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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
#1
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/30301614/-supraclavicular-nerve-and-superior-trunk-block-for-surgical-treatment-of-clavicle-fracture-in-a-patient-with-steinert-s-disease-case-report
#2
Leonardo Diniz Correa Pinto, Cláudia Helena Ribeiro da Silva, Pedro Marcos Silva E Gonçalves, Roberto José Valadares
BACKGROUND AND OBJECTIVES: Ultrasound-guided upper limb blocks may provide great benefits to patients with serious diseases. Patients with Steinert's disease have muscle weakness and risk of triggering myotomy or malignant hyperthermia due to the use of anesthetic agents and surgical stress. The objective of this report was to demonstrate a viable alternative for clavicle fracture surgery with upper trunk and supraclavicular nerve block, thus reducing the spread of local anesthetic to the phrenic nerve in a patient with muscular dystrophy...
October 6, 2018: Revista Brasileira de Anestesiologia
https://www.readbyqxmd.com/read/30297489/myasthenia-gravis-crisis-coinciding-with-asthma-exacerbation-in-a-patient-with-recent-heroin-use-three-causes-of-acute-hypercarbic-respiratory-failure
#3
Adem Aktas, Edward Rojas, Hardik A Parikh, Kathleen Pergament
A 57-year-old woman with a history of asthma, hypertension and substance abuse disorder was admitted to the medical intensive care unit with hypercapnic respiratory failure. After the history was obtained, patient admitted heroin use earlier that day. The initial physical examination revealed right eye ptosis, diplopia, fatigability of neck flexion and extension. She also presented with wheezing and a prolonged expiratory phase. Pupils were 4 mm, with sluggish response to light bilaterally. CT chest with contrast showed a large mediastinal mass...
October 7, 2018: BMJ Case Reports
https://www.readbyqxmd.com/read/30288759/hypoalbuminemia-pathogenesis-and-clinical-significance
#4
REVIEW
Peter B Soeters, Robert R Wolfe, Alan Shenkin
Hypoalbuminemia is associated with inflammation. Despite being addressed repeatedly in the literature, there is still confusion regarding its pathogenesis and clinical significance. Inflammation increases capillary permeability and escape of serum albumin, leading to expansion of interstitial space and increasing the distribution volume of albumin. The half-life of albumin has been shown to shorten, decreasing total albumin mass. These 2 factors lead to hypoalbuminemia despite increased fractional synthesis rates in plasma...
October 4, 2018: JPEN. Journal of Parenteral and Enteral Nutrition
https://www.readbyqxmd.com/read/30269320/-a-retrospective-comparison-of-thoracoscopic-and-laparoscopic-esophagectomy-between-right-neck-anastomosis-and-left-neck-anastomosis
#5
Yanzhao Xu, Xinqiang Shi, Jingge Cheng, Yuefeng Zhang, Shiwang Wen, Zhenhua Li, Huilai Lvy, Ziqiang Tian
OBJECTIVE: To evaluate the feasibility of right neck anastomosis in thoracoscopic and laparoscopic esophagectomy. METHODS: This study used a retrospective cohort study method. Clinical data of 169 patients with stage I-III esophageal squamous cell carcinoma undergoing neck anastomosis in thoracoscopic and laparoscopic esophagectomy at the Department 5 of Thoracic Surgery, the Fourth Hospital of Hebei Medical University from November 2013 to October 2016 were retrospectively analyzed...
September 25, 2018: Zhonghua Wei Chang Wai Ke za Zhi, Chinese Journal of Gastrointestinal Surgery
https://www.readbyqxmd.com/read/30264933/chest-physiotherapy-with-early-mobilization-may-improve-extubation-outcome-in-critically-ill-patients-in-the-intensive-care-units
#6
Tsung-Hsien Wang, Chin-Pyng Wu, Li-Ying Wang
BACKGROUND: Extubation failure can lead to a longer intensive care unit (ICU) stay, higher mortality rate, and higher risk of requiring tracheostomy. Chest physiotherapy (CPT) can help patients in reducing the accumulation of airway secretion, preventing collapsed lung, improving lung compliance and reducing comorbidities. Much research has investigated the correlation between CPT and respiratory system clearance. However, few studies have investigated the correlation between CPT and failed ventilator extubation...
