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Acute and critical care

Pedro Bichaff, Karina T Setani, Emiliana H G Motta, Artur F Delgado, Werther B Carvalho, Michele Luglio
OBJECTIVE: Opioid abstinence syndrome is common in the pediatric intensive care environment because sedation is often needed during the children's treatment. There is no specific guideline regarding the management of these patients; and lately, methadone is an important drug for the prevention of abstinence symptoms during the weaning of opioids. This study gathers the available research to establish the initial dose of methadone, the rate of taper and tools to recognize this syndrome and act promptly...
October 2018: Revista da Associação Médica Brasileira
Chethan P Venkatasubba Rao, Jose I Suarez
PURPOSE OF REVIEW: This article provides updated information regarding the diagnosis and treatment (specifically critical care management) of acute ischemic stroke. This article also discusses the increased use of thrombolysis and thrombectomy in clinical practice. RECENT FINDINGS: Stroke is the leading cause of disability in the United States. A significant proportion of patients with acute ischemic stroke require critical care management. Much has changed in the early evaluation and treatment of patients presenting with acute ischemic stroke...
December 2018: Continuum: Lifelong Learning in Neurology
Bruno L Ferreyro, Laveena Munshi
PURPOSE OF REVIEW: A wide spectrum of heterogeneous conditions can render a patient immunocompromised. Recent years have seen an increase in the number of immunocompromised patients given the earlier detection of conditions that require immunosuppressive therapies, changes in immunosuppressive regimens leading to increased survival or novel therapeutic advancements in oncologic care. Acute respiratory failure (ARF) is the leading cause of critical illness and mortality in this population...
December 3, 2018: Current Opinion in Critical Care
Toyin Tofade, Brian M Shepler, Donna M Feudo, Mara A Kieser, Christene Jolowsky, Monica L Miller, Donald Sullivan, Susan S Vos, Mark Brueckl, Paul C Walker
INTRODUCTION: With over a third of the doctor of pharmacy curriculum relying on experiential education (EE), it is critical that students are assessed and graded in accordance with their actual performance. The objective of this paper is to review advanced pharmacy practice experience (APPE) grading across the Big Ten Academic Alliance to describe how APPE grading occurs at these institutions and highlight differences in approach and outcomes. METHODS: Experiential directors/deans were asked to import de-identified data (e...
November 2018: Currents in Pharmacy Teaching & Learning
Yoshiaki Iwashita, Kazuto Yamashita, Hiroshi Ikai, Masamitsu Sanui, Hiroshi Imai, Yuichi Imanaka
BACKGROUND: In most countries, patients receiving mechanical ventilation (MV) are treated in intensive care units (ICUs). However, in some countries, including Japan, many patients on MV are not treated in ICUs. There are insufficient epidemiological data on these patients. Here, we sought to describe the epidemiology of patients on MV in Japan by comparing and contrasting patients on MV treated in ICUs and in non-ICU settings. A preliminary comparison of patient outcomes between ICU and non-ICU patients was a secondary objective...
December 4, 2018: Critical Care: the Official Journal of the Critical Care Forum
Lichen Xu, Shuangwei Ying, Jianhua Hu, Yunyun Wang, Meifang Yang, Tiantian Ge, Chunhong Huang, Qiaomai Xu, Haihong Zhu, Zhi Chen, Weihang Ma
BACKGROUND: Cirrhosis always goes with profound immunity compromise, and makes those patients easily be the target of pneumonia. Cirrhotic patients with pneumonia have a dramatically increased mortality. To recognize the risk factors of mortality and to optimize stratification are critical for improving survival rate. METHODS: Two hundred and three cirrhotic patients with pneumonia at a tertiary care hospital were included in this retrospective study. Demographical, clinical and laboratory parameters, severity models and prognosis were recorded...
December 4, 2018: Respiratory Research
Prashant Parulekar, Ed Neil-Gallacher, Alex Harrison
Acute kidney injury is common in critically ill patients, with ultrasound recommended to exclude renal tract obstruction. Intensive care unit clinicians are skilled in acquiring and interpreting ultrasound examinations. Intensive Care Medicine Trainees wish to learn renal tract ultrasound. We sought to demonstrate that intensive care unit clinicians can competently perform renal tract ultrasound on critically ill patients. Thirty patients with acute kidney injury were scanned by two intensive care unit physicians using a standard intensive care unit ultrasound machine...
November 2018: Journal of the Intensive Care Society
(no author information available yet)
No abstract text is available yet for this article.
December 2018: Critical Care Nurse
Justin L Regner, Courtney N Shaver
INTRODUCTION: Venous thromboembolism (VTE) remains one of the principal causes of morbidity and death in trauma patients that survive the first 24 h. Recent literature on VTE prevention focuses on choice of chemoprophylaxis, specifically unfractionated heparin (UFH) versus low molecular weight heparin (LMWH). This singular focus on a multifactorial process may be inadequate to fully understand the optimal approach to VTE prevention. We hypothesized that variations in care between trauma centers could be used to identify key components of VTE prevention associated with better outcomes...
November 20, 2018: American Journal of Surgery
Pragasan Dean Gopalan, Santosh Pershad
BACKGROUND: The ICU is a scarce resource within a high-stress, high-stakes, time-sensitive environment where critically ill patients with life-threatening conditions receive expensive life-sustaining care under the guidance of expert qualified personnel. The implications of decisions such as suitability for admission into ICU are potentially dire and difficult. OBJECTIVES: To conduct a systematic review of clinicians' subjective perceptions of factors that influence the decision to accept or refuse patients referred to ICU...
