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"Intensive Care" OR "ICU"

Elizabeth Y Killien, Brianna Mills, R Scott Watson, Monica S Vavilala, Frederick P Rivara
OBJECTIVES: To determine risk factors identifiable at hospital arrival associated with acute respiratory distress syndrome development among critically injured children. DESIGN: Retrospective cohort study. SETTING: Level I or II adult or pediatric trauma centers contributing to the National Trauma Data Bank from 2007 to 2016. PATIENTS: Patients less than 18 years admitted to an ICU with traumatic injury. INTERVENTIONS: None...
August 16, 2018: Critical Care Medicine
Maia S Kredentser, Marcus Blouw, Nicole Marten, Jitender Sareen, O Joseph Bienvenu, Jennifer Ryu, Brooke E Beatie, Sarvesh Logsetty, Lesley A Graff, Shauna Eggertson, Sophia Sweatman, Braeden Debroni, Nina Cianflone, Rakesh C Arora, Ryan Zarychanski, Kendiss Olafson
OBJECTIVES: Critical illness can have a significant psychological impact on patients and their families. To inform the design of a larger trial, we assessed feasibility of ICU diaries and psychoeducation to prevent posttraumatic stress disorder, depression, and anxiety following ICU stays. DESIGN: Four-arm pilot randomized controlled trial. SETTING: A 10-bed tertiary ICU in Winnipeg, MB, Canada. PATIENTS: Critically ill patients greater than 17 years old with predicted ICU stays greater than 72 hours and mechanical ventilation duration greater than 24 hours...
August 16, 2018: Critical Care Medicine
Kate Hayes, Anne E Holland, Vincent A Pellegrino, Sunita Mathur, Carol L Hodgson
PURPOSE: Muscle weakness is common in patients requiring extracorporeal membrane oxygenation (ECMO), but early identification is challenging. This study aimed to 1) quantify the change in quadriceps size and quality (echogenicity) from baseline to day 10 using ultrasound in patients requiring ECMO, 2) determine the relationship between ultrasound measures, muscle strength and highest mobility level. MATERIALS AND METHODS: Prospective cohort study involving ultrasound measurement of quadriceps at baseline, days 10 and 20...
August 7, 2018: Journal of Critical Care
Robert A Berg, Ron W Reeder, Kathleen L Meert, Andrew R Yates, John T Berger, Christopher J Newth, Joseph A Carcillo, Patrick S McQuillen, Rick E Harrison, Frank W Moler, Murray M Pollack, Todd C Carpenter, Daniel A Notterman, Richard Holubkov, J Michael Dean, Vinay M Nadkarni, Robert M Sutton
BACKGROUND: Based on laboratory cardiopulmonary resuscitation (CPR) investigations and limited adult data, the American Heart Association Consensus Statement on CPR Quality recommends titrating CPR performance to achieve end-tidal carbon dioxide (ETCO2) >20 mmHg. AIMS: We prospectively evaluated whether ETCO2 > 20 mmHg during CPR was associated with survival to hospital discharge. METHODS: Children ≥37 weeks gestation in Collaborative Pediatric Critical Care Research Network intensive care units with chest compressions for ≥1 minute and ETCO2 monitoring prior to and during CPR between July 1, 2013 and June 31, 2016 were included...
August 14, 2018: Resuscitation
José Moreira, Ariane Paixão, Juliana Oliveira, Waldir Jaló, Ofélio Manuel, Rafaela Rodrigues, Alexandra Oliveira, Leonardo Tinoco, João Lima, Beatriz Grinsztejn, Valdiléa G Veloso, André M Japiassú, Cristiane C Lamas
OBJECTIVES: To compare the discriminatory capacity of the quick Sequential Organ Failure Assessment (qSOFA) versus the Systemic Inflammatory Response Syndrome (SIRS) score for predicting 30-day mortality and intensive care unit (ICU) admission in patients with suspicion of infection at an HIV reference center. METHODS: Prospective cohort study including consecutive adult patients who had suspected infection and subsequently admitted to the medical ward. Variables related to qSOFA and SIRS were measured at admission...
August 14, 2018: Clinical Microbiology and Infection
Emily Marsh, Sylvia M Verhoven, Joseph J Groszek, William H Fissell, Guohua An, Pratish Patel, Buddy Creech, Matthew Shotwell
BACKGROUND: Therapeutic drug monitoring is used for aminoglycosides and vancomycin, and has been proposed for β-lactam antibiotics. Clinical blood samples in the ICU are often obtained via an existing vascular catheter rather than fresh needle phlebotomy. If antibiotics had previously been infused through a vascular catheter then used for blood sampling, carryover of antibiotic from the infusion to the sample might result in misleading assessments of target attainment. To address this concern we conducted a series of in vitro measurements of carryover for three commonly used antibiotics...
