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https://www.readbyqxmd.com/read/30543176/shock-classification-and-pathophysiological-principles-of-therapeutics
#1
Olga N Kislitsina, Jonathan D Rich, Jane E Wilcox, Duc T Pham, Andrei Churyla, Esther B Vorovich, Kambiz Ghafourian, Clyde W Yancy
The management of patients with shock is extremely challenging because of the myriad of possible clinical presentations in cardiogenic shock, septic shock and hypovolemic shock and the limitations of contemporary therapeutic options. The treatment of shock includes the administration of endogenous catecholamines (epinephrine, norepinephrine, and dopamine) as well as various vasopressor agents that have shown efficacy in the treatment of the various types of shock. In addition to the endogenous catecholamines, dobutamine, isoproterenol, phenylephrine, and milrinone have served as the mainstays of shock therapy for several decades...
December 12, 2018: Current Cardiology Reviews
https://www.readbyqxmd.com/read/30539349/closed-loop-vasopressor-control-in-silico-study-of-robustness-against-pharmacodynamic-variability
#2
Joseph Rinehart, Alexandre Joosten, Michael Ma, Michael-David Calderon, Maxime Cannesson
Initial feasibility of a novel closed-loop controller created by our group for closed-loop control of vasopressor infusions has been previously described. In clinical practice, vasopressor potency may be affected by a variety of factors including other pharmacologic agents, organ dysfunction, and vasoplegic states. The purpose of this study was therefore to evaluate the effectiveness of our controller in the face of large variations in drug potency, where 'effective' was defined as convergence on target pressure over time...
December 11, 2018: Journal of Clinical Monitoring and Computing
https://www.readbyqxmd.com/read/30537533/impact-of-a-multimodal-strategy-combining-a-new-standard-of-care-and-restriction-of-carbapenems-fluoroquinolones-and-cephalosporins-on-antibiotic-consumption-and-resistance-of-p-aeruginosa-in-an-icu
#3
Salam Abbara, Aurélia Pitsch, Sébastien Jochmans, Kyann Hodjat, Dr Pascale Cherrier, Mehran Monchi, Christophe Vinsonneau, Sylvain Diamantis
OBJECTIVES: To assess if the postprescription review and feedback (PPRF) of all antibiotics with restriction of carbapenems, fluoroquinolones and third generation cephalosporins, along with a change of medical standard of care, impacted the consumption of antibiotics and bacterial resistance in a medical/surgical intensive care unit (MSICU). METHODS: A four years before (2007-2010) and after (2011-2014) retrospective comparative study. Antibiotics consumption was evaluated in Defined Daily Doses per 1000 patient days...
December 8, 2018: International Journal of Antimicrobial Agents
https://www.readbyqxmd.com/read/30526494/vasoplegia-after-implantation-of-a-continuous-flow-left-ventricular-assist-device-incidence-outcomes-and-predictors
#4
Eric E C de Waal, Bas van Zaane, Marnix M van der Schoot, Albert Huisman, Faiz Ramjankhan, Wilton A van Klei, Nandor Marczin
BACKGROUND: Vasoplegia after routine cardiac surgery is associated with severe postoperative complications and increased mortality. It is also prevalent in patients undergoing implantation of pulsatile flow left ventricular assist devices (LVAD). However, less is known regarding vasoplegia after implantation of newer generations of continuous flow LVADs (cfLVAD). We aim to report the incidence, impact on outcome and predictors of vasoplegia in these patients. METHODS: Adult patients scheduled for primary cfLVAD implantation were enrolled into a derivation cohort (n = 118, 2006-2013) and a temporal validation cohort (n = 73, 2014-2016)...
December 8, 2018: BMC Anesthesiology
https://www.readbyqxmd.com/read/30523516/co-2-embolism-can-complicate-transanal-total-mesorectal-excision
#5
C R Harnsberger, K Alavi, J S Davids, P R Sturrock, M Zayaruzny, J A Maykel
BACKGROUND: Carbon dioxide (CO2 ) embolism is a rare but potentially devastating complication of minimally invasive abdominal and retroperitoneal surgery. Characterized by a decrease in end-tidal CO2 (ETCO2 ) and oxygen saturation (SpO2 ), CO2 emboli can cause rapid intraoperative hypotension and cardiovascular collapse. Transanal total mesorectal excision (taTME) is a novel surgical approach for rectal resection, which requires high flow CO2 insufflation in a low volume operative field...
