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Post intensive care

Sharon R Lewis, Michael W Pritchard, Oliver J Schofield-Robinson, David Jw Evans, Phil Alderson, Andrew F Smith
BACKGROUND: During intensive care unit (ICU) admission, patients and their carers experience physical and psychological stressors that may result in psychological conditions including anxiety, depression, and post-traumatic stress disorder (PTSD). Improving communication between healthcare professionals, patients, and their carers may alleviate these disorders. Communication may include information or educational interventions, in different formats, aiming to improve knowledge of the prognosis, treatment, or anticipated challenges after ICU discharge...
October 13, 2018: Cochrane Database of Systematic Reviews
Sarah Chuzi, Sarah Hale, Jason Arnold, Amy Zhou, Rebecca Harap, Kathleen L Grady, Jonathan D Rich, Clyde W Yancy, Adeboye Ogunseitan, Eytan Szmuilowicz, Jane E Wilcox
INTRODUCTION: In 2013 the Centers for Medicare and Medicaid Services (CMS) issued a mandate requiring that all patients undergoing destination therapy ventricular assist device (DT VAD) implantation have access to a palliative care team prior to surgery. Subsequently, many VAD programs implemented a mandatory pre-implantation palliative care consultation for patients considering DT VAD. However, little is known about the quality of these consults. METHODS: All patients undergoing DT VAD at Northwestern Memorial Hospital from October 30, 2013 (the CMS decision date) through March 1, 2018 were included...
October 10, 2018: Journal of Pain and Symptom Management
Xiu Wu, Wei Cao, Bin Zhang, Shengyu Wang
INTRODUCTION: The effect of high-flow nasal cannula (HFNC) on adult post cardiothoracic operation remains controversial. We conducted a meta-analysis of randomized controlled trials to evaluate the effect of HFNC and conventional oxygen therapy (COT) on postcardiothoracic surgery. METHODS: A search was conducted in Embase, MEDLINE, Ovid, and Cochrane databases until December, 2017 for all the controlled study to compare HFNC with COT in adult postcardiothoracic surgery...
October 2018: Medicine (Baltimore)
Anibal Basile-Filho, Alessandra Fabiane Lago, Mayra Gonçalves Menegueti, Edson Antonio Nicolini, Roosevelt Santos Nunes, Silas Lucena de Lima, João Paulo Uvera Ferreira, Marcus Antonio Feres
Guidelines for patients with subarachnoid hemorrhage (SAH) management and several grading systems or prognostic indices have been used not only to improve the quality of care but to predict also the outcome of these patients. Among them, the gold standards Fisher radiological grading scale, Hunt-Hess and the World Federation of Neurological Surgeons (WFNS) are the most employed. The objective of this study is to compare the predictive values of simplified acute physiology score (SAPS) 3, sequential organ failure assessment (SOFA), and Glasgow Coma Scale (GCS) in the outcome of patients with aneurysmal SAH...
October 2018: Medicine (Baltimore)
Woo Jong Kim, Hong Seop Lee, Sung Hun Won, Yong Cheol Hong, Dhong Won Lee, Ji-Hye Lee, Chang Hyun Kim
RATIONALE: The Morel-Lavallée lesion (MLL) is a closed degloving injury developing when shear force acts between the muscle fascia and the subcutaneous layer. MLLs develop principally in the trochanteric area or the pelvis; lesions in the proximal calf are rare. Acute lesions can be treated conservatively, but chronic lesions are best treated surgically because of a high rate of recurrence. To the best of our knowledge, this is a rare case of successful treatment of an MLL in the proximal calf associated with tibio-fibular shaft fracture...
October 2018: Medicine (Baltimore)
David Blitzer, Elizabeth H Stephens, Vakhtang Tchantchaleishvili, Xiaoying Lou, Peter Chen, Greg Pattakos, Panos N Vardas
BACKGROUND: Changes in healthcare have led to increasing utilization of Advanced Practice Providers (APPs), but their role in Cardiothoracic Surgery (CTS) education remains undefined. This study aimed to analyze the extent of APP utilization on the CTS team, their role within the hierarchy of clinical care, and the impact of PEs on CTS training from the resident perspective. METHODS: CTS residents' responses to the 2017 Thoracic Surgery Residents Association (TSRA)/Thoracic Surgery Directors Association (TSDA) In-Service Training Examination (ITE) survey regarding the role of APPs in specific clinical scenarios, and perception of APP contribution to residents' educational environment were analyzed...
