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https://www.readbyqxmd.com/read/30533392/feasibility-of-on-table-extubation-after-cardiac-surgery-with-cardiopulmonary-bypass-a-randomized-clinical-trial
#1
Ziae Totonchi, Rasoul Azarfarin, Louise Jafari, Alireza Alizadeh Ghavidel, Bahador Baharestani, Azin Alizadehasl, Farideh Mohammadi Alasti, Mohammad Hassan Ghaffarinejad
Background: The use of short-acting anesthetics, muscle relaxation, and anesthesia depth monitoring allows maintaining sufficient anesthesia depth, fast recovery, and extubation of the patients in the operating room (OR). We evaluated the feasibility of extubation in the OR in cardiac surgery. Methods: This clinical trial was performed on 100 adult patients who underwent elective noncomplex cardiac surgery using cardiopulmonary bypass. Additional to the routine monitoring, the patients' depth of anesthesia and neuromuscular blocked were assessed by bispectral index and nerve stimulator, respectively...
October 2018: Anesthesiology and Pain Medicine
https://www.readbyqxmd.com/read/30528733/constant-light-exposure-aggravates-pomc-mediated-muscle-wasting-associated-with-hypothalamic-alteration-of-circadian-clock-and-sirt1-in-endotoxemia-rats
#2
Yan Chen, Minhua Cheng, Ting Su, Tao Gao, Wenkui Yu
Constant light exposure is widespread in the intensive care unit (ICU) and could increase the rate of brain dysfunction as delirium and sleep disorders in critical patients. And the activation of hypothalamic neuropeptides is proved to play a crucial role in regulating hypercatabolism, especially skeletal muscle wasting in critical patients, which could lead to serious complications and poor prognosis. Here we investigated the hypothesis that constant light exposure could aggravate skeletal muscle wasting in endotoxemia rats and whether it was associated with alterations of circadian clock and hypothalamic proopiomelanocortin(POMC) expression...
December 7, 2018: Biochemical and Biophysical Research Communications
https://www.readbyqxmd.com/read/30527476/computed-tomography-evidence-of-psoas-muscle-atrophy-without-concomitant-tendon-wasting-in-early-sepsis
#3
Carrie A Kubiak, Kavitha Ranganathan, Niki Matusko, Jon A Jacobson, Stewart C Wang, Pauline K Park, Benjamin L Levi
BACKGROUND: Morphomic studies have demonstrated a correlation between sarcopenia and clinical outcomes in septic patients. However, tendon morphomics has not yet been studied in this context. The purpose of the present study was to evaluate tendon morphology in septic patients through analytic morphomics. We hypothesized that morphomic analyses would reveal concomitant muscle and tendon wasting in sepsis patients. The results of this study may help to implement different rehabilitation modalities for critically ill patients...
February 2019: Journal of Surgical Research
https://www.readbyqxmd.com/read/30513718/assessment-of-muscle-wasting-in-long-stay-icu-patients-using-a-new-ultrasound-protocol
#4
Carmen Rosa Hernández-Socorro, Pedro Saavedra, Juan Carlos López-Fernández, Sergio Ruiz-Santana
There is currently no standardized procedure to assess sarcopenia in long-stay catabolic patients. Our aim is to analyze a novel ultrasound muscle assessment protocol in these patients versus healthy controls, by carrying out a prospective observational study. We designed a new ultrasound protocol that assesses quadriceps rectus femoris (QRF) muscle quality in real-time B-mode, color-Doppler, and M-mode ultrasound, and evaluates QRF intramuscular central tendon thickness, cross-sectional area, and muscle thickness in ultrasound B-mode...
December 1, 2018: Nutrients
https://www.readbyqxmd.com/read/30507677/incremental-value-of-noncerebral-somatic-tissue-oxygenation-monitoring-for-patients-undergoing-surgery
#5
Dong-Liang Mu, Dong-Xin Wang, Lingzhong Meng
PURPOSE OF THE REVIEW: There is increasing interest in the use of noncerebral somatic tissue oxygen saturation (SstO2) monitoring on the basis of near-infrared spectroscopy in patients undergoing surgery or residing in intensive care unit. The relevant question is whether SstO2 monitoring can improve the quality of care. In this article, we reviewed the clinical application of SstO2 monitoring in acute care, focusing on its use in patients undergoing surgery. RECENT FINDINGS: Multiple small cohort studies conducted on pediatric patients reported close associations of SstO2 measurements over different regions such as the splanchnic and renal tissue beds with systemic oxygenation, transfusion, hemodynamic indices, morbidity, and mortality...
