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https://www.readbyqxmd.com/read/30105600/association-of-frailty-with-short-term-outcomes-organ-support-and-resource-use-in-critically-ill-patients
#1
Fernando G Zampieri, Theodore J Iwashyna, Elizabeth M Viglianti, Leandro U Taniguchi, William N Viana, Roberto Costa, Thiago D Corrêa, Carlos Eduardo N Moreira, Marcelo O Maia, Giulliana M Moralez, Thiago Lisboa, Marcus A Ferez, Carlos Eduardo F Freitas, Clayton B de Carvalho, Bruno F Mazza, Mariza F A Lima, Grazielle V Ramos, Aline R Silva, Fernando A Bozza, Jorge I F Salluh, Marcio Soares
PURPOSE: Frail patients are known to experience poor outcomes. Nevertheless, we know less about how frailty manifests itself in patients' physiology during critical illness and how it affects resource use in intensive care units (ICU). We aimed to assess the association of frailty with short-term outcomes and organ support used by critically ill patients. METHODS: Retrospective analysis of prospective collected data from 93 ICUs in Brazil from 2014 to 2015. We assessed frailty using the modified frailty index (MFI)...
August 13, 2018: Intensive Care Medicine
https://www.readbyqxmd.com/read/30101630/the-challenge-of-avoiding-intubation-in-immunocompromised-patients-with-acute-respiratory-failure
#2
Audrey de Jong, Laure Calvet, Virginie Lemiale, Alexandre Demoule, Djamel Mokart, Michael Darmon, Samir Jaber, Elie Azoulay
A growing number of immunocompromised (IC) patients with acute hypoxemic respiratory failure (ARF) is admitted to the intensive care unit (ICU) worldwide. Initial management of these patients aims primarily to avoid invasive mechanical ventilation (IMV), while adequately managing hypoxemia. Areas covered: This review provides an overview of the current knowledge of the ways to prevent intubation in IC patients with ARF, including discussion about optimal timing of ICU admission, available respiratory support therapies and the best ways to identify ARF etiology...
August 12, 2018: Expert Review of Respiratory Medicine
https://www.readbyqxmd.com/read/30100569/levosulpiride-induced-neuroleptic-malignant-syndrome-in-rheumatoid-arthritis
#3
Devashish Desai, Kartik Gupta, Rohit Kumar, Ashutosh Biswas
A 53-year-old woman, known case of diabetes mellitus and rheumatoid arthritis, presented with a 4-day history of hyperthermia, rigidity, tremor and altered sensorium. She developed these symptoms after having been administered parenteral levosulpiride to control vomiting due to secondary adrenal insufficiency. We managed her as a case of life-threatening neuroleptic malignant syndrome (NMS) requiring mechanical ventilation, bromocriptine and other supportive care. She subsequently recovered and was discharged in a stable condition...
August 11, 2018: BMJ Case Reports
https://www.readbyqxmd.com/read/30100192/differences-in-code-status-and-end-of-life-decision-making-in-patients-with-limited-english-proficiency-in-the-intensive-care-unit
#4
Amelia Barwise, Carolina Jaramillo, Paul Novotny, Mark L Wieland, Charat Thongprayoon, Ognjen Gajic, Michael E Wilson
OBJECTIVE: To determine whether code status, advance directives, and decisions to limit life support were different for patients with limited English proficiency (LEP) in the intensive care unit (ICU) as compared with patients whose primary language was English. PATIENTS AND METHODS: We conducted a retrospective cohort study in adult patients admitted to 7 ICUs in a single tertiary academic medical center from May 31, 2011, through June 1, 2014. RESULTS: Of the 27,523 patients admitted to the ICU, 779 (2...
August 9, 2018: Mayo Clinic Proceedings
https://www.readbyqxmd.com/read/30100095/acute-postobstructive-pulmonary-edema-following-laryngospasm-in-elderly-patients-a-case-report
#5
Yan Chen, Xu Zhang
Only a few cases regarding postobstructive pulmonary edema following laryngospasm in older patients aged more than 60 years have been reported; however, acute pulmonary edema or pulmonary hemorrhage would be more deadly to elderly patients who have cerebrovascular disease than young healthy adults. After review of the literature, we report an unusual case of a 67-year-old man with ischemic cerebrovascular disease, who underwent carotid angioplasty and stenting and experienced severe pulmonary edema and hemorrhage secondary to laryngospasm after general anesthesia with laryngeal mask airway...