September 28, 2018: Clinical Respiratory Journal
https://www.readbyqxmd.com/read/30261920/estimation-of-the-diaphragm-neuromuscular-efficiency-index-in-mechanically-ventilated-critically-ill-patients
#7
Diana Jansen, Annemijn H Jonkman, Lisanne Roesthuis, Suvarna Gadgil, Johannes G van der Hoeven, Gert-Jan J Scheffer, Armand Girbes, Jonne Doorduin, Christer S Sinderby, Leo M A Heunks
BACKGROUND: Diaphragm dysfunction develops frequently in ventilated intensive care unit (ICU) patients. Both disuse atrophy (ventilator over-assist) and high respiratory muscle effort (ventilator under-assist) seem to be involved. A strong rationale exists to monitor diaphragm effort and titrate support to maintain respiratory muscle activity within physiological limits. Diaphragm electromyography is used to quantify breathing effort and has been correlated with transdiaphragmatic pressure and esophageal pressure...
September 27, 2018: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/30246555/addition-of-blood-flow-restriction-to-passive-mobilization-reduces-the-rate-of-muscle-wasting-in-elderly-patients-in-the-intensive-care-unit-a-within-patient-randomized-trial
#8
Matheus Barbalho, Angel Caroline Rocha, Thamires Lorenzet Seus, Rodolfo Raiol, Fabrício Boscolo Del Vecchio, Victor Silveira Coswig
OBJECTIVE: To evaluate the addition of blood flow restriction to passive mobilization in patients in the intensive care unit. DESIGN: The study was a within-patient randomized trial. SETTING: Two intensive care units in Belém, from September to October 2017. SUBJECTS: In total, 34 coma patients admitted to the intensive care unit sector, and 20 patients fulfilled the study requirements. INTERVENTIONS: All participants received the passive mobilization protocol for lower limbs, and blood flow restriction was added only for one side in a concurrent fashion...
September 24, 2018: Clinical Rehabilitation
https://www.readbyqxmd.com/read/30236876/clinical-results-and-quality-of-life-after-reconstruction-following-sacrectomy-for-primary-bone-malignancy
#9
Juha Kiiski, Hannu O Kuokkanen, Minna Kääriäinen, Ilkka S Kaartinen, Toni-Karri Pakarinen, Minna K Laitinen
BACKGROUND: Sacrectomy is a rare and demanding surgical procedure that results in major soft tissue defects and spinopelvic discontinuity. No consensus is available on the optimal reconstruction algorithm. Therefore, the present study evaluated the results of sacrectomy reconstruction and its impact on patients' quality of life (QOL). METHODS: A retrospective chart review was conducted for 21 patients who underwent sacrectomy for a primary bone tumour. Patients were divided into groups based on the timing of reconstruction as follows: no reconstruction, immediate reconstruction or delayed reconstruction...
August 24, 2018: Journal of Plastic, Reconstructive & Aesthetic Surgery: JPRAS
https://www.readbyqxmd.com/read/30224027/quantitative-peripheral-muscle-ultrasound-in-sepsis-muscle-area-superior-to-thickness
#10
Jessica A Palakshappa, John P Reilly, William D Schweickert, Brian J Anderson, Viviane Khoury, Michael G Shashaty, David Fitzgerald, Caitlin Forker, Kelly Butler, Caroline A Ittner, Rui Feng, D Clark Files, Michael P Bonk, Jason D Christie, Nuala J Meyer
PURPOSE: The objective of this study is to describe the relationship between two quantitative muscle ultrasound measures, the rectus femoris cross-sectional area (RF-CSA) and quadriceps muscle thickness, with volitional measures of strength and function in critically ill patients with sepsis. MATERIALS AND METHODS: We performed a prospective study of patients admitted to a medical ICU with sepsis and shock or respiratory failure. We examined the association of two ultrasound measurements - the RF-CSA and quadriceps muscle thickness - with strength and function at day 7...
