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Intensive AND Care

Nicholas Di Mascio, Padraic MacMathuna, Sean Murphy, Eoin Carl Kavanagh
A 68-year-old gentleman was referred for elective upper gastrointestinal endoscopy on a background of dysphagia and esophageal candidiasis. A benign peptic stricture was noted, managed with balloon dilation without apparent immediate complication. At completion, however, the patient became confused and agitated, with no improvement despite the reversal of sedation. Two hours later, with all investigations for suspected complications including perforation, negative, he developed acute left-sided hemiparesis...
October 20, 2018: Clinical Journal of Gastroenterology
Tamara Merz, Martin Wepler, Benedikt Nußbaum, Josef Vogt, Enrico Calzia, Rui Wang, Csaba Szabo, Peter Radermacher, Oscar McCook
BACKGROUND: Sepsis is associated with disturbed glucose metabolism and reduced mitochondrial activity and biogenesis, ultimately leading to multiple organ dysfunction, e.g., acute kidney injury (AKI). Cystathionine-γ-lyase (CSE), the major cardiovascular source of endogenous H2 S release, is implicated in the regulation of glucose metabolism and mitochondrial activity through a PGC1α-dependent mechanism, and critical for kidney function. Atherosclerosis is associated with mitochondrial dysfunction and reduced CSE expression...
October 20, 2018: Intensive Care Medicine Experimental
Christophe Milési, Anne-Florence Pierre, Anna Deho, Robin Pouyau, Jean-Michel Liet, Camille Guillot, Anne-Sophie Guilbert, Jérôme Rambaud, Astrid Millet, Mickael Afanetti, Julie Guichoux, Mathieu Genuini, Thierry Mansir, Jean Bergounioux, Fabrice Michel, Marie-Odile Marcoux, Julien Baleine, Sabine Durand, Philippe Durand, Stéphane Dauger, Etienne Javouhey, Stéphane Leteurtre, Olivier Brissaud, Sylvain Renolleau, Aurélie Portefaix, Aymeric Douillard, Gilles Cambonie
PURPOSE: High-flow nasal cannula (HFNC) therapy is increasingly proposed as first-line respiratory support for infants with acute viral bronchiolitis (AVB). Most teams use 2 L/kg/min, but no study compared different flow rates in this setting. We hypothesized that 3 L/kg/min would be more efficient for the initial management of these patients. METHODS: A randomized controlled trial was performed in 16 pediatric intensive care units (PICUs) to compare these two flow rates in infants up to 6 months old with moderate to severe AVB and treated with HFNC...
October 21, 2018: Intensive Care Medicine
Johan Mårtensson, Shailesh Bihari, Jonathan Bannard-Smith, Neil J Glassford, Patryck Lloyd-Donald, Luca Cioccari, Nora Luethi, Aiko Tanaka, Marco Crisman, Nicolas Rey de Castro, Marcus Ottochian, Agnes Huang, Maria Cronhjort, Andrew D Bersten, Shivesh Prakash, Michael Bailey, Glenn M Eastwood, Rinaldo Bellomo
PURPOSE: We set out to assess the resuscitation fluid requirements and physiological and clinical responses of intensive care unit (ICU) patients resuscitated with 20% albumin versus 4-5% albumin. METHODS: We performed a randomised controlled trial in 321 adult patients requiring fluid resuscitation within 48 h of admission to three ICUs in Australia and the UK. RESULTS: The cumulative volume of resuscitation fluid at 48 h (primary outcome) was lower in the 20% albumin group than in the 4-5% albumin group [median difference - 600 ml, 95% confidence interval (CI) - 800 to - 400; P < 0...
October 21, 2018: Intensive Care Medicine
Amanda D Osta, Marta A King, Janet R Serwint, Susan B Bostwick
Challenging situations and intense emotions are inherent to clinical practice. Failure to address these emotions has been associated with health care provider burnout. One way to combat this burnout and increase resilience is participation in emotional debriefing. Although there are many models of emotional debriefing, these are not commonly performed in clinical practice. We provide a guide for implementing emotional debriefing training, utilizing the AAP Resilience Curriculum, into clinical training programs with a focus on preparing senior residents and fellows to act as debriefing facilitators...
October 18, 2018: Academic Pediatrics
Chloe de Grood, Christiane Job McIntosh, Jamie M Boyd, Karolina Zjadewicz, Jeanna Parsons Leigh, Henry Thomas Stelfox
PURPOSE: Transitions of care from the intensive care unit (ICU) to a hospital ward are high risk and contingent on effective communication. We sought to identify essential information elements to be included in an ICU to hospital ward transfer summary tool, and describe tool functionality and composition perceived to be important. MATERIALS AND METHODS: A panel of 13 clinicians representing ICU and hospital ward providers used a modified Delphi process to iteratively review and rate unique information elements identified from existing ICU transfer tools through three rounds of review (two remote and one in person)...