November 22, 2018: Journal of Critical Care
Lisa A Fortier, Eric J Strauss, David O Shepard, Liliya Becktell, John G Kennedy
With our aging population desiring to remain active, the incidence and costs associated with managing knee pain from both acute injury and symptomatic knee osteoarthritis continue to dramatically increase. Current treatment methods fall short with respect to their ability to improve the intra-articular environment and restore normal joint homeostasis. With increasing basic science and clinical evidence showing efficacy, cell-based therapies such as bone marrow concentrate (BMC) hold promise as a nonsurgical joint preserving treatment approach...
November 30, 2018: Journal of Knee Surgery
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
Sarah Switzer, Soo Chan Carusone, Adrian Guta, Carol Strike
Recently, scholars have begun to critically interrogate the way community participation functions discursively within community-based participatory research (CBPR) and raise questions about its function and limits. Community advisory committees (CACs) are often used within CBPR as one way to involve community members in research from design to dissemination. However, CACs may not always be designed in ways that are accessible for communities experiencing the intersections of complex health issues and marginalization...
November 30, 2018: Qualitative Health Research
Sean Esmonde, Divyesh Sharma, Aaron Peace
Despite over 40 years since the first percutaneous coronary intervention (PCI) was performed, the optimal dual antiplatelet therapy (DAPT) regime poses a significant challenge for clinicians, especially in certain scenarios. DAPT is the standard of care in PCI following an acute coronary syndrome (ACS) or for elective patients with obstructive coronary artery disease (CAD). There remains significant uncertainty regarding DAPT in patients at high risk of bleeding, such as the elderly and patients requiring anticoagulation...
October 2018: Cardiovascular Diagnosis and Therapy
H W He, D W Liu, Y Long, X T Wang, C Yu, B Yao, R Zhang
Objective: The relationship of venous-to-arterial CO(2) difference(Pv-aCO(2))/arterial-central venous O(2) difference (Ca-vO(2)) ratio, peripheral perfusion index(PI) and lactate clearance(LC) were investigated during resuscitation in septic patients. And, the meaning of the combination PI and Pv-aCO(2)/Ca-vO(2) ratio to interpret incoherence of lactate clear was explored. Methods: The patients with sepsis were prospectively observed, who admitted to critically care medicine department of Peking Union Medical College Hospital...
December 1, 2018: Zhonghua Nei Ke za Zhi [Chinese Journal of Internal Medicine]
Igor Barjaktarevic, Roxana Cortes Lopez, Randolph Steadman, Christopher Wray, Nida Qadir, Steven Y Chang, Tisha Wang
Liver transplantation (LT) has the potential to cure patients with acute and chronic liver failure as well as a number of hepatic and biliary malignancies. Over time, due to the increasing demand for organs as well as improvements in the survival of LT recipients, patients awaiting LT have become sicker, and often undergo the procedure while critically ill. This trend has made the process of preoperative assessment and planning, intraoperative management, and postoperative management even more crucial to the success of LT programs...
October 2018: Seminars in Respiratory and Critical Care Medicine
Amanda Cheung, Sajal Tanna, Michael G Ison
Infections remain a leading cause of morbidity and mortality among patients with liver failure. A number of factors, including relative immune dysfunction and systemic inflammation, bacterial translocation, gut dysbiosis, small intestine bacterial overgrowth, altered bile acid pools, and changes in pH due to acid suppression, contribute to the high rates of infection in this population. Though a range of infections can complicate the course of cirrhotic patients, spontaneous bacterial peritonitis (SBP), cholangitis, and cholecystitis in addition to other infections (i...
October 2018: Seminars in Respiratory and Critical Care Medicine
Anthony Bonavia, Kai Singbartl
The liver and kidney are key organs of metabolic homeostasis in the body and display complex interactions. Liver diseases often have direct and immediate effects on renal physiology and function. Conversely, acute kidney injury (AKI) is a common problem in patients with both acute and chronic liver diseases. AKI in patients with acute liver failure is usually multifactorial and involves insults similar to those seen in the general AKI population. Liver cirrhosis affects and is directly affected by aberrations in systemic and renal hemodynamics, inflammatory response, renal handling of sodium and free water excretion, and additional nonvasomotor mechanisms...
October 2018: Seminars in Respiratory and Critical Care Medicine
Nida Qadir, Tisha Wang, Igor Barjaktarevic, Steven Y Chang
Acute respiratory failure has a high mortality in patients with end-stage liver disease (ESLD). These patients may develop acute respiratory failure for reasons specific to advanced liver disease, including hepatopulmonary syndrome, portopulmonary hypertension, and hepatic hydrothorax. They may also develop respiratory complications due to conditions seen in the general intensive care unit population to which ESLD patients are at higher risk, including infection, volume overload, and the acute respiratory distress syndrome...
October 2018: Seminars in Respiratory and Critical Care Medicine
Suzanne Forsyth Herling, Ingrid E Greve, Eduard E Vasilevskis, Ingrid Egerod, Camilla Bekker Mortensen, Ann Merete Møller, Helle Svenningsen, Thordis Thomsen
BACKGROUND: Delirium is defined as a disturbance in attention, awareness and cognition with reduced ability to direct, focus, sustain and shift attention, and reduced orientation to the environment. Critically ill patients in the intensive care unit (ICU) frequently develop ICU delirium. It can profoundly affect both them and their families because it is associated with increased mortality, longer duration of mechanical ventilation, longer hospital and ICU stay and long-term cognitive impairment...
November 23, 2018: Cochrane Database of Systematic Reviews
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