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Acute and critical care

Lindsay Horton, Jeffrey L Bennett
The current management of acute optic neuritis (ON) is focused on expediting visual recovery through the use of high-dose intravenous corticosteroids. The recent identification of specific autoantibodies associated with central nervous system inflammatory disorders has provided novel insights into immune targets and mechanisms that impact the prognosis, treatment, and recurrence of ON. Therefore, neurologists and ophthalmologists need to be aware of clinical, laboratory, and imaging findings that may provide important clues to the etiology of ON and the potential need for aggressive management...
September 2018: Journal of Neuro-ophthalmology: the Official Journal of the North American Neuro-Ophthalmology Society
S Valade, L Biard, V Lemiale, L Argaud, F Pène, L Papazian, F Bruneel, A Seguin, A Kouatchet, J Oziel, S Rouleau, N Bele, K Razazi, O Lesieur, F Boissier, B Megarbane, N Bigé, N Brulé, A S Moreau, A Lautrette, O Peyrony, P Perez, J Mayaux, E Azoulay
BACKGROUND: Chlamydophila pneumoniae (CP) and Mycoplasma pneumoniae (MP) patients could require intensive care unit (ICU) admission for acute respiratory failure. METHODS: Adults admitted between 2000 and 2015 to 20 French ICUs with proven atypical pneumonia were retrospectively described. Patients with MP were compared to Streptococcus pneumoniae (SP) pneumonia patients admitted to ICUs. RESULTS: A total of 104 patients were included, 71 men and 33 women, with a median age of 56 [44-67] years...
August 13, 2018: Annals of Intensive Care
Daozheng Huang, Huan Ma, Zhiyuan Xiao, Michael Blaivas, Ying Chen, Jianyi Wen, Weixin Guo, Jun Liang, Xiaolong Liao, Zhonghua Wang, Hanbiao Li, Jie Li, Yangong Chao, Xiao Ting Wang, Yan Wu, Tiehe Qin, Ke Su, Shouhong Wang, Ning Tan
BACKGROUND: Lung ultrasound and echocardiography are mainly applied in critical care and emergency medicine. However, the diagnostic value of cardiopulmonary ultrasound in elderly patients with acute respiratory distress syndrome (ARDS) is still unclear. METHODS: Consecutive patients admitted to ICU with the diagnosis of suspected ARDS based on clinical grounds were enrolled. Cardiopulmonary ultrasound was performed as part of monitoring on day 1, day 2 and day 3...
August 13, 2018: BMC Pulmonary Medicine
Laura Rafaela Monteiro de Almeida Maciel, Oellen Stuani Franzosi, Diego Silva Leite Nunes, Sérgio Henrique Loss, Audrey Machado Dos Reis, Bibiana de Almeida Rubin, Silvia Regina Rios Vieira
BACKGROUND: The Nutritional Risk Screening 2002 (NRS-2002) is a widely recommended nutrition risk indicator. Two cut-offs have been proposed for intensive care unit (ICU) patients to classify nutrition risk: ≥3-<5, at risk and ≥5, high risk. To date, no study has directly compared these cut-offs. The aim of this study is to compare the NRS-2002 ICU nutrition risk cut-offs as predictors of clinical outcomes including infections, ICU and hospital mortality, length of stay (LOS), duration of mechanical ventilation (MVd), weaning failure, tracheotomy for prolonged MVd, and chronic critical illness (CCI)...
August 13, 2018: Nutrition in Clinical Practice
Ying Zhou, Qianqian Fan, Omer Cavus, Xuezheng Zhang
Purpose: The purpose of the study was to review and summarize current literature concerning the validation and application of lung ultrasound (LUS) in critically ill patients with acute respiratory distress syndrome (ARDS). Materials and Methods: An extensive literature search was conducted using PubMed, Cochrane Review, Google Scholar, and Ohio State University Link based on the question if LUS should be considered a reliable investigational technique for ARDS diagnosis, treatment, and prognosis in pediatric and adult population...
July 2018: Saudi Journal of Anaesthesia
Puneet Khanna, Ravinder Kumar Pandey, Chandralekha Chandralekha, Ankur Sharma, Neha Pangasa
Background and Objectives: Pain assessment of nonverbal, critically ill patients continues to present a challenge in Intensive Care Unit (ICU). The Critical-Care Pain Observation Tool (CPOT) rates critically ill patients' pain based on clinical observation. In the present study, the accuracy of CPOT was compared with physiological indicators of pain in mechanically ventilated, critically ill patients. Methods: This quantitative prospective observational study was conducted to assess pain in the critically ill, mechanically ventilated patients in comparison to physiologic indicators such as blood pressure and heart rate...