October 2018: Journal of Critical Care
https://www.readbyqxmd.com/read/30223993/the-pathophysiology-of-neuromuscular-dysfunction-in-critical-illness
#11
REVIEW
Matteo Parotto, Jane Batt, Margaret Herridge
Disability after critical illness is heterogeneous and related to multiple morbidities. Muscle and nerve injury represent prevalent and important determinants of long-term disability. As the population ages and accrues a greater burden of comorbid illness and medical complexity, those patients admitted to an intensive care unit will be challenged in their recovery because of diminished organ reserve and variable tissue resiliency. This represents a significant burgeoning public health concern. This article presents a brief overview of the pathophysiology and the emerging basic science of neuromuscular dysfunction in critical illness...
October 2018: Critical Care Clinics
https://www.readbyqxmd.com/read/30217640/impact-of-vasoactive-medications-on-icu-acquired-weakness-in-mechanically-ventilated-patients
#12
Krysta S Wolfe, Bhakti K Patel, Erica L MacKenzie, Shewit P Giovanni, Anne S Pohlman, Matthew M Churpek, Jesse B Hall, John P Kress
BACKGROUND: Vasoactive medications are commonly used in the treatment of critically ill patients, but their impact on the development of ICU-acquired weakness is not well described. The objective of this study is to evaluate the relationship between vasoactive medication use and the outcome of ICU-acquired weakness. METHODS: This is a secondary analysis of mechanically ventilated patients (N = 172) enrolled in a randomized clinical trial of early occupational and physical therapy vs conventional therapy, which evaluated the end point of ICU-acquired weakness on hospital discharge...
October 2018: Chest
https://www.readbyqxmd.com/read/30217216/study-protocol-for-single-center-open-label-randomized-controlled-trial-to-clarify-the-preventive-efficacy-of-electrical-stimulation-for-muscle-atrophy-after-trauma
#13
Makiko Yamamoto, Akio Kimura, Kento Takii, Naruaki Otake, Wataru Matsuda, Tatsuki Uemura, Takunori Sato, Kentaro Kobayashi, Ryo Sasaki, Akiyoshi Hagiwara, Junko Fujitani
BACKGROUND: Management of trauma involves long-term bed rest even when muscle strength in the lower extremities is preserved. Prolonged bed rest reduces muscle mass and causes muscle atrophy. A recent study reported the efficacy of rehabilitation using electrical muscle stimulation (EMS) for muscle strength maintenance in intensive care unit patients with disturbance of consciousness. However, despite the expected benefits of EMS in maintaining muscle strength, little is known about its efficacy in trauma patients...
September 14, 2018: Trials
https://www.readbyqxmd.com/read/30214949/impact-of-the-chelsea-critical-care-physical-assessment-cpax-tool-on-clinical-outcomes-of-surgical-and-trauma-patients-in-an-intensive-care-unit-an-experimental-study
#14
Megan Whelan, Heleen van Aswegen, Evelyn Corner
Background: Critically ill patients following traumatic injury or major surgery are at risk of loss of skeletal muscle mass, which leads to decreased physical function. Early rehabilitation in an intensive care unit (ICU) is thought to preserve or restore physical functioning. The Chelsea critical care physical assessment (CPAx) is a measurement tool used to assess physical function in the ICU. Objectives: To determine whether the use of the CPAx tool as part of physiotherapy patient assessment, in two adult trauma and surgical ICU settings where early patient mobilisation forms part of standard physiotherapy practice, had an impact on ICU and hospital length of stay (LOS) through delivery of problem-oriented treatment plans...
2018: South African Journal of Physiotherapy
https://www.readbyqxmd.com/read/30214124/rehabilitation-and-early-mobilization-in-the-critical-patient-systematic-review
#15
REVIEW
Patricia Arias-Fernández, Macarena Romero-Martin, Juan Gómez-Salgado, Daniel Fernández-García
[Purpose] To review the literature that examines rehabilitation and early mobilization and that involves different practices (effects of interventions) for the critically ill patient. [Materials and Methods] A PRISMA-Systematic review has been conducted based on different data sources: Biblioteca Virtual en Salud, CINHAL, Pubmed, Scopus, and Web of Science were used to identify randomized controlled trials, crossover trials, and case-control studies. [Results] Eleven studies were included. Early rehabilitation had no significant effect on the length of stay and number of cases of Intensive Care Unit Acquired Weaknesses...