August 14, 2018: Clinica Chimica Acta; International Journal of Clinical Chemistry
Hamed Haghi-Aminjan, Bagher Farhoud, Mahban Rahimifard, Tina Didari, Maryam Baeeri, Shokoufeh Hassani, Rohollah Hosseini, Mohammad Abdollahi
Chemotherapy agents are widely and effectively used for the treatment of different malignant tumors. Nonetheless, their use may lead to different adverse outcomes such as nephrotoxicity which is the main cause of morbidity and hospitalization of patients in intensive care units. Melatonin is a small molecule with pleiotropic healing properties and effectiveness in the management of a wide range of diseases. The aim of this study was to investigate the potential role of melatonin in the prevention of chemotherapy-induced nephrotoxicity at the preclinical level...
August 17, 2018: Expert Opinion on Drug Metabolism & Toxicology
Helen Stanton Chapple
"Clinical momentum" refers to the curious expansion of interventions applied to patients in the intensive care unit (ICU) without pause or design, leading to extensions of care that can violate patient wishes and distress clinicians. In this article, clinical momentum is placed in a wider context that includes ritual, reimbursement patterns, and actor network theory. These contextual features help motivate understanding of one way in which dying patients are underserved in intensive care settings...
August 1, 2018: AMA Journal of Ethics
Jose Garnacho-Montero, Irene Barrero-García, Maria de Gracia Gómez-Prieto, Ignacio Martín-Loeches
Despite advances in modern medicine, severe community-acquired pneumonia (CAP) continues to be a potentially deadly disease. Mortality rate reaches up to the 50% in patients requiring admission to the Intensive Care Unit (ICU) when developing septic shock. Areas covered: We aim to describe the optimal management of severe CAP including antibiotic therapy, future antimicrobial options, and non-antibiotic (so-called adjunctive) therapies. A literature search was performed to identify all clinical trials, observational studies, meta-analysis, and reviews about this topic from PubMed...
August 17, 2018: Expert Review of Anti-infective Therapy
Tanya Holt, Michael Prodanuk, Gregory Hansen
OBJECTIVE: Determining care disposition for pediatric patients during interfacility transport is often challenging. Severity of illness scoring can assist with this process. The purpose of this retrospective study was to compare currently utilized scoring systems and their ability to reliably match pediatric transport patients' severity of illness with the level of care necessary. METHODS: The retrospective transport registry review for our region included 209 patients <18 years, transported between 2015 and 2016 and admitted to tertiary care...
August 17, 2018: Prehospital Emergency Care
Payam Vali, Maximo Vento, Mark Underwood, Satyan Lakshminrusimha
Inhaled NO (iNO) is an approved therapy for pulmonary hypertension (PH) in term infants and its use is now increasing in preterm infants with hypoxemic respiratory failure (HRF) and, or, PH, despite the lack of sustained benefits. In the current issue of Acta Paediatrica, Dixon et al report that iNO use in the neonatal intensive care unit (NICU) may increase childhood cancer (1). In an earlier publication, Naumburg et al found that delivery room oxygen may increase childhood leukemia (2). Spector et al agree confirmed this association...
August 17, 2018: Acta Paediatrica
Brigitte Katharina Ziegelmüller, Bernadett Szabados, Annabel Spek, Jozefina Casuscelli, Christian Stief, Michael Staehler
INTRODUCTION: Emphysematous pyelonephritis is a rare necrotizing infection of the kidney with a poor prognosis. If it occurs in patients with a reduced general condition, this infection is life threatening. Early diagnosis is made by computed tomography. Treatment options are drainage and intensive care or immediate nephrectomy in severe cases. CASE DESCRIPTION: A 73-year-old woman in a poor general condition presented with a fulminant urosepsis. Computed tomography revealed an impressive abscess formation of the right kidney with free air retro and intraperitoneal...
August 2018: Urologia
Tessie W October, Zoelle B Dizon, Melinda F Hamilton, Vanessa N Madrigal, Robert M Arnold
BACKGROUND: Inter-specialty clinicians often co-lead family conferences for hospitalised patients. Families frequently report receiving different messages from different clinicians. We developed a communication training workshop that crosses disciplines and co-trains clinicians in one setting to create a culture of delivering a unified message. METHODS: We developed a 2-day paediatric communication skills workshop to teach the skills necessary to conduct a family conference...
August 16, 2018: Clinical Teacher
Lyvonne N Tume, Frédéric V Valla
Ensuring optimal nutrition is vital in critically ill children and enteral feeding is the main route of delivery in intensive care. Feeding intolerance is the most commonly cited reason amongst pediatric intensive care unit healthcare professionals for stopping or withholding enteral nutrition, yet the definition for this remains inconsistent, nebulous, and entirely arbitrary. Not only does this pose problems clinically, but research in this field frequently uses feeding intolerance as an endpoint and the heterogeneity in this definition makes the comparison of studies difficult and meta-analysis impossible...