December 6, 2018: Techniques in Coloproctology
https://www.readbyqxmd.com/read/30511646/-finger-necrosis-following-arterial-cannulation-a-case-report
#6
Atli Steinn Valgardsson, Sigurbergur Karason, Elin Laxdal, Kristin Huld Haraldsdottir
Arterial cannulation is a common procedure in critically ill patients, as it facilitates continuous monitoring of blood pressure, titration of inotropes, vasopressors and fluids and is also used for blood sampling. Serious complications from arterial lines are very rare, permanent ischemic damage occurs in less than 0,1% of patients. We report the case of a 60-year-old woman in septic shock caused by a perforated duodenal ulcer which was treated with emergent laparoscopic repair. She required high doses of vasopressors and received several arterial lines, including lines in both the ulnar and the radial arteries of the left arm...
December 2018: Læknablađiđ
https://www.readbyqxmd.com/read/30511562/evidence-for-vasopressors-during-cardiopulmonary-resuscitation-in-newborn-infants
#7
Megan O'reilly, Georg M Schmölzer
An estimated 0.1% of term infants and up to 15% of preterm infants (2-3 million worldwide) need extensive resuscitation, defined as chest compression and 100% oxygen with or without epinephrine in the delivery room. Despite these interventions, infants receiving extensive resuscitation in the DR have a high incidence of mortality and neurologic morbidity. Successful resuscitation from neonatal cardiac arrest requires the delivery of high-quality chest compression using the most effective vasopressor with the optimal dose, timing, and route of administration during CPR...
December 3, 2018: Minerva Pediatrica
https://www.readbyqxmd.com/read/30511392/lower-short-term-mortality-in-icu-patients-on-chronic-dialysis-than-in-those-requiring-acute-dialysis
#8
Robin Lohse, Michael Ibsen, Jørgen Wiis, Anders Perner, Theis Lange, Mette Brimnes Damholt
BACKGROUND: In ICU patients, we aimed to describe the outcomes of those with end-stage renal disease (ESRD) as compared to those requiring acute renal replacement therapy (RRT). METHODS: Retrospective analysis of all adult patients admitted to a general, university hospital ICU from 2005 to 2012. ESRD was defined as use of chronic RRT >90 days prior to admission. RESULTS: We included 5927 patients of whom 1004 (17%) received acute RRT and 161 (3%) had pre-existing ESRD requiring RRT...
December 3, 2018: Acta Anaesthesiologica Scandinavica
https://www.readbyqxmd.com/read/30497862/extending-endovascular-aneurysm-repair-to-more-patients-without-better-outcomes
#9
Devin S Zarkowsky, Caitlin W Hicks, Ian C Bostock, Mahmoud B Malas, Philip P Goodney
OBJECTIVE: This study quantifies the survival and outcomes associated with endovascular aneurysm repair (EVAR) patients treated in two eras. We hypothesized that both end points will improve over time. METHODS: Patients receiving EVAR between January 2003 and May 2017 contained within the Vascular Quality Initiative data set were examined. Those patients treated between January 2003 and December 2007 were included in the early era, and those treated between January 2012 and December 2015 were considered late era...
November 26, 2018: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/30489313/a-comparison-of-spinal-anesthesia-versus-monitored-anesthesia-care-with-local-anesthesia-in-minimally-invasive-fetal-surgery
#10
Marla B Ferschl, John Feiner, Lan Vu, Devon Smith, Mark D Rollins
BACKGROUND: Minimally invasive fetal surgery is commonly performed to treat twin-to-twin transfusion syndrome with selective fetoscopic laser photocoagulation and twin-reversed arterial perfusion sequence using radiofrequency ablation. Although an increasing number of centers worldwide are performing these procedures, anesthetic management varies. Both neuraxial anesthesia and monitored anesthesia care with local anesthesia are used at different institutions. We sought to determine the efficacy and outcomes of these 2 anesthetic techniques for fetal procedures at our institution...
