
https://www.readbyqxmd.com/read/27932426/extracorporeal-membrane-oxygenation-for-hemodynamic-support-of-ventricular-tachycardia-ablation
#10
Francesca Baratto, Federico Pappalardo, Teresa Oloriz, Caterina Bisceglia, Pasquale Vergara, John Silberbauer, Nicolò Albanese, Manuela Cireddu, Giuseppe D'Angelo, Ambra Licia Di Prima, Fabrizio Monaco, Gabriele Paglino, Andrea Radinovic, Damiano Regazzoli, Simona Silvetti, Nicola Trevisi, Alberto Zangrillo, Paolo Della Bella
BACKGROUND: We report the experience in a cohort of consecutive patients receiving extracorporeal membrane oxygenation during catheter ablation of unstable ventricular tachycardia (VT) at our center. METHODS AND RESULTS: From 2010 to 2015, extracorporeal membrane oxygenation was initiated in 64 patients (average age: 63±15 years; left ventricular ejection fraction in 27±9%; cardiogenic shock in 23%, and electrical storm in 62% of patients) undergoing 74 unstable VT catheter ablation procedures...
December 2016: Circulation. Arrhythmia and Electrophysiology
https://www.readbyqxmd.com/read/27931654/the-response-of-the-microcirculation-to-mechanical-support-of-the-heart-in-critical-illness
#11
REVIEW
Sakir Akin, Atila Kara, Corstiaan A den Uil, Can Ince
Critical illness associated with cardiac pump failure results in reduced tissue perfusion in all organs and occurs in various conditions such as sepsis, cardiogenic shock, and heart failure. Mechanical circulatory support (MCS) devices can be used to maintain organ perfusion in patients with cardiogenic shock and decompensated chronic heart failure. However, correction of global hemodynamic parameters by MCS does not always cause a parallel improvement in microcirculatory perfusion and oxygenation of the organ systems, a condition referred to as a loss of hemodynamic coherence between macro- and microcirculation (MC)...
December 2016: Best Practice & Research. Clinical Anaesthesiology
https://www.readbyqxmd.com/read/27818380/novel-minimally-invasive-surgical-approach-using-an-external-ventricular-assist-device-and-extracorporeal-membrane-oxygenation-in-refractory-cardiogenic-shock
#12
Koji Takeda, Arthur R Garan, Veli K Topkara, Ajay J Kirtane, Dimitri Karmpaliotis, Paul Kurlansky, Melana Yuzefpolskaya, Paolo C Colombo, Yoshifumi Naka, Hiroo Takayama
OBJECTIVES: The use of short-term mechanical circulatory support (MCS) has increased in the treatment of refractory cardiogenic shock (RCS). Percutaneous short-term MCS technology has emerged rapidly; however, limitations in flow and durability remain. We therefore investigated a minimally invasive surgical approach using an external ventricular assist device (VAD) and extracorporeal membrane oxygenation (ECMO) in patients with RCS. METHODS: Twenty-five patients underwent minimally invasive external VAD insertion with a magnetically levitated centrifugal pump for various causes of cardiogenic shock between April 2010 and May 2016...
November 6, 2016: European Journal of Cardio-thoracic Surgery
https://www.readbyqxmd.com/read/27760561/acute-transfusion-related-abdominal-injury-in-trauma-patients-a-case-report
#13
P Michel, D Wähnert, M Freistühler, M G Laukoetter, S Rehberg, M J Raschke, P Garcia
BACKGROUND: Secondary abdominal compartment syndrome is well known as a life-threatening complication in critically ill patients in an intensive care unit. Massive crystalloid fluid resuscitation has been identified as the most important risk factor. The time interval from hospital admittance to the development of manifest abdominal compartment syndrome is usually greater than 24 hours. In the absence of any direct abdominal trauma, we observed a rapidly evolving secondary abdominal compartment syndrome shortly after hospital admittance associated with massive transfusion of blood products and only moderate crystalloid resuscitation...
October 19, 2016: Journal of Medical Case Reports
https://www.readbyqxmd.com/read/27751222/-changes-in-serum-cortisol-and-adrenocorticotropic-hormone-in-children-with-sepsis-shock-and-their-clinical-significance
#14
Hai Lin, Zi-Jing Wang, Shi-Biao Wang, Yu-Lan Kang
OBJECTIVE: To study the changes in serum levels of cortisol and adrenocorticotropic hormone (ACTH) in children with septic shock (SS) and to explore their relationship with the disease severity and prognosis. METHODS: Twenty-five children with decompensated SS and 24 children with early SS were enrolled. Serum cortisol and ACTH levels were determined on admission and days 3 and 8 after admission. Twenty-five healthy children were used as the control group. The children with decompensated SS were further divided into death group (n=5) and survival group (n=20) based on their clinical outcome...