August 9, 2018: Journal of Perianesthesia Nursing: Official Journal of the American Society of PeriAnesthesia Nurses
https://www.readbyqxmd.com/read/30097185/-anesthesia-and-perioperative-challenges-for-surgical-separation-of-thoraco-omphalopagus-twins-case-report
#6
Milton Halyson Benevides de Freitas, Luciana Cavalcanti Lima, Tania Cursino de Menezes Couceiro, Maria Célia Ferreira da Costa, Márcio Handerson Benevides de Freitas
BACKGROUND AND OBJECTIVES: Conjoined twins are monozygotic twins physically joined at some part of the body. This is a rare phenomenon, estimated between 1:50,000 to 1:200,000 births. The objective of this report is to present the anesthetic management and the perioperative challenges for a separation surgery. CASE REPORT: Thoraco-omphalopagus twins were diagnosed by ultrasound and were followed by the fetal medicine team of the service. After 11hours of cesarean, the pediatric surgical team chose to separate the twins...
August 7, 2018: Revista Brasileira de Anestesiologia
https://www.readbyqxmd.com/read/30096466/the-temporal-effect-of-category-ii-fetal-monitoring-on-neonatal-outcomes
#7
Tal Weissbach, Ishai Heusler, Michal Ovadia, Liron David, Yair Daykan, Faye Schreiber, Tal Biron-Shental
OBJECTIVE: To correlate the duration of Category II cardiotocograms (CTG) with adverse neonatal outcomes associated with perinatal asphyxia and determine the duration before fetal compromise. STUDY DESIGN: This retrospective, observational study used electronic medical record data from a cohort of 271 patients, delivered by C-section due to non-reassuring fetal heart rate, at a tertiary medical center, from 2015 through 2017. Duration of Category II CTG, variability, tachycardia and deceleration frequency were analyzed and correlated to immediate postnatal outcomes...
July 30, 2018: European Journal of Obstetrics, Gynecology, and Reproductive Biology
https://www.readbyqxmd.com/read/30095746/randomized-study-of-early-continuous-positive-airways-pressure-in-acute-respiratory-failure-in-children-with-impaired-immunity-scarf-isrctn82853500
#8
Mark J Peters, Rachel Agbeko, Peter Davis, Nigel Klein, Zohra Zenasi, Amy Jones, Christine Mackerness, Susan George, Paul Veys, Samiran Ray, Paul R Mouncey, David A Harrison, Kathy Rowan
OBJECTIVES: Previous trials in adults with impaired immunity and respiratory failure suggest that early noninvasive ventilation avoids endotracheal intubation and improves survival. No randomized clinical trials have addressed this question in children. DESIGN: We undertook an open, parallel-group randomized trial in three pediatric hospitals. SUBJECTS: Children with impaired immunity and acute respiratory failure defined as tachypnoea (> 90th centile); a new requirement for supplemental oxygen; and new chest radiograph infiltrates...
August 7, 2018: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/30095500/extracorporeal-membrane-oxygenation-can-successfully-support-patients-with-severe-acute-respiratory-distress-syndrome-in-lieu-of-mechanical-ventilation
#9
Chitaru Kurihara, James M Walter, Benjamin D Singer, Hector Cajigas, Shahriar Shayan, Abbas Al-Qamari, Malcolm M DeCamp, Rich Wunderink, G R Scott Budinger, Ankit Bharat
OBJECTIVES: Extracorporeal membrane oxygenation is increasingly used in the management of severe acute respiratory distress syndrome. With extracorporeal membrane oxygenation, select patients with acute respiratory distress syndrome can be managed without mechanical ventilation, sedation, or neuromuscular blockade. Published experience with this approach, specifically with attention to a patient's respiratory drive following cannulation, is limited. DESIGN: We describe our experience with three consecutive patients with severe acute respiratory distress syndrome supported with right jugular-femoral configuration of venovenous extracorporeal membrane oxygenation without therapeutic anticoagulation as an alternative to lung-protective mechanical ventilation...
