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https://www.readbyqxmd.com/read/30317782/-advances-in-the-application-of-regional-citrate-anticoagulation-for-continuous-renal-replacement-therapy-in-patients-with-liver-failure
#1
Q Q Ning, Q H Meng, Y K Zhu
Currently, continuous renal replacement therapy (CRRT) is one of the most important means of organ support methods in critical care medicine. Anticoagulation is an essential part of the treatment process due to its prolonged duration. Patients with liver failure often have coagulation dysfunction and heparin anticoagulant can increase the risk of bleeding, but without heparin anticoagulant, coagulation can easily occur. In addition, an increased volumetric load, hemodynamic instability, nursing workload and other problems are major issues...
July 20, 2018: Zhonghua Gan Zang Bing za Zhi, Zhonghua Ganzangbing Zazhi, Chinese Journal of Hepatology
https://www.readbyqxmd.com/read/30317708/-minimally-invasive-approach-vs-full-sternotomy-for-aortic-valve-and-ascending-aorta-replacement-results-from-our-center
#2
Tiago R Velho, Hugo Duarte Ferreira, Catarina Carvalheiro, André Sena, Nádia Juqueira, Nuno Guerra, Javier Gallego, Ângelo Nobre
BACKGROUND: Aortic valve disease is the most common valvular heart disease. Surgical aortic valve replacement remains the gold-standard of treatment. Recently, minimally invasive approaches have been developed to reduce surgical trauma and to compete with percutaneous treatment of valvular heart disease. Minimally invasive approaches are associated with reduced perioperative morbidity and mortality. METHODS: Single-center retrospective study comparing clinical data of patients submitted to surgical treatment of aortic stenosis by limited sternotomy versus conventional sternotomy between January 2014 and August 2016...
January 2018: Revista Portuguesa de Cirurgia Cardio-torácica e Vascular
https://www.readbyqxmd.com/read/30317536/use-of-noninvasive-mechanical-ventilation-with-pressure-support-guaranteed-with-average-volume-in-de-novo-hypoxaemic-respiratory-failure-a-pilot-study
#3
Killen Harold Briones-Claudett, Antonio Esquinas Rodriguez, Mónica H Briones-Claudett, Miguel Puga-Tejada, Mariuxi Del Pilar Cabrera Baños, Christian Roberto Pazmiño Dueñas, Carlos Israel Torres Herrera, Michelle Grunauer
BACKGROUND: This study was designed to determine the results associated with the use of noninvasive mechanical ventilation (NIV) using the BiPAP S/T-AVAPS ventilation strategy in subjects with mild to moderate de novohypoxaemicrespiratory failure. METHODS: This is a prospective study that includes subjects with de novohypoxaemic respiratory failure (not produced by acute exacerbations of COPD, chronic lung disease, or congestive heart failure) with mild to moderate PaO₂/FiO₂, who were admitted to the Intensive Care Unit (ICU) of Santa Maria Clinic in Guayaquil, Ecuador...
October 14, 2018: Anaesthesiology Intensive Therapy
https://www.readbyqxmd.com/read/30317258/the-predictive-value-of-the-inflammatory-markers-p-selectin-and-mcp1-in-determining-the-length-of-stay-and-30-day-survival-in-the-differentiation-of-sepsis-patients
#4
Ali Duman, Kenan Ahmet Turkdogan, Mucahit Avcil, Cigdem Yenisey, Mevlut Ture, Ayhan Akoz, Bekir Dagli, Mucahit Kapci, Serhat Orun
OBJECTIVE: Sepsis is the leading disease that is diagnosed late and still has a mortal course in emergency departments. The primary factors that will reduce both morbidity and mortality are early diagnosis and an early treatment approach. Therefore, in this study, P-selectin and MCP1 levels, which are known to be markers of inflammation, were examined in patients being followed up in intensive care. METHODS: Patients evaluated with a preliminary diagnosis of sepsis in the emergency intensive care unit between September 2015 and August 2016 were classified as having sepsis or infection according to the Q- SOFA criteria, and the P- selectin values were compared...