September 2018: Journal of Physical Therapy Science
https://www.readbyqxmd.com/read/30194465/urinary-creatinine-excretion-is-related-to-short-term-and-long-term-mortality-in-critically-ill-patients
#16
Lara Hessels, Niels Koopmans, Antonio W Gomes Neto, Meint Volbeda, Jacqueline Koeze, Annemieke Oude Lansink-Hartgring, Stephan J Bakker, Heleen M Oudemans-van Straaten, Maarten W Nijsten
PURPOSE: Patients with reduced muscle mass have a worse outcome, but muscle mass is difficult to quantify in the ICU. Urinary creatinine excretion (UCE) reflects muscle mass, but has not been studied in critically ill patients. We evaluated the relation of baseline UCE with short-term and long-term mortality in patients admitted to our ICU. METHODS: Patients who stayed ≥ 24 h in the ICU with UCE measured within 3 days of admission were included. We excluded patients who developed acute kidney injury stage 3 during the first week of ICU stay...
September 7, 2018: Intensive Care Medicine
https://www.readbyqxmd.com/read/30172644/commencing-out-of-bed-rehabilitation-in-critical-care-what-influences-clinical-decision-making
#17
Sue C Berney, Joleen W Rose, Linda Denehy, Catherine L Granger, George Ntoumenopoulos, Elise Crothers, Bronwyn Steel, Sandy Clarke, Elizabeth H Skinner
OBJECTIVES: To develop a decision tree that objectively identifies the most discriminative variables in the decision to provide out-of-bed rehabilitation, measure the impact of this decision and to identify the factors that intensive care unit (ICU) practitioners think most influential in that clinical decision. DESIGN: A prospective three-part study: i) consensus identification of influential factors in mobilization via survey, ii) development of an early rehabilitation decision tree and iii) measurement of practitioner mobilisation decision-making...
August 30, 2018: Archives of Physical Medicine and Rehabilitation
https://www.readbyqxmd.com/read/30160070/feasibility-of-muscle-activity-assessment-with-surface-electromyography-during-bed-cycling-exercise-in-intensive-care-unit-patients
#18
Juultje Sommers, Michelle Van Den Boorn, Raoul H H Engelbert, Frans Nollet, Marike Van Der Schaaf, Janneke Horn
INTRODUCTION: Intensive care unit (ICU) patients often develop weakness. Rehabilitation is initiated early to prevent physical deterioration, but knowledge of optimal training schedules is lacking. A reliable method to assess muscle activity during exercise is needed. In this study we explored the feasibility of electrical activity measurement by surface electromyography (sEMG) during bed cycling in ICU patients. METHODS: SEMG was performed in 9 ICU patients and 6 healthy controls...
August 30, 2018: Muscle & Nerve
https://www.readbyqxmd.com/read/30148741/emerging-outcome-measures-for-nutrition-trials-in-the-critically-ill
#19
Danielle E Bear, David Griffith, Zudin A Puthucheary
PURPOSE OF REVIEW: Mortality has long been the gold-standard outcome measure for intensive care clinical trials. However, as the critical care community begins to understand and accept that survivorship is associated with functional disability and a health and socioeconomic burden, the clinical and research focus has begun to shift towards long-term physical function RECENT FINDINGS: To use mortality as a primary outcome measure, one would either have to choose an improbable effect (e...
November 2018: Current Opinion in Clinical Nutrition and Metabolic Care
https://www.readbyqxmd.com/read/30142315/feasibility-of-exercise-testing-in-patients-who-are-critically-ill-a-prospective-observational-multicenter-study
#20
Juultje Sommers, Emily Klooster, Siebrand B Zoethout, Huub LA van den Oever, Frans Nollet, Robert Tepaske, Janneke Horn, Raoul Hh Engelbert, Marike van der Schaaf
OBJECTIVE: To evaluate the feasibility and safety of exercise testing and to describe the physiological response to exercise of patients in the Intensive Care Unit (ICU). DESIGN: A prospective observational multicenter study. SETTING: Two mixed medical-surgical ICUs. PARTICIPANTS: Patients (N= 37; with no primary neurological disorders, 59% male; median age 50 years; ICU length of stay 14.5 days; APACHE IV 73.0) who had been mechanically ventilated for more than 48 hours and were hemodynamically stable enough to perform physical exercise...
August 21, 2018: Archives of Physical Medicine and Rehabilitation
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