October 9, 2018: Annals of Thoracic Surgery
Binfei Li, Geqin Sun, Zhou Cheng, Chuangchuang Mei, Xiaozu Liao, Jianwei Li, Yong Yuan
OBJECTIVES: This study aims to analyze the nosocomial infection factors in post-cardiac surgery extracorporeal membrane oxygenation (ECMO) supportive treatment (pCS-ECMO). METHODS: The clinical data of the pCS-ECMO patients who obtained nosocomial infections (NI) were collected and analyzed retrospectively. Among the 74 pCS-ECMO patients, 30 occurred with NI, accounting for 40.5%; a total of 38 pathogens were isolated, including 22 strains of Gram-negative bacteria (57...
September 17, 2018: Heart Surgery Forum
M Neckebroek, C M Ionescu, K van Amsterdam, T De Smet, P De Baets, J Decruyenaere, R De Keyser, M M R F Struys
PURPOSE: We evaluated the feasibility and robustness of three methods for propofol-to-bispectral index (BIS) post-operative intensive care sedation, a manually-adapted target controlled infusion protocol (HUMAN), a computer-controlled predictive control strategy (EPSAC) and a computer-controlled Bayesian rule-based optimized control strategy (BAYES). METHODS: Thirty-six patients undergoing short lasting sedation following cardiac surgery were included to receive propofol to maintain a BIS between 40 and 60...
October 11, 2018: Journal of Clinical Monitoring and Computing
Marco Albertini, Marco Tosi
Previous studies have shown that parental divorce has negative consequences on parent-child relationships and that these effects extend to relations between grandchildren and their grandparents. After parental divorce, grandchildren have less intense and lower quality relations with their grandparents. Some studies suggest that this negative association between union dissolution in the middle generation and grandparent-grandchild relations is explained by the post-divorce residential arrangements and, to a lesser extent, by the gatekeeping role exercised by the resident parent...
September 2018: European Journal of Ageing
Kento Fukumoto, Masaki Anraku
Extracorporeal membrane oxygenation (ECMO) is a temporary mode of providing life support by totally/partially augmenting heart and lung function over a few days to weeks. More than 30,000 cases involving ECMO usage in adults have been reported worldwide since the introduction of this unique therapy, and its applications continue to evolve rapidly. In recent times, ECMO plays a key role not only in the domain of critical care in intensive care units, but is also useful in the field of cardiothoracic surgery;it provides cardiopulmonary support intra- and post-operatively, respiratory support for primary graft dysfunction after lung transplantation and serves as a bridge to lung transplantation...
September 2018: Kyobu Geka. the Japanese Journal of Thoracic Surgery
Malcolm R Battin, Christopher Jd McKinlay
AIM: The aim was to survey the Australian and New Zealand Neonatal Network (ANZNN) member units regarding current services and management guidelines for the ex-premature infant with severe chronic lung disease (CLD) still requiring significant respiratory support at term. METHODS: A 16-question survey was sent to clinical directors of all Level 3 units in Australia and New Zealand via the network. Reminder emails were sent, as required, to prompt a satisfactory response rate...
October 10, 2018: Journal of Paediatrics and Child Health
Giorgia Caspani, Georgina Corbet Burcher, M Elena Garralda, Mehrengise Cooper, Christine M Pierce, Lorraine C Als, Simon Nadel
BACKGROUND: Survivors of critical illness in childhood commonly display subsequent psychiatric symptoms including emotional and behavioural difficulties, and manifestations of post-traumatic stress disorder (PTSD). Anomalies in inflammatory profiles are an established finding in these childhood psychiatric conditions. OBJECTIVE: This exploratory study aimed to investigate whether abnormal peripheral blood inflammatory markers measured during paediatric intensive care unit (PICU) admission were associated with psychiatric symptoms after discharge...
October 9, 2018: Evidence-based Mental Health
David Hahn, Chie Emoto, Joshua C Euteneuer, Tomoyuki Mizuno, Alexander A Vinks, Tsuyoshi Fukuda
Morphine is commonly used for analgesia in the neonatal intensive care unit (NICU) despite having highly variable pharmacokinetics between individual patients. The pharmacogenetic effect of variants at the loci of OCT1 and UGT2B7 on age-dependent morphine clearance were evaluated in a cohort of critically ill neonatal patients using an opportunistic sampling design. Our primary results demonstrate the significant influence of OCT1 genotype (p<0.05) and gestational age (p≤0.005) on morphine pharmacokinetics...