September 2018: JPMA. the Journal of the Pakistan Medical Association
https://www.readbyqxmd.com/read/30317205/early-initiation-of-venovenous-extracorporeal-membrane-oxygenation-in-a-mechanically-ventilated-patient-with-severe-acute-respiratory-distress-syndrome
#5
Nisha Krishnakant Raiker, Hector Cajigas
A 49-year-old man presented to the emergency department with acute-onset dyspnoea and hypoxaemia 1 day following nasal surgery for obstructive sleep apnoea. A chest X-ray showed diffuse bilateral pulmonary infiltrates. Supplemental 100% fractional inspired oxygen (FiO2 ) via non-rebreather mask was delivered with resulting arterial oxygen tension:FiO2 ratio of 67. Transthoracic echocardiogram demonstrated normal heart function. A clinical diagnosis of severe acute respiratory distress syndrome (ARDS) was promptly made...
October 12, 2018: BMJ Case Reports
https://www.readbyqxmd.com/read/30317050/the-impact-of-non-blinding-in-critical-care-medicine-trials
#6
M Baiardo Redaelli, A Belletti, G Monti, R Lembo, A Ortalda, G Landoni, R Bellomo
PURPOSE: It is uncertain whether, in critical care medicine, non-blinded trials are associated with a bias toward a different effect size. The aim of our study was to assess if conducting non-blinded/open label studies leads to greater effect size than blinded studies, and to provide an estimate of the weight of this difference. MATERIALS AND METHODS: We systematically searched all papers published in peer-reviewed journals between January 2000 and December 2015, dealing with non surgical interventions in critically ill adults and reporting a statistically significant difference in mortality...
September 29, 2018: Journal of Critical Care
https://www.readbyqxmd.com/read/30317049/an-open-loop-physiological-model-based-decision-support-system-can-reduce-pressure-support-while-acting-to-preserve-respiratory-muscle-function
#7
Savino Spadaro, Dan Stieper Karbing, Francesca Dalla Corte, Tommaso Mauri, Federico Moro, Antonio Gioia, Carlo Alberto Volta, Stephen Edward Rees
PURPOSE: To assess whether a clinical decision support system (CDSS) suggests PS and FIO2 maintaining appropriate breathing effort, and minimizing FIO2 . MATERIALS: Prospective, cross-over study in PS ventilated ICU patients. Over support (150% baseline) and under support (50% baseline) were applied by changing PS (15 patients) or PEEP (8 patients). CDSS advice was followed. Tension time index of inspiratory muscles (TTies), respiratory and metabolic variables were measured...
October 5, 2018: Journal of Critical Care
https://www.readbyqxmd.com/read/30316952/laboratory-alerts-to-guide-early-intensive-care-team-review-in-surgical-patients-a-feasibility-safety-and-efficacy-pilot-randomized-controlled-trial
#8
Rinaldo Bellomo, Matthew Chan, Christopher Guy, Helena Proimos, Federica Franceschi, Marco Crisman, Aniket Nadkarni, Paolo Ancona, Kevin Pan, Francesca Di Muzio, Barbara Presello, James Bailey, Marcus Young, Graeme K Hart
AIM: Common blood tests can help identify patients at risk of death, unplanned intensive care unit (ICU) admission, or rapid response team (RRT) call. We aimed to test whether early ICU-team review triggered by such laboratory tests (lab alert) is feasible, safe, and can alter physiological variables, clinical management, and clinical outcomes. METHODS: In prospective pilot randomized controlled trial in surgical wards of a tertiary hospital, we studied patients admitted for > 24 hours...
October 11, 2018: Resuscitation
https://www.readbyqxmd.com/read/30316913/too-many-patients%C3%A2-a-framework-to-guide-statewide-allocation-of-scarce-mechanical-ventilation-during-disasters
#9
REVIEW
Elizabeth Lee Daugherty Biddison, Ruth Faden, Howard S Gwon, Darren P Mareiniss, Alan C Regenberg, Monica Schoch-Spana, Jack Schwartz, Eric S Toner
The threat of a catastrophic public health emergency causing life threatening illness or injury on a massive scale has prompted extensive federal, state, and local preparedness efforts. Modeling studies suggest that an influenza pandemic similar to that of 1918 would require ICU and mechanical ventilation capacity that is significantly greater than what is available. Several groups have published recommendations for allocating life-support measures during a public health emergency. Because there are multiple ethically permissible approaches to allocating scarce life-sustaining resources and because the public will bear the consequences of these decisions, knowledge of public perspectives and moral points of reference on these issues is critical...