October 6, 2018: Journal of Critical Care
Hiroshi Nonogi
The in-hospital mortality rate of acute myocardial infarction (AMI) has dramatically decreased due to the treatment at the coronary care unit (CCU), especially with the progress of arrhythmia therapy and reperfusion therapy. On the other hand, severe heart failure and multiple organ failure are increasing due to aging populations and multiple organ diseases. As a result, patients with AMI without complications are less likely to be admitted to the CCU, and cardiologists staying in the CCU have also decreased...
October 17, 2018: Journal of Cardiology
Leda Tomiko Yamada da Silveira, Janete Maria da Silva, Clarice Tanaka, Carolina Fu
OBJECTIVES: To compare the functional status at intensive care unit (ICU) discharge of patients who were later readmitted to the ICU and patients discharged home and to verify whether a decline in functional status is associated with ICU readmission. DESIGN: Prospective cohort study. SETTING: ICU at a tertiary teaching hospital. PARTICIPANTS: Patients admitted to the ICU, ≥18 years old, submitted to invasive mechanical ventilation (IMV), and discharged to the ward...
August 2, 2018: Physiotherapy
Jae Young Kwack, Yong-Soon Kwon
OBJECTIVE: Although laparoscopic hysterectomy, a worldwide popular surgery, ensures faster recovery and less postoperative pain than with laparotomic hysterectomy, immediate pain control still improving postoperative care. We introduce an effective method, intraoperative injection of ropivacaine into both uterosacral ligaments, to control immediate postoperative pain. MATERIALS AND METHODS: We performed a prospective, double-blind, and randomized study. We analyzed 40 cases of laparoscopic vaginal hysterectomy performed between July 2015 and November 2016 by a single surgeon (Y...
October 2018: Taiwanese Journal of Obstetrics & Gynecology
Vibeke Sparring, Emma Granström, Magna Andreen Sachs, Mats Brommels, Monica E Nyström
BACKGROUND: Swedish National Quality Registries (NQRs) are observational clinical registries that have long been seen as an underused resource for research and quality improvement (QI) in health care. In recent years, NQRs have also been recognised as an area where patients can be involved, contributing with self-reported experiences and estimations of health effects. This study aimed to investigate what the registry management perceived as barriers and facilitators for the use of NQRs in QI, research, and interaction with patients, and main activities undertaken to enhance their use for these purposes...
October 20, 2018: BMC Health Services Research
Christian Dalton-Locke, Rosie Attard, Helen Killaspy, Sarah White
BACKGROUND: Specialist mental health supported accommodation services are a key component to a graduated level of care from hospital to independently living in the community for people with complex, longer term mental health problems. However, they come at a high cost and there has been a lack of research on the quality of these services. The QuEST (Quality and Effectiveness of Supported tenancies) study, a five-year programme of research funded by the National Institute for Health Research, aimed to address this...
October 20, 2018: BMC Psychiatry
Nirupama Yechoor, Amir Adeli, Shaheryar Hafeez
INTRODUCTION: Although overall mortality of status epilepticus is high, baseline patient characteristics and co-morbidities may be helpful to predict outcomes and shape treatment decisions. Two previously published scoring systems exist to predict outcomes: the Status Epilepticus Severity Score (STESS) and the Epidemiology-based Mortality Score in Status Epilepticus (EMSE). However, a comparison of the two scores has not previously been completed in an American intensive care unit. We hypothesize that both scores will adequately predict the primary outcome of in-hospital death, but that the EMSE may more accurately predict functional outcomes, and significantly impact treatment decisions for both clinicians and families...
October 3, 2018: Epilepsy Research
Neha Rastogi, Surbhi Khurana, Balaji Veeraraghavan, Francis Yesurajan Inbanathan, Suresh Kumar Rajamani Sekar, Deepak Gupta, Keshav Goel, Ashish Bindra, Navdeep Sokhal, Ashutosh Panda, Rajesh Malhotra, Purva Mathur
OBJECTIVE: This study describes a detailed epidemiological and molecular characterization of an outbreak of Burkholderia cepacia at a neuro-trauma intensive care unit of a level-1 trauma centre. It emphasizes stringent infection control interventions taken to successfully curb this outbreak. METHODS: Clinical and microbiological data was reviewed for the patients, who had more than one blood culture that grew B. cepacia. Bacterial identification and antimicrobial susceptibility was done using automated VITEK II systems...