August 7, 2018: Critical Care Medicine
https://www.readbyqxmd.com/read/30095035/effects-of-reinstitution-of-prolonged-mechanical-ventilation-on-the-outcomes-of-370-patients-in-a-long-term-acute-care-hospital
#10
Giorgio R Sansone, J Dermot Frengley, Allan Horland, John J Vecchione, Robert J Kaner
OBJECTIVE: To investigate the effects of the reinstitution of continuous mechanical ventilator support of >21 days in 370 prolonged mechanical ventilation (PMV) patients, all free from ventilator support for ≥5 days. METHODS: Four groups were formed based on the time and number of PMV reinstitutions and compared (group A: reinstitutions within 28 days, n = 51; group B: a single reinstitution after 28 days, n = 53; group C: multiple reinstitutions after 28 days, n = 52; and group D: no known reinstitutions, n = 214)...
September 2018: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/30093997/conservative-management-of-pelvic-sepsis-with-severe-shock-and-multiple-organ-dysfunction-syndrome-after-rubber-band-ligation-of-internal-haemorrhoids-surgery-is-not-the-only-option
#11
Bojana Misheva, Roy Hajjar, Frédéric Mercier, Frank Schwenter, Herawaty Sebajang
Rubber-band ligation (RBL) is a safe and cost-effective approach to internal haemorrhoids. Potential side effects include pain, bleeding, urinary retention and occasionally pelvic sepsis and systemic inflammatory response syndrome (SIRS). At-risk patients are mainly those with immunocompromising conditions. Although aggressive surgical debridement or diverting colostomy appear to be obvious options when patients' life is threatened, their superiority to conservative measures has not been proven. We present the case of a 58-year-old female patient who presented 48 h after a RBL with pelvic pain, dysuria and leukocytosis...
August 2018: Journal of Surgical Case Reports
https://www.readbyqxmd.com/read/30093540/down-syndrome-and-the-risk-of-severe-rsv-infection-a-meta-analysis
#12
REVIEW
Andrea A Beckhaus, Jose A Castro-Rodriguez
CONTEXT: Down syndrome (DS) is the most common chromosomal condition in live-born infants worldwide, and lower respiratory infection caused by respiratory syncytial virus (RSV) is a leading cause of hospital admissions. OBJECTIVE: To evaluate RSV-associated morbidity among children with DS compared with a population without DS. DATA SOURCES: Four electronic databases were searched. STUDY SELECTION: All cohorts or case-control studies of DS with an assessment of RSV infection and the associated morbidity or mortality were included without language restriction...
August 9, 2018: Pediatrics
https://www.readbyqxmd.com/read/30090668/white-cord-syndrome-a-devastating-complication-of-spinal-decompression-surgery
#13
Vayara P Vinodh, Senthil K Rajapathy, Pulivendhan Sellamuthu, Regunath Kandasamy
Background: Reperfusion injury of the spinal cord or "white cord syndrome" refers to the sudden onset of neurological deterioration after spinal decompressive surgery. Associated magnetic resonance (MR) findings only include focal hyperintensity on T2-weighted images without any other pathological changes. Case Description: A patient with cervical stenosis secondary to metastatic tumor in the intradural and extradural compartments presented with lower limb paraparesis...
2018: Surgical Neurology International
https://www.readbyqxmd.com/read/30089091/less-is-more-modern-neonatology
#14
REVIEW
Amir Kugelman, Liron Borenstein-Levin, Huda Jubran, Gil Dinur, Shlomit Ben-David, Elena Segal, Julie Haddad, Fanny Timstut, Iris Stein, Imad R Makhoul, Ori Hochwald
Iatrogenesis is more common in neonatal intensive care units (NICUs) because the infants are vulnerable and exposed to prolonged intensive care. Sixty percent of extremely low-birth-weight infants are exposed to iatrogenesis. The risk factors for iatrogenesis in NICUs include prematurity, mechanical or non-invasive ventilation, central lines, and prolonged length of stay. This led to the notion that "less is more." In the delivery room delayed cord clamping is recommended for term and preterm infants, and suction for the airways in newborns with meconium-stained fluid is not performed anymore...
July 30, 2018: Rambam Maimonides Medical Journal
https://www.readbyqxmd.com/read/30088861/successful-treatment-of-canine-acute-respiratory-distress-syndrome-secondary-to-inhalant-toxin-exposure
#15
Thomas D Greensmith, Stefano Cortellini
OBJECTIVE: To describe the successful management of a dog with acute respiratory distress syndrome secondary to inhalant toxin exposure. CASE SUMMARY: An 8-year-old male neutered Greyhound was referred with severe respiratory distress 56 hours after exposure to an aerosol toxicant. The patient developed respiratory difficulties requiring veterinary attention within 12 hours of initial exposure. Treatment at the referral hospital included mechanical ventilation and supportive care...