July 2018: Saudi Journal of Anaesthesia
Husayn A Ladhani, Sarah E Posillico, Brenda M Zosa, Emily A Verbus, Christopher P Brandt, Jeffrey A Claridge
BACKGROUND: Our institutional emergency general surgery service is staffed by both trauma and critical care-trained surgeons and other boarded general surgeons and subspecialists. We compared efficiency of care for common emergency general surgery conditions between trauma and critical care-trained surgeons and boarded general surgeons and subspecialists. METHODS: Adults admitted between February 2014 and May 2017 with acute appendicitis, acute cholecystitis, intestinal obstruction, incarcerated hernia, or other acute abdominal diagnoses seen by emergency general surgery service were included...
August 8, 2018: Surgery
Claire E O'Hanlon, Anne M Walling, Edward Okeke, Sharon Stevenson, Neil S Wenger
BACKGROUND: Advance care planning (ACP) is fundamental to guiding medical care at the end of life. Understanding the economic impact of ACP is critical to implementation, but most economic evaluations of ACP focus on only a few actors, such as hospitals. OBJECTIVE: To develop a framework for understanding and quantifying the economic effects of ACP, particularly its distributional consequences, for use in economic evaluations. DESIGN: Literature review of economic analyses of ACP and related costs to estimate magnitude and direction of costs and benefits for each actor and how data on these costs and benefits could be obtained or estimated...
August 10, 2018: Journal of Palliative Medicine
Saritha Marella, Naga Venkata Krishna Vara Prasad Tollamadugu
Diabetes mellitus (DM) is a chronic illness that requires continuing medical care and patient self-management education to prevent acute complications and to reduce the risk of long-term complications. The number of people with diabetes is increasing due to population growth, ageing, urbanisation and increasing prevalence of obesity and physical inactivity. Apart from currently available therapeutic options, many herbal medicines have been recommended for the treatment of diabetes. Herbal drugs are prescribed widely because of their effectiveness, less side effects and relatively low cost...
August 2018: IET Nanobiotechnology
Yasuhiro Norisue, Yoshihisa Fujimoto, Kazuma Nakagawa
Background: Because of the complex pathophysiological processes involved, neurocritical care has been driven by anecdotal experience and physician preferences, which has led to care variation worldwide. Standardization of practice has improved outcomes for many of the critical conditions encountered in the intensive care unit. Main body: In this review article, we introduce preliminary guideline- and pathophysiology-based protocols for (1) prompt shivering management, (2) traumatic brain injury and intracranial pressure management, (3) neurological prognostication after cardiac arrest, (4) delayed cerebral ischemia after subarachnoid hemorrhage, (5) nonconvulsive status epilepticus, and (6) acute or subacute psychosis and seizure...
2018: Journal of Intensive Care
Ayobami T Akenroye, Abayomi Ajala, Elham Azimi-Nekoo, Gabriele S de Vos
BACKGROUND: In asthmatics, making a diagnosis of anaphylaxis could be challenging as respiratory symptoms are a common feature of both conditions. Identifying anaphylaxis is important to providing appropriate care. A prior study showed that anaphylaxis is sometimes misdiagnosed as acute asthma in children. We sought to identify the percentage of adults admitted to the intensive care unit (ICU) with asthma exacerbations who met criteria for anaphylaxis. METHODS: Retrospective chart review of adults admitted with acute asthma to the ICU at Jacobi Medical Center, a Level 1 trauma centre in Bronx, New York...
August 9, 2018: Emergency Medicine Journal: EMJ
Nabil M Elkassabany, Stavros G Memtsoudis, Edward R Mariano
Demonstrating value added to patients' experience through regional anesthesiology and acute pain medicine is critical. Evidence supporting improved outcomes can be derived from prospective studies or retrospective cohort studies. Population-based studies relying on existing clinical and administrative databases are helpful when an outcome is rare and detecting a change would require studying large numbers of patients. This article discusses the effect of regional anesthesiology and acute pain medicine interventions on mortality and morbidity, infection rate, cancer recurrence, inpatient falls, local anesthetic systemic toxicity, persistent postsurgical pain, and health care costs...
September 2018: Anesthesiology Clinics
Kathryn Beck, Angelique Mukantaganda, Scheilla Bayitondere, Richard Ndikuriyo, Almaque Dushimirimana, Vianney Bihibindi, Souzane Nyiranganji, Michel Habiyaremye, Jennifer Werdenberg
In low-resource settings, inpatient case fatality for severe acute malnutrition (SAM) remains high despite evidenced-based protocols and resources to treat SAM. Key reasons include a combination of insufficiently trained staff, poor teamwork and inadequate compliance to WHO treatment guidelines which are proven to reduce mortality. Checklists have been used in surgery and obstetrics to ameliorate similarly complicated yet repetitive work processes and may be a key strategy to improving inpatient SAM protocol adherence and reducing unnecessary death...