October 11, 2018: Chest
https://www.readbyqxmd.com/read/30316906/evaluation-of-three-step-procedure-shehata-s-technique-as-a-conservative-management-for-placenta-accreta-at-a-tertiary-care-hospital-in-egypt
#10
Ayman Shehata Dawood, Adel Elshahat Elgergawy, Ahmed Elsayed Elhalwagy
OBJECTIVE: To evaluate the benefits and risks of three-step technique as a conservative treatment for women with placenta accreta and desiring future fertility. STUDY DESIGN: This study is a retrospective study where the files of 91 cases of placenta accreta managed by three-step technique were reviewed. This study was conducted at Tanta University Hospitals in the period from June 1, 2015 to May 31, 2017. All demographic and operative data were extracted and recorded...
October 11, 2018: Journal of Gynecology Obstetrics and Human Reproduction
https://www.readbyqxmd.com/read/30316713/prediction-of-sga-at-birth-by-using-the-right-portal-vein-diameter-measurement-at-the-30-35-week-scan
#11
Iglika Ivancheva Simeonova-Brachot
OBJECTIVE: This study sought to test the hypothesis that the measurement of the right portal vein (RPV) diameter on the transverse abdominal view at the 32-week ultrasound scan is small in fetuses with growth retardation and to validate the use of this measurement as a tool for detecting SGA at birth. METHODS: This was a retrospective cohort study at a single centre. The study population comprised 326 consecutive pregnancies, including 29 SGA at delivery and 297 unaffected cases...
October 10, 2018: Journal of Obstetrics and Gynaecology Canada: JOGC, Journal D'obstétrique et Gynécologie du Canada: JOGC
https://www.readbyqxmd.com/read/30316640/right-ventricular-systolic-performance-determined-by-2d-speckle-tracking-echocardiography-and-acute-kidney-injury-after-cardiac-surgery
#12
Shaun R Yockelson, Stephen B Heitner, Sarah Click, Gemechu Geleto, Miriam M Treggiari, Michael P Hutchens
OBJECTIVE: An association between central venous pressure and acute kidney injury (AKI) has been observed following cardiac surgery, but it is unknown whether this reflects intravascular volume status or impaired right ventricular (RV) myocardial performance. This study was performed to test the hypothesis that decreased RV peak longitudinal strain (PLSS), as measured by 2-dimensional speckle-tracking echocardiography, is associated with AKI following cardiac surgery. DESIGN: Retrospective observational cohort study...
September 12, 2018: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/30316638/csf-neopterin-a-useful-biomarker-in-children-presenting-with-influenza-associated-encephalopathy
#13
Emma Macdonald-Laurs, Archana Koirala, Philip N Britton, William Rawlinson, Chee Chung Hiew, Jocelynne Mcrae, Russell C Dale, Cheryl Jones, Kristine Macartney, Brendan McMullan, Sekhar Pillai
PURPOSE: Neurological complications of influenza cause significant disease in children. Central nervous system inflammation, the presumed mechanism of influenza-associated encephalopathy, is difficult to detect. Characteristics of children presenting with severe neurological complications of influenza, and potential biomarkers of influenza-associated encephalopathy are described. METHODS: A multi-center, retrospective case-series of children with influenza and neurological complications during 2017 was performed...
September 28, 2018: European Journal of Paediatric Neurology: EJPN
https://www.readbyqxmd.com/read/30316537/transthyretin-for-the-routine-assessment-of-malnutrition-a-clinical-dilemma-highlighted-by-an-international-survey-of-experts-in-the-field
#14
Sarah Dellière, Nathalie Neveux, Jean-Pascal De Bandt, Luc Cynober
The value of transthyretin (TTR) measurement for assessing malnutrition is under debate due to its sensitivity to inflammation and frequent confusion over its meaning (i.e. as a marker of diagnosis, prognosis, or efficacy of refeeding). Moreover, there is still no ESPEN/ASPEN guideline on its use and cut-off values. Here the aim was to evaluate the overall perception of the value of this parameter and its utilization worldwide. A panel of international experts in the field were surveyed on the use of TTR in clinical practice in their country, on the guidelines issued by their national health authorities, and on the cut-off values used to diagnose malnutrition...
September 25, 2018: Clinical Nutrition: Official Journal of the European Society of Parenteral and Enteral Nutrition
https://www.readbyqxmd.com/read/30316199/information-or-education-interventions-for-adult-intensive-care-unit-icu-patients-and-their-carers
#15
REVIEW
Sharon R Lewis, Michael W Pritchard, Oliver J Schofield-Robinson, David Jw Evans, Phil Alderson, Andrew F Smith
BACKGROUND: During intensive care unit (ICU) admission, patients and their carers experience physical and psychological stressors that may result in psychological conditions including anxiety, depression, and post-traumatic stress disorder (PTSD). Improving communication between healthcare professionals, patients, and their carers may alleviate these disorders. Communication may include information or educational interventions, in different formats, aiming to improve knowledge of the prognosis, treatment, or anticipated challenges after ICU discharge...