August 8, 2018: Journal of Veterinary Emergency and Critical Care
https://www.readbyqxmd.com/read/30084977/lung-donation-after-circulatory-determined-death-a-single-centre-experience
#16
Cristina Barbero, Simon Messer, Ayyaz Ali, David P Jenkins, John Dunning, Steven Tsui, Jasvir Parmar
OBJECTIVES: Donor organ utilization and shortage remain the major limitations to the opportunity of a lung transplantation (LTx). Donation after circulatory determined death (DCD) has been adopted as a source of additional organs worldwide. However, concerns about organ quality and ischaemia-reperfusion injury have limited its application. The aim of this study was to retrospectively analyse a single-centre experience in the DCD LTx and compare early and mid-term outcomes with those from a standard donation after brain death (DBD)...
August 1, 2018: European Journal of Cardio-thoracic Surgery
https://www.readbyqxmd.com/read/30083346/a-favorable-outcome-of-intensive-immunotherapies-for-new-onset-refractory-status-epilepticus-norse
#17
Satoshi Kodama, Noritoshi Arai, Akiyoshi Hagiwara, Akio Kimura, Sousuke Takeuchi
Background: New-onset refractory status epilepticus (NORSE) is a newly defined critical disease entity characterized by prolonged periods of refractory epileptic seizure with no readily identifiable cause in otherwise healthy individuals. Its etiology is uncertain, but autoimmune encephalitis is a possible candidate for the underlying cause of this condition. Immunotherapies could be considered for this condition, but its efficacy is not established. Case presentation: A 31-year-old man with no prior history presented with refractory status epilepticus...
2018: Journal of Intensive Care
https://www.readbyqxmd.com/read/30080701/epidemiology-of-icu-acquired-pneumonia
#18
Miquel Ferrer, Antoni Torres
PURPOSE OF REVIEW: Review of the epidemiology of ICU-acquired pneumonia, including both ventilator-associated pneumonia (VAP) and hospital-acquired pneumonia (HAP) in nonventilated ICU patients, with critical review of the most recent literature in this setting. RECENT FINDINGS: The incidence of ICU-acquired pneumonia, mainly VAP has decrease significantly in recent years possibly due to the generalized implementation of preventive bundles. However, the exact incidence of VAP is difficult to establish due to the diagnostic limitations and the methods employed to report rates...
August 2, 2018: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/30079751/intensive-care-outcomes-and-mortality-prediction-at-a-national-referral-hospital-in-western-kenya
#19
Hussain S Lalani, Wangari Waweru-Siika, Thomas Mwogi, Protus Kituyi, Joseph R Egger, Lawrence P Park, Peter S Kussin
RATIONALE: The burden of critical care is greatest in resource-limited settings (RLS). Intensive care unit (ICU) outcomes at public hospitals in Kenya are unknown. This study is timely given the Ministry of Health initiative to expand ICU capacity. OBJECTIVES: Identify factors associated with mortality at Moi Teaching and Referral Hospital; validate the Mortality Probability Admission Model-II0 (MPM-II0). METHODS: A retrospective cohort of 450 patients from January 1, 2013 to April 5, 2015 was evaluated using demographics, presenting diagnoses, interventions, mortality, and cost data...
August 4, 2018: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/30079494/the-axial-anatomy-of-monitor-lizards-varanidae
#20
Robert L Cieri
Because the musculoskeletal anatomy of the trunk is the framework for the behaviors of locomotion, ventilation, and body support in lepidosaurs, comparative study of trunk anatomy in this group is critical for unraveling the selective pressures leading to extant diversity in axial form and function among vertebrates. This work uses gross dissection and computed tomography to describe the muscular and skeletal anatomy of the trunk of varanid lizards (Varanidae, Anguimorpha). Gross muscle dissections were conducted to investigate the axial muscular anatomy of Varanus exanthematicus, Varanus giganteus, Varanus rosenbergi, and Varanus panoptes...
August 6, 2018: Journal of Anatomy
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