August 17, 2018: European Journal of Pediatrics
Farzad Momenfar, Alireza Abdi, Nader Salari, Ali Soroush, Behzad Hemmatpour
Background: The main problem of hospitalized patients in intensive care units is feeding, and if the patient does not receive the daily caloric intake required to his body, he will have malnutrition and problems related to it. Abdominal massage is a method used to improve digestive function in various studies, but few studies have been conducted in intensive care units, and sometimes, contradictory results have been obtained. Therefore, the present study is conducted with the aim of determining the effect of abdominal massage on the gastric residual volume in patients hospitalized in intensive care units...
2018: Journal of Intensive Care
Fumiaki Tokioka, Hiroshi Okamoto, Akio Yamazaki, Akihiro Itou, Tadashi Ishida
Background: Quick Sepsis-related Organ Failure Assessment (qSOFA) is a new screening system for sepsis. The prognostic performance of qSOFA for patients with suspected infections outside the intensive care unit (ICU) is similar to that of full SOFA; however, its performance for community-acquired pneumonia (CAP) has not yet been evaluated in detail.The objectives of the present study were to compare the prognostic performance of qSOFA with existing pneumonia severity scores, such as CURB-65 (confusion, blood urea nitrogen > 19 mg/dL, respiratory rate ≥ 30/min, systolic blood pressure < 90 mmHg, or diastolic blood pressure ≤ 60 mmHg, age ≥ 65 years) and the pneumonia severity index (PSI), and examine its usefulness for predicting mortality and ICU admission in patients with CAP of high severity and mortality that requires hospitalization...
2018: Journal of Intensive Care
Andrés Laserna, Sudhakar Tummala, Neel Patel, Diaa Eldin Mohamed El Hamouda, Cristina Gutiérrez
Atezolizumab is a monoclonal antibody that targets programmed death ligand-1. Treatments with this drug may cause immune-related adverse events by creating an exaggerated inflammatory response. The most common side effects are fatigue, rash, and gastrointestinal symptoms. Cases of central nervous system toxicity such as encephalitis and encephalopathy are uncommon. We present the case of a 53-year-old female with metastatic squamous cell carcinoma of the cervix who presented to the emergency room 13 days after receiving atezolizumab with altered mental status, headache, and meningeal signs...
2018: SAGE Open Medical Case Reports
Zühre Uz, Can Ince, Philippe Guerci, Yasin Ince, Renata P Araujo, Bulent Ergin, Matthias P Hilty, Thomas M van Gulik, Bas A de Mol
Background: Management of tissue perfusion following cardiac surgery is a challenging task where common clinical parameters do not reflect microcirculatory dysfunction. Heterogeneity in blood flow perfusion and abnormalities in capillary density characterize microcirculatory dysfunction. The restoration of a normal microcirculation may become a novel target for therapy in the future in addition to macrocirculatory parameters. The aim of this study is to determine how the sublingual microcirculatory parameters vary at the bedside in post-cardiac surgery patients which underwent diuretic therapy to correct fluid overload...
2018: Perioperative Medicine
Ying Wan, Shuang-Shuang Sun, Hai-Yan Fu, Yin-Kun Xu, Qing Liu, Jiang-Tao Yin, Bing Wan
The aim of the present study was to investigate the effects of adjuvant rhubarb on the recovery of patients with heat stroke. A total of 85 patients with heat stroke were randomly assigned to two treatment groups: One group receiving conventional treatment for heat stroke (conventional group) and one group receiving rhubarb supplement in addition to conventional treatment (rhubarb group). Liver and kidney function parameters, Acute Physiology and Chronic Health Evaluation (APACHE) II scores, plasma interleukin-6 (IL-6), procalcitonin (PCT), C-reactive protein (CRP) levels and venous white blood cell count (WBC) were analyzed...
August 2018: Experimental and Therapeutic Medicine
Jianhong Wang, Zicheng Hu, Shu Yang, Chengchun Liu, Haimei Yang, Duozi Wang, Fuqiang Guo
Cerebral apoplexy is a disease caused by obstruction of the blood circulation in the brain. Evidence has indicated that inflammatory cytokines are implicated in ischaemic cerebral apoplexy and are regarded as a general cardiovascular risk factor, which may be a possible immediate trigger, a component of the response to tissue injury and a therapeutic target. The present study investigated changes of inflammatory cytokines and cells in patients with cerebral apoplexy at the intensive care unit (ICU). The plasma concentrations of inflammatory cytokines, including tumor necrosis factor (TNF)-α, interleukin (IL)-4, IL-6, IL-8, IL-10, IL-1β and IL-17A were evaluated using ELISA...
August 2018: Experimental and Therapeutic Medicine
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