November 29, 2018: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/30499789/sleep-and-intensive-care-unit-acquired-weakness-in-critically-ill-older-adults
#6
Maya N Elías, Cindy L Munro, Zhan Liang, Karel Calero, Ming Ji
BACKGROUND: Older adults in the intensive care unit (ICU) often experience sleep disturbances, which may stem from life-threatening illness, the ICU environment, medications/sedation, or psychological stress. Two complementary endocrinological responses occur as a result of compromised sleep and consequently could exacerbate ICU-acquired weakness: a decrease in anabolic hormones leading to decreased protein synthesis and an increase in catabolic hormones leading to increased protein degradation...
January 2019: Dimensions of Critical Care Nursing: DCCN
https://www.readbyqxmd.com/read/30489437/use-of-levosimendan-in-intensive-care-unit-settings-an-opinion-paper
#7
A Herpain, S Bouchez, M Girardis, F Guarracino, J Knotzer, B Levy, T Liebregts, P Pollesello, S-E Ricksten, H Riha, A Rudiger, F Sangalli
Levosimendan is an inodilator that promotes cardiac contractility primarily via calcium sensitization of cardiac troponin C and vasodilatation via opening of adenosine triphosphate-sensitive potassium (KATP) channels in vascular smooth muscle cells; the drug also exerts organ-protective effects via a similar effect on mitochondrial KATP channels.This pharmacological profile identifies levosimendan as a drug that may have applications in a wide range of critical illness situations encountered in intensive care unit medicine: hemodynamic support in cardiogenic or septic shock; weaning from mechanical ventilation or from extracorporeal membrane oxygenation; and in the context of cardiorenal syndrome...
November 22, 2018: Journal of Cardiovascular Pharmacology
https://www.readbyqxmd.com/read/30454870/respiratory-and-peripheral-muscle-assessment-in-the-intensive-care-unit
#8
REVIEW
Agustín Carámbula, Antonella Visca, Silvana D'Amico, Martín Angulo
Atrophy and weakness of the respiratory and peripheral muscles is a common problem in the intensive care unit (ICU). It is difficult to diagnose, particularly in the early stages of critical disease. Consequently, many cases are detected only in advanced stages, for example, when difficulties in mechanical ventilation weaning are encountered. The aim of this review is to describe the main tools that are currently available for evaluation of peripheral and respiratory muscles in the ICU. Techniques of varying complexity and specificity are discussed, and particular emphasis is placed on those with greater relevance in daily clinical practice, such as ultrasound...
November 16, 2018: Archivos de Bronconeumología
https://www.readbyqxmd.com/read/30453774/ventilator-induced-diaphragm-dysfunction-in-critical-illness
#9
Yung-Yang Liu, Li-Fu Li
Mechanical ventilation (MV) is life-saving for patients with acute respiratory failure but also causes difficult liberation of patients from ventilator due to rapid decrease of diaphragm muscle endurance and strength, which is termed ventilator-induced diaphragmatic damage (VIDD). Numerous studies have revealed that VIDD could increase extubation failure, ICU stay, ICU mortality, and healthcare expenditures. However, the mechanisms of VIDD, potentially involving a multistep process including muscle atrophy, oxidative loads, structural damage, and muscle fiber remodeling, are not fully elucidated...
November 19, 2018: Experimental Biology and Medicine
https://www.readbyqxmd.com/read/30448193/supplemental-parenteral-nutrition-improves-immunity-with-unchanged-carbohydrate-and-protein-metabolism-in-critically-ill-patients-the-spn2-randomized-tracer-study
#10
Mette M Berger, Olivier Pantet, Nathalie Jacquelin-Ravel, Mélanie Charrière, Sabine Schmidt, Fabio Becce, Régine Audran, François Spertini, Luc Tappy, Claude Pichard
BACKGROUND & AIMS: Individualized supplemental parenteral nutrition (SPN) providing measured energy expenditure from day 4 reduced infectious complications in a previous study including 305 intensive care (ICU) patients. The study aimed at investigating the metabolic, and immune responses underlying the clinical response of the previous trial. METHODS: Randomized controlled trial enrolling 23 critically ill patients on day 3 (D3) of admission to the ICU who were fed less than 60% of their energy target by the enteral nutrition (EN) alone: allocation to either continued EN or to SPN to a target validated by indirect calorimetry...