November 21, 2018: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/30486885/early-goal-directed-and-lactate-guided-therapy-in-adult-patients-with-severe-sepsis-and-septic-shock-a-meta-analysis-of-randomized-controlled-trials
#11
Xian-Fei Ding, Zi-Yue Yang, Zhen-Tao Xu, Li-Feng Li, Bo Yuan, Li-Na Guo, Le-Xin Wang, Xi Zhu, Tong-Wen Sun
BACKGROUND: The ProCESS, ARISE, and ProMISe trials have failed to show that early goal-directed therapy (EGDT) reduces mortality in patients with severe sepsis and septic shock. Although lactate-guided therapy (LGT) has been shown to result in significantly lower mortality, its use remains controversial. Therefore, we performed a meta-analysis to evaluate EGDT vs. LGT or usual care (UC) in adult patients with severe sepsis and septic shock. METHODS: Relevant randomized controlled trials published from January 1, 2001 to March 30, 2017 were identified in PubMed, EMBASE, Web of Science, and the Cochrane Library...
November 29, 2018: Journal of Translational Medicine
https://www.readbyqxmd.com/read/30477976/empirical-systemic-anticoagulation-is-associated-with-decreased-venous-thromboembolism-in-critically-ill-influenza-a-h1n1-acute-respiratory-distress-syndrome-patients
#12
Andrea T Obi, Christopher J Tignanelli, Benjamin N Jacobs, Shipra Arya, Pauline K Park, Thomas W Wakefield, Peter K Henke, Lena M Napolitano
BACKGROUND: An association between increased venous thromboembolism (VTE) events and influenza A H1N1 (H1N1) was noted in the first 10 patients with severe acute respiratory distress syndrome (ARDS). An empirical systemic anticoagulation protocol (heparin intravenous infusion) was initiated when autopsy of patients with severe hypoxemia confirmed multiple primary pulmonary thrombi and emboli. The purpose of this study was to examine the relationship between H1N1 and VTE events and to assess the efficacy of empirical systemic heparin anticoagulation in preventing VTE and death in H1N1 severe ARDS patients...
November 23, 2018: Journal of Vascular Surgery. Venous and Lymphatic Disorders
https://www.readbyqxmd.com/read/30475825/the-prevalence-of-cardiovascular-autonomic-neuropathy-and-its-influence-on-post-induction-hemodynamic-variables-in-patients-with-and-without-diabetes-a-prospective-cohort-study
#13
Jorinde A W Polderman, Nicolaas H Sperna Weiland, Michel H Klaver, Judy Biginski, Marijn Horninge, Markus W Hollmann, J Hans DeVries, Rogier V Immink, Benedikt Preckel, Jeroen Hermanides
BACKGROUND: Cardiovascular autonomic neuropathy (CAN) is a known complication of diabetes, but is also diagnosed in patients without diabetes. CAN may be related to perioperative hemodynamic instability. Our objective was to investigate if patients with diabetes would have a higher prevalence of CAN compared to patients without diabetes undergoing surgery. We further studied its relation to changes in post-induction hemodynamic variables. METHODS: We prospectively included 82 adult patients, 55 with DM, 27 without DM, scheduled for major abdominal or cardiac surgery...
2018: PloS One
https://www.readbyqxmd.com/read/30470853/polymyxin-b-hemoperfusion-in-endotoxemic-septic-shock-patients-without-extreme-endotoxemia-a-post-hoc-analysis-of-the-euphrates-trial
#14
D J Klein, D Foster, P M Walker, S M Bagshaw, H Mekonnen, M Antonelli
PURPOSE: The EUPHRATES trial examined the impact of polymyxin B hemoperfusion (PMX) on mortality in patients with septic shock and endotoxemia, defined as EAA ≥ 0.60. No difference was found in 28-day all-cause mortality. However, the trial showed that in some patients with septic shock the burden of endotoxin activity was extreme (EAA ≥ 0.9). In a post hoc analysis, we evaluated the impact of PMX use in patients with septic shock and endotoxin activity measured between 0...