October 17, 2018: International Journal of Infectious Diseases: IJID
Oh Tak Kyu, Eunjeong Ji, Soyeon Ahn, Dong Jung Kim, In-Ae Song
BACKGROUND: This study aimed to investigate the association between postoperative surgical Intensive Care Unit (ICU) admission during a time when there was intensivist coverage and 30-day mortality after ICU admission. METHODS: This was a retrospective observational study in a tertiary care academic hospital ICU, with daytime intensivist coverage. We collected the electronic medical records for all patients who were admitted to the postoperative ICU after undergoing a surgery between January 1, 2007 and December 31, 2016...
October 17, 2018: Anaesthesia, Critical Care & Pain Medicine
Marc Sørensen, Lars Willy Andersen
Limiting intensive care is paid increasing attention. In the echoing call for physicians' ethical self-restriction, it is easily overlooked, however, that ethics needs a critical epistemological analysis before it can suffice as an emergency brake to futile treatment. This analysis is provided by the present essay. The authors suggest that the difficulties of resolving moral dilemmas related to limiting intensive care may just be due to the unclarified epistemological status of moral claims. Even if normative ethics cannot prescribe right decisions, but only draw conclusions from defined premises, the premises may or may not be true...
October 20, 2018: Bioethics
Aravind Duruvasal, Lakshmi, Srinivasan, Sowmya, Preetam Arthur
Hemophagocytic Lymphohistiocytosis (HLH), is an uncommon, aggressive and life threatening syndrome of excessive immune activation. We report an unusual case of HLH, in a 34 year old male, who was admitted with Subarachnoid hemorrhage and cerebellar contusion in a Neurosurgical Intensive care unit, whose trigger is not clear.
March 2018: Journal of the Association of Physicians of India
Varsha S Jagtap, Anurag R Lila, Vijaya Sarathi, Amol P Bukan, Tushar R Bandgar, Nalini S Shah
Objectives: Co existent pituitary adenoma and Rathke's cleft cyst (RCC) is a rare entity. Purpose of this study is to describe the clinical presentation, imaging findings, and management of patients with this combination. Methods: Retrospective review of records from a single tertiary care center for a period of three years [2009-2012]. Results: Out of the total 284 pituitary adenoma patients in the study period, there were four patients one each of Cushing's disease, acromegaly, prolactinoma and non-secretory pituitary adenoma with coexisting RCC in all...
March 2018: Journal of the Association of Physicians of India
Reinier B Beks, David Reetz, Mirjam B de Jong, Rolf H H Groenwold, Falco Hietbrink, Michael J R Edwards, Luke P H Leenen, Roderick Marijn Houwert, Jan Paul M Frölke
BACKGROUND: Over the years, a trend has evolved towards operative treatment of flail chest although evidence is limited. Furthermore, little is known about operative treatment for patients with multiple rib fractures without a flail chest. The aim of this study was to compare rib fixation based on a clinical treatment algorithm with nonoperative treatment for both patients with a flail chest or multiple rib fractures. METHODS: All patients with ≥ 3 rib fractures admitted to one of the two contributing hospitals between January 2014 and January 2017 were retrospectively included in this multicenter cohort study...
October 19, 2018: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
Evelyn Obregon, Camilia R Martin, Ivan D Frantz Iii, Palak Patel, Vincent C Smith
OBJECTIVE: We compared the Neonatal Intensive Care Unit discharge preparedness of families with and without Limited English Proficiency (LEP). STUDY DESIGN: We performed a retrospective analysis of discharged families. Each family's discharge preparation was self-assessed on the day of discharge, and the discharging nurse assessed the family's overall emotional and technical discharge preparedness all on 9-point Likert scales. Families were considered not prepared for discharge if they rated themselves or the nurse rated their preparedness as <7 on the Likert scale...
October 19, 2018: Journal of Perinatology: Official Journal of the California Perinatal Association
Taha B M J Ouarda, Christian Charron
Persistent extreme heat events are of growing concern in a climate change context. An increase in the intensity, frequency and duration of heat waves is observed in several regions. Temperature extremes are also influenced by global-scale modes of climate variability. Temperature-Duration-Frequency (TDF) curves, which relate the intensity of heat events of different durations to their frequencies, can be useful tools for the analysis of heat extremes. To account for climate external forcings, we develop a nonstationary approach to the TDF curves by introducing indices that account for the temporal trend and teleconnections...
October 19, 2018: Scientific Reports
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