November 5, 2018: Clinical Nutrition: Official Journal of the European Society of Parenteral and Enteral Nutrition
https://www.readbyqxmd.com/read/30439312/-comparison-of-the-effect-of-cpap-pps-mode-and-cpap-asb-mode-in-weaning-on-acute-exacerbation-of-chronic-obstructive-pulmonary-disease-patients
#11
Chengfen Yin, Xinjing Gao, Zhibo Li, Jie Zhang, Lei Xu
OBJECTIVE: To investigate the effect of different appropriate modes of weaning from mechanical ventilation (MV) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). METHODS: Patients with AECOPD and mechanically ventilated by orotracheal intubation, suitable for continuous positive airway pressure+proportional pressure support (CPAP+PPS) and CPAP+assisted spontaneous breath (ASB) ventilation mode for weaning from MV, admitted to intensive care unit (ICU) of Tianjin Third Central Hospital form January 1st, 2016 to December 31st, 2017 were enrolled...
October 2018: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
https://www.readbyqxmd.com/read/30431575/ambulation-capacity-and-functional-outcome-in-patients-undergoing-neuromuscular-electrical-stimulation-after-cardiac-valve-surgery-a-randomised-clinical-trial
#12
RANDOMIZED CONTROLLED TRIAL
Telma Cristina Fontes Cerqueira, Manoel Luiz de Cerqueira Neto, Lucas de Assis Pereira Cacau, Géssica Uruga Oliveira, Walderi Monteiro da Silva Júnior, Vitor Oliveira Carvalho, José Teles de Mendonça, Valter Joviniano de Santana Filho
BACKGROUND: Early mobilization and physical exercise are considered fundamental components in cardiovascular surgery rehabilitation; however, occasionally they are inadequate for inhibiting functional decline. Neuromuscular electrical stimulation (NMES) is a promising tool in cardiovascular rehabilitation; however, to date, no randomized clinical trial has measured the effects of NMES on functional capacity and quality of life in patients who undergo routine cardiac surgery with a short intensive care unit (ICU) stay...
November 2018: Medicine (Baltimore)
https://www.readbyqxmd.com/read/30429133/obstructive-sleep-apnoea-and-hypoventilation-in-an-adult-with-congenital-myasthenic-syndrome
#13
Haris Younas, Ricardo Roda, Jonathan Jun
In this case report, we describe an adult male with congenital myasthenic syndrome due to mutations in muscle-specific receptor tyrosine kinase ( MuSK , c.79+2 T>G; IVS1 +2 T>G, c.2368 G>A, Val790Met) presenting with sleep apnoea and hypercapnic respiratory failure. In the intensive care unit, he required intubation followed by tracheostomy which resolved obstructive sleep apnoea. Later, due to persistent sleep-associated hypoventilation, he required nocturnal mechanical ventilation. His case illustrates how respiratory muscle weakness due to mutations in MuSK can lead to various forms of sleep disordered breathing...
November 14, 2018: BMJ Case Reports
https://www.readbyqxmd.com/read/30427933/effects-of-early-combined-endurance-and-resistance-training-in-mechanically-ventilated-critically-ill-patients-a-randomised-controlled-trial
#14
Sabrina Eggmann, Martin L Verra, Gere Luder, Jukka Takala, Stephan M Jakob
INTRODUCTION: Neuromuscular weakness resulting in severe functional impairment is common in critical care survivors. This study aimed to evaluate effects of an early progressive rehabilitation intervention in mechanically ventilated adults at risk. METHODS: This was a parallel, two-arm, assessor-blinded, randomised controlled trial with 6-months follow-up that was conducted in a mixed ICU of an academic centre in Switzerland. Previously independent, mechanically ventilated, critically ill adults with expected critical care stay ≥72 hours (n = 115) were randomised to a control group receiving standard physiotherapy including early mobilisation or to an experimental group with early endurance and resistance training combined with mobilisation...
2018: PloS One
https://www.readbyqxmd.com/read/30406356/characteristics-and-outcome-of-newborn-admitted-with-acute-bilirubin-encephalopathy-to-a-tertiary-neonatal-intensive-care-unit
#15
Nahed Fahmy Helal, Eman Abdel Ghany Abdel Ghany, Walaa Alsharany Abuelhamd, Amna Yehea Ahmed Alradem
BACKGROUND: Acute bilirubin encephalopathy (ABE) still represents a significant cause of morbidity and mortality throughout the world, especially in developing countries. We aimed to determine the prevalence of ABE based on the Johnson bilirubin-induced neurologic dysfunction (BIND) score and to describe the discharge outcomes. METHODS: We prospectively studied all newborns ≥ 35 weeks with ABE by evaluating signs of mental sensorium, muscle tone, and cry patterns over 1 year...