October 9, 2018: Clinical Pharmacology and Therapeutics
Adrian A Coleoglou Centeno, Christopher B Horn, Rohit K Rasane, Jose A Aldana, Qiao Zhang, Kelly M Bochicchio, Grant V Bochicchio, Obeid N Ilahi
BACKGROUND: Clostridium difficile infection (CDI) is an important surgical complication. Emergency general surgery (EGS) is a developing area of the acute care surgical practice. Few studies evaluating the incidence and risk factors of CDI in this patient population are available. PATIENTS AND METHODS: A prospectively maintained Acute and Critical Care Surgery registry spanning from 2008 to 2015 was queried for cases of operative EGS with clinical suspicion of CDI post-operatively...
October 9, 2018: Surgical Infections
Izabela Leahy, Connor Johnson, Steven J Staffa, Reza Rahbar, Lynne R Ferrari
BACKGROUND: The Pediatric Perioperative Surgical Home (PPSH) model is an integrative care model designed to provide better patient care and value by shifting focus from the patient encounter level to the overarching surgical episode of care. So far, no PPSH model has targeted a complex airway disorder. It was hypothesized that the development of a PPSH for laryngeal cleft repair would reduce the high rates of postoperative resource utilization observed in this population. METHODS: Institutional review board approval was obtained for the purpose of data collection and analysis...
October 8, 2018: Anesthesia and Analgesia
Eva Rydahl, Lena Eriksen, Mette Juhl
OBJECTIVE: The objective of this review was to identify, assess and synthesize the best available evidence on the effects of induction prior to post-term on the mother and fetus. Maternal and fetal outcomes after routine labor induction in low-risk pregnancies at 41+0 to 41+6 gestational weeks (prior to post-term) were compared to routine labor induction at 42+0 to 42+6 gestational weeks (post-term). INTRODUCTION: Induction of labor when a pregnancy exceeds 14 days past the estimated due date has long been used as an intervention to prevent adverse fetal and maternal outcomes...
October 5, 2018: JBI Database of Systematic Reviews and Implementation Reports
Carola Saure, Belisario Almeyra Ibarra, Carolina Caminiti, Mariela Krynski, Mercedes Montonati, Ricardo Rodriguez, María Althabe
BACKGROUND: After heart surgery requiring cardiopulmonary bypass, neonates have a profound metabolic response to stress. If adequate nutritional support is not provided this leads to loss of lean mass and deterioration of vital organs. Our objective was to describe the nutritional status and nutritional support achieved in infants younger than 3 months of life undergo in cardiovascular surgery. METHODS: A prospective, descriptive study was conducted in a Pediatric Cardiovascular intensive therapy at tertiary care center...
October 4, 2018: Minerva Pediatrica
Michael E Detsky, Rachel Kohn, Aaron M Delman, Anna E Buehler, Saida A Kent, Isabella V Ciuffetelli, Mark E Mikkelsen, Alison E Turnbull, Michael O Harhay
PURPOSE: To determine how patients perceive their quality of life (QOL) six months following critical illness and to measure clinicians' discriminative accuracy of predicting this outcome. MATERIALS AND METHODS: This prospective cohort study of intensive care unit (ICU) survivors asked patients to report their QOL strictly at six months compared to one month before their critical illness as better, the same, or worse. ICU physicians and nurses made six-month QOL predictions for these patients...
October 1, 2018: Journal of Critical Care
Marc Schluep, Saskia Rijkenberg, Robert Jan Stolker, Sanne Hoeks, Henrik Endeman
PURPOSE: Little is known about long-term survival after In-Hospital Cardiac Arrest (IHCA). The purpose of this study is to report the one-year survival of patients after IHCA and to identify predicting factors. METHODS: Single-center retrospective study of all adult in-hospital CPR attempts conducted between 2003 and 2014 in a tertiary teaching hospital. Demographic and clinical variables of patients were obtained at 24 h pre-arrest, during CPR and post-CPR. All patients were tracked one year after discharge from hospital...
September 27, 2018: Journal of Critical Care
Oscar Mancera-Páez, Gustavo C Román, Rodrigo Pardo-Turriago, Yhojan Rodríguez, Juan-Manuel Anaya
We review post-infectious and post-vaccination neurological syndromes involving peripheral and central nervous system (CNS) and report an illustrative case of simultaneous occurrence of Guillain-Barré syndrome (GBS), confirmed by nerve conduction velocities, plus MRI-demonstrated transverse myelitis (TM) and acute encephalitis [acute disseminated encephalomyelitis] (ADEM+GBS) affecting a 24-year-old woman from Cúcuta, Colombia, who developed acute Zika virus (ZIKV) infection confirmed by serum reverse transcriptase-polymerase chain reaction (RT-PCR) and convalescent ZIKV IgG antibodies...
September 26, 2018: Journal of the Neurological Sciences
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