2018: Global Health Action
Gerard Fealy, Suzanne Donnelly, Gerardine Doyle, Maria Brenner, Mary Hughes, Elaine Mylotte, Emma Nicholson, Marina Zaki
AIMS/OBJECTIVES: The objectives of this study were to identify how civilian nurses are caring for military veterans following mandatory continuing education (CE) on veterans' mental health needs and to describe challenges nurses are facing in provision of that care. BACKGROUND: Veterans and military personnel experience mental health conditions at a high rate and are increasingly receiving care in civilian healthcare facilities. Non-military providers may not be prepared to address this population's challenging needs...
August 9, 2018: Journal of Clinical Nursing
Stavros Spiliopoulos, Konstantinos Moulakakis, Konstantinos Palialexis, Chrysostomos Konstantos, Lazaros Reppas, Ioannis Kakisis, Andreas Lazaris, George Geroulakos, Elias Brountzos
PURPOSE: To investigate the safety and efficacy of percutaneous stenting for the management of chronic ischemia caused by endograft limb occlusion following endovascular aneurysm repair (EVAR). MATERIALS AND METHODS: This is a retrospective, single-centre study investigating all patients who underwent percutaneous endovascular covered or bare metal stent placement for the management of intermittent claudication (IC) or critical limb ischemia (CLI) following EVAR limb occlusion, between January 2010 and October 2017...
August 6, 2018: Annals of Vascular Surgery
Simona Lattanzi, Francesco Brigo, Eugen Trinka, Claudia Cagnetti, Mario Di Napoli, Mauro Silvestrini
Spontaneous intracerebral hemorrhage (ICH) accounts for approximately 10 to 30% of all acute cerebrovascular events, and it is the type of stroke associated with the highest rates of mortality and residual disability. The inflammatory response is early triggered by hematoma components and can enhance the damage within the hemorrhagic brain. Assessment of peripheral biomarkers of inflammation could contribute to increase knowledge about some of the mechanisms involved in the ICH-induced injury and yield information on the disease course...
August 8, 2018: Translational Stroke Research
Manish Gutch, Sukriti Kumar, Keshav Kumar Gupta
Background: Patients suffering from critical illness admitted to the Intensive Care Unit (ICU) exhibit alterations in their thyroid hormone levels, collectively termed as euthyroid sick syndrome or nonthyroidal illness syndrome. Our study was conducted to determine the correlation between these changes in thyroid hormone levels and the prognosis of ICU-admitted patients. Methods: A total of 270 ICU-admitted patients without previous history of thyroid disorder were included in the study...
May 2018: Indian Journal of Endocrinology and Metabolism
Yong-Gang Wang, Jian-Cang Zhou, Kang-Song Wu
Objective This study was performed to explore the characteristics and outcomes of patients with sepsis accompanied by active cancer who were admitted to the intensive care unit (ICU). Methods The baseline characteristics, infection profiles, and outcomes of patients with sepsis were retrospectively analyzed according to the presence of concomitant active cancer. The association between concomitant active cancer and 28-day mortality was explored. Results Of 23,956 patients with sepsis, 1574 (6.6%) had concomitant active cancer...
August 8, 2018: Journal of International Medical Research
Kathryn O Mansel, Sophia W Chen, April A Mathews, M David Gothard, Michael T Bigham
BACKGROUND: Children admitted to the general care floor sometimes require acute escalation of care and rapid transfer (RT) to the PICU shortly after admission. In this study, we aim to investigate the characteristics of RTs and the impact RTs have on patient outcomes, including PICU length of stay (LOS), mortality, and emergency transfer defined as critical care interventions occurring within 1 hour on either side of transfer to the PICU. METHODS: We conducted a 2-year, single-center, retrospective analysis including all patients admitted to the general care floor of a tertiary children's hospital that were subsequently transferred to the PICU, with attention to those transferred within 4 hours of admission, meeting criteria as RTs...
August 7, 2018: Hospital Pediatrics
Philip Yang, Perry Formanek, Steven Scaglione, Majid Afshar
AIM: Prior randomized controlled trials of acute respiratory distress syndrome (ARDS) excluded critically ill patients with cirrhosis. Data regarding risk factors for ARDS development and outcomes from ARDS in patients with cirrhosis are scarce. We sought to characterize outcomes from ARDS in patients with cirrhosis. METHODS: An observational cohort of patients with cirrhosis admitted to an intensive care unit (ICU) at a high-volume liver transplant center between January 1, 2012 and December 31, 2014 were reviewed...
August 7, 2018: Hepatology Research: the Official Journal of the Japan Society of Hepatology
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