October 2016: Zhongguo Dang Dai Er Ke za Zhi, Chinese Journal of Contemporary Pediatrics
https://www.readbyqxmd.com/read/27709722/cardiogenic-shock-in-intensive-care-units-evolution-of-prevalence-patient-profile-management-and-outcomes-1997-2012
#15
Etienne Puymirat, Jean Yves Fagon, Philippe Aegerter, Jean Luc Diehl, Alexandra Monnier, Caroline Hauw-Berlemont, Florence Boissier, Gilles Chatellier, Bertrand Guidet, Nicolas Danchin, Nadia Aissaoui
AIM: To address the paucity of data on the characteristics, outcome and temporal trends in mortality of cardiogenic shock (CS) patients admitted to intensive care units (ICUs) we examined key features, variations in mortality from CS, and predictors of death in ICU patients over the past 15 years. METHODS AND RESULTS: From the 1997-2012 database of the Collège des Utilisateurs de Bases de données en Réanimation (CUB-Réa) that prospectively collects data from ICUs in the greater Paris area, we determined temporal trends in the incidence of CS, patient outcomes [Crude and Simplified Acute Physiology Score (SAPS)-II Standardized Mortality] and predictors of in-ICU mortality...
October 6, 2016: European Journal of Heart Failure
https://www.readbyqxmd.com/read/27662216/acute-appendiceal-abscess-and-atraumatic-splenic-rupture-a-case-of-dual-pathology
#16
Piriyankan Ananthavarathan, Kamlesh Patel, Catherine Doran, Nigel Suggett
INTRODUCTION: Atraumatic splenic rupture is a rare surgical emergency that is often attributed to neoplastic or infectious causes. Rarely, it has been identified to also occur in the setting of an acute severe sepsis and in cases of pelvic or splenic abscess formation post-appendicectomy. However, to our knowledge, the co-presentation of acute appendiceal abscess and splenic rupture has not been previously described. PRESENTATION OF CASE: We present the case of a 67-year old male with decompensating haemorrhagic shock secondary to atraumatic splenic rupture on a background of an inadequately treated complicated appendicitis originally managed as diverticulitis with antibiotics in the community...
April 13, 2016: International Journal of Surgery Case Reports
https://www.readbyqxmd.com/read/27660567/using-the-minimally-invasive-impella-5-0-via-the-right-subclavian-artery-cutdown-for-acute-on-chronic-decompensated-heart-failure-as-a-bridge-to-decision
#17
Aditya Bansal, Jay K Bhama, Rajan Patel, Sapna Desai, Stacy A Mandras, Hamang Patel, Tyrone Collins, John P Reilly, Hector O Ventura, P Eugene Parrino
BACKGROUND: Outcomes of traditional mechanical support paradigms (extracorporeal membrane oxygenation, intraaortic balloon pump [IABP], and permanent left ventricular assist device [LVAD]) in acute decompensated heart failure have generally been suboptimal. Novel approaches, such as minimally invasive LVAD therapy (Impella 5.0 device), promise less invasive but equivalent hemodynamic support. However, it is yet unknown whether the outcomes with such devices support widespread acceptance of this new technology...
2016: Ochsner Journal
https://www.readbyqxmd.com/read/27614719/-facial-trauma-and-injury-in-children
#18
M-P Vazquez, N Kadlub, V Soupre, E Galliani, C Neiva-Vaz, I Pavlov, A Picard
Facial traumas are common in children but often unconsidered. Facial injury is responsible of impressive bleeding because of the rich vascularization of the face; this bleeding is often underestimated because of the immediate arterial vasoconstriction that is very strong for children. The blood volume is 80ml/kg for a newborn, with a total of 250ml, reaching 70ml/kg at one year of age. The evaluation must be rigorously performed due to the risk of a sudden decompensation. Regarding the wounds, the primary repair must be performed directly neat or optimal in case of damaged tissues...
October 2016: Annales de Chirurgie Plastique et Esthétique
https://www.readbyqxmd.com/read/27553703/state-of-the-art-monitoring-in-treatment-of-dengue-shock-syndrome-a-case-series
#19
Steven L Moulton, Jane Mulligan, Anon Srikiatkhachorn, Siripen Kalayanarooj, Greg Z Grudic, Sharone Green, Robert V Gibbons, Gary W Muniz, Carmen Hinojosa-Laborde, Alan L Rothman, Stephen J Thomas, Victor A Convertino
BACKGROUND: Early recognition and treatment of circulatory volume loss is essential in the clinical management of dengue viral infection. We hypothesized that a novel computational algorithm, originally developed for noninvasive monitoring of blood loss in combat casualties, could: (1) indicate the central volume status of children with dengue during the early stages of "shock"; and (2) track fluid resuscitation status. METHODS: Continuous noninvasive photoplethysmographic waveforms were collected over a 5-month period from three children of Thai ethnicity with clinical suspicion of dengue...
August 24, 2016: Journal of Medical Case Reports
https://www.readbyqxmd.com/read/27538311/-cardiorenal-syndromes-definition-and-classification
#20
Bruno Moulin
Cardiorenal syndromes refer to clinical and metabolic consequences of acute and chronic heart failure or kidney disease on other organ. Recent studies have further clarified the pathophysiological mechanisms behind the different types of cardiorenal syndromes and propose a new classification. The cardiorenal syndrome type 1 corresponds to an acute heart failure (cardiogenic shock, acute decompensated congestive heart failure) which induces acute renal dysfunction. In the cardiorenal syndrome type 2 heart failure is chronic (congestive heart failure) and induces chronic kidney damages in the long-term...
June 2016: La Revue du Praticien
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