November 7, 2018: World Journal of Pediatrics: WJP
https://www.readbyqxmd.com/read/30404980/effective-combination-of-different-surgical-strategies-for-deep-sternal-wound-infection-and-mediastinitis
#16
Lachmandath Tewarie, Ajay K Moza, Mohammad Amen Khattab, Rüdiger Autschbach, Rashad Zayat
PURPOSE: Timing and ideal reconstructive approach in deep sternal wound infection (DSWI) and mediastinitis still remain controversially debated. We present our own combined surgical strategy of bilateral pectoralis major muscle flap (BPMMF) or omental flap (OF) transposition. METHODS: Between July 2010 and July 2016, poststernotomy patients with DSWI and mediastinitis underwent a secondary wound closure with modified BPMMF (Group A, center for disease control class (CDC)-II, n = 21; Group B, CDC-III, n = 20) or with OF (Group C, CDC-III, n = 19) following vacuum-assisted closure (VAC)...
November 7, 2018: Annals of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/30389829/measurement-of-diaphragmatic-electrical-activity-by-surface-electromyography-in-intubated-subjects-and-its-relationship-with-inspiratory-effort
#17
Giacomo Bellani, Alfio Bronco, Stefano Arrigoni Marocco, Matteo Pozzi, Vittoria Sala, Nilde Eronia, Giulia Villa, Giuseppe Foti, Giovanni Tagliabue, Marcus Eger, Antonio Pesenti
BACKGROUND: Quantification of patient effort during spontaneous breathing is important to tailor ventilatory assistance. Because a correlation between inspiratory muscle pressure (Pmus ) and electrical activity of the diaphragm (EAdi ) has been described, we aimed to assess the reliability of surface electromyography (EMG) of the respiratory muscles for monitoring diaphragm electrical activity and subject effort during assisted ventilation. METHODS: At a general ICU of a single university-affiliated hospital, we enrolled subjects who were intubated and on pressure support ventilation (PSV) and were on mechanical ventilation for > 48 h...
November 2018: Respiratory Care
https://www.readbyqxmd.com/read/30385541/effect-of-transcutaneous-electrical-neuromuscular-stimulation-on-myopathy-in-intensive-care-patients
#18
Evangelia Koutsioumpa, Demosthenes Makris, Athina Theochari, Dimitra Bagka, Stathis Stathakis, Efstratios Manoulakas, Markos Sgantzos, Epaminondas Zakynthinos
BACKGROUND: Critical illness polyneuropathy or myopathy is a severe disorder that may adversely affect patients in the intensive care unit, resulting in reduced mobilization, decline in muscle mass, and prolonged recovery periods. OBJECTIVE: To examine whether the application of trans-cutaneous electrical neuromuscular stimulation (TENMS) reduces the incidence or severity of myopathy related to critical illness in intensive care unit patients. METHODS: A total of 80 patients aged 18 years or older with an intensive care unit stay of 96 hours or more and receipt of mechanical ventilation for 96 hours or more were initially enrolled in a prospective, open-label randomized controlled trial in a university hospital...
November 2018: American Journal of Critical Care: An Official Publication, American Association of Critical-Care Nurses
https://www.readbyqxmd.com/read/30368121/necrotizing-fasciitis-of-chest-and-right-abdominal-wall-caused-by-acute-perforated-appendicitis-case-report
#19
Lotfi Rebai, Aziz Daghmouri, Ines Boussaidi
INTRODUCTION: Necrotizing fasciitis is an uncommon infection characterized by a necrotic infection that rapidly diffuse along the fascia and progresses to systemic sepsis. The combined occurrence of necrotizing fasciitis of the chest wall and acute appendicitis is extremely unusual. CASE PRESENTATION: A 27-year-old man without any significant medical history presented to the emergency department, in the postoperative course of a laparotomy for perforated acute appendicitis, with septic shock and a large erythematous region over the right abdominal wall...
October 4, 2018: International Journal of Surgery Case Reports
https://www.readbyqxmd.com/read/30360760/high-protein-intake-during-the-early-phase-of-critical-illness-yes-or-no
#20
Jean-Charles Preiser
The rationale for the provision of nitrogen from proteins given via the enteral route or from intravenous amino acids is to boost the synthesis of muscle proteins, and thereby to limit the severity of intensive care unit-acquired weakness by the prevention of muscle loss. However, the optimal timing for supplemental nitrogen provision is a matter of debate and controversy. Indeed, consistent data from retrospective studies support an association between high early protein intakes and better outcomes, while recent post-hoc findings from prospective studies raise safety concerns...
October 25, 2018: Critical Care: the Official Journal of the Critical Care Forum
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