October 13, 2018: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/30316038/physiotherapy-in-the-neurotrauma-intensive-care-unit-a-scoping-review
#16
Anastasia N L Newman, Janelle Gravesande, Stephanie Rotella, Stephen S Wu, Nam Topp-Nguyen, Michelle E Kho, Jocelyn E Harris, Alison Fox-Robichaud, Patricia Solomon
PURPOSE: This scoping review summarizes the literature on the safety and effectiveness of physiotherapy interventions in patients with neurological and/or traumatic injuries in the intensive care unit (ICU), identifies literature gaps and provides recommendations for future research. MATERIALS AND METHODS: We searched five databases from inception to June 2, 2018. We included published retrospective studies, case studies, observation and randomized controlled trials describing physiotherapy interventions in ICU patients with neurotrauma injuries...
October 3, 2018: Journal of Critical Care
https://www.readbyqxmd.com/read/30315921/quantifying-the-importance-of-active-antimicrobial-therapy-among-patients-with-gram-negative-bloodstream-infections-cefepime-as-a-representative-agent
#17
C Miglis, N J Rhodes, J Liu, J Gener, E Hang, M Scheetz
The quantitative importance of active antibiotic treatment relative to other modifiable and non-modifiable risk factors for mortality has not been well defined in the literature. Here we quantify the impact of active antibiotic treatment on mortality relative to other disease modifiers in patients with Gram-negative bacteremia. Patients with at least one positive blood culture who were treated with ≥24 hours of cefepime for GNBSI were included for study. To examine in-hospital survival, a full primary model and a base model with the least significant covariate from the primary model were established...
October 10, 2018: International Journal of Antimicrobial Agents
https://www.readbyqxmd.com/read/30315917/pre-ventricular-assist-device-palliative-care-consultation-a-qualitative-analysis
#18
Sarah Chuzi, Sarah Hale, Jason Arnold, Amy Zhou, Rebecca Harap, Kathleen L Grady, Jonathan D Rich, Clyde W Yancy, Adeboye Ogunseitan, Eytan Szmuilowicz, Jane E Wilcox
INTRODUCTION: In 2013 the Centers for Medicare and Medicaid Services (CMS) issued a mandate requiring that all patients undergoing destination therapy ventricular assist device (DT VAD) implantation have access to a palliative care team prior to surgery. Subsequently, many VAD programs implemented a mandatory pre-implantation palliative care consultation for patients considering DT VAD. However, little is known about the quality of these consults. METHODS: All patients undergoing DT VAD at Northwestern Memorial Hospital from October 30, 2013 (the CMS decision date) through March 1, 2018 were included...
October 10, 2018: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/30315915/changes-in-the-care-setting-of-first-consults-to-palliative-and-supportive-care-over-a-7-year-period
#19
Bernard Prado, Ali Haider, Syed Naqvi, Roberto C Pestana, Janet L Williams, Seyedeh Dibaj, Diane Liu, Julio Allo, Vera De La Cruz, Eduardo Bruera
CONTEXT: Optimal benefits from Palliative Cancer Care (PC) are achieved when first consults (PC1) occur early, in the outpatient setting. Late PC1, like those in the intensive care unit (ICU), limit these benefits. OBJECTIVES: To determine the proportion of PC1 over time in the outpatient, ICU, and inpatient non-ICU settings. We also examined patients' baseline characteristics and the timing of PC access (from PC1 to death) by the setting of PC1. METHODS: We retrospectively evaluated consecutive cancer patients' records at our cancer center to ascertain the annual number of PC1 and its distribution across settings (2011 to 2017)...
October 10, 2018: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/30315914/latent-class-analysis-of-specialized-palliative-care-needs-in-adult-intensive-care-units-from-a-single-academic-medical-center
#20
David Wang, Caleb Ing, Craig Blinderman, May Hua
CONTEXT: In the intensive care unit (ICU), 14% of patients meet criteria for specialized palliative care, but whether subgroups of patients differ in their palliative care needs is unknown. OBJECTIVES: To use latent class analysis (LCA) to separate ICU patients into different classes of palliative care needs, and determine if such classes differ in their palliative care resource requirements. METHODS: Retrospective cohort study of ICU patients who received specialized palliative care, August 2013 - August 2015...
October 10, 2018: Journal of Pain and Symptom Management
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