November 23, 2018: Intensive Care Medicine
https://www.readbyqxmd.com/read/30467807/development-and-performance-of-a-novel-vasopressor-driven-mortality-prediction-model-in-septic-shock
#15
Saraschandra Vallabhajosyula, Jacob C Jentzer, Aditya A Kotecha, Dennis H Murphree, Erin F Barreto, Ashish K Khanna, Vivek N Iyer
BACKGROUND: Vasoactive medications are essential in septic shock, but are not fully incorporated into current mortality prediction risk scores. We sought to develop a novel mortality prediction model for septic shock incorporating quantitative vasoactive medication usage. METHODS: Quantitative vasopressor use was calculated in a cohort of 5352 septic shock patients and compared using norepinephrine equivalents (NEE), cumulative vasopressor index and the vasoactive inotrope score models...
November 22, 2018: Annals of Intensive Care
https://www.readbyqxmd.com/read/30464654/potential-mortality-and-cost-reduction-in-adult-severe-sepsis-and-septic-shock-through-the-use-of-an-innovative-fluid-delivery-device
#16
Elizabeth A Brooks, Mark Piehl
Background: While early fluid resuscitation has been shown to significantly improve health and economic metrics in septic shock, providers are often unable to achieve fluid delivery guidelines using current techniques. Purpose: To examine expected clinical and economic consequences of more consistent achievement of fluid resuscitation guidelines through use of a novel fluid delivery technology. Patients and methods: A decision analytic model was developed to compare expected costs and outcomes associated with the standard technique vs a novel, faster technique for rapid fluid resuscitation in adult patients with severe sepsis or septic shock...
2018: Open Access Emergency Medicine: OAEM
https://www.readbyqxmd.com/read/30454042/landiolol-in-patients-with-septic-shock-resident-in-an-intensive-care-unit-landi-sep-study-protocol-for-a-randomized-controlled-trial
#17
Martin Unger, Andrea Morelli, Mervyn Singer, Peter Radermacher, Sebastian Rehberg, Helmut Trimmel, Michael Joannidis, Gottfried Heinz, Vladimír Cerny, Pavel Dostál, Christian Siebers, Fabio Guarracino, Francesca Pratesi, Gianni Biancofiore, Massimo Girardis, Pavla Kadlecova, Olivier Bouvet, Michael Zörer, Barbara Grohmann-Izay, Kurt Krejcy, Christoph Klade, Günther Krumpl
BACKGROUND: In patients with septic shock, the presence of an elevated heart rate (HR) after fluid resuscitation marks a subgroup of patients with a particularly poor prognosis. Several studies have shown that HR control in this population is safe and can potentially improve outcomes. However, all were conducted in a single-center setting. The aim of this multicenter study is to demonstrate that administration of the highly beta1-selective and ultrashort-acting beta blocker landiolol in patients with septic shock and persistent tachycardia (HR ≥ 95 beats per minute [bpm]) is effective in reducing and maintaining HR without increasing vasopressor requirements...
November 19, 2018: Trials
https://www.readbyqxmd.com/read/30451381/vasopressor-magnitude-predicts-poor-outcome-in-adults-with-congenital-heart-disease-after-cardiac-surgery
#18
Joseph T Poterucha, Saraschandra Vallabhajosyula, Alexander C Egbe, Joseph S Krien, Devon O Aganga, Kimberly Holst, Adele W Golden, Joseph A Dearani, Sheri S Crow
BACKGROUND: High levels of vasoactive inotrope support (VIS) after congenital heart surgery are predictive of morbidity in pediatric patients. We sought to discern if this relationship applies to adults with congenital heart disease (ACHD). METHODS: We retrospectively studied adult patients (≥18 years old) admitted to the intensive care unit after cardiac surgery for congenital heart disease from 2002 to 2013 at Mayo Clinic. Vasoactive medication dose values within 96 hours of admission were examined to determine the relationship between VIS score and poor outcome of early mortality, early morbidity, or complication related morbidity...
November 19, 2018: Congenital Heart Disease
https://www.readbyqxmd.com/read/30445970/appropriateness-of-empiric-antimicrobial-therapy-with-imipenem-colistin-in-severe-septic-patients-observational-cohort-study
#19
Ahlem Trifi, Sami Abdellatif, Cyrine Abdennebi, Foued Daly, Rochdi Nasri, Yosr Touil, Salah Ben Lakhal
BACKGROUND: Empiric antimicrobial therapy (EAMT) using imipenem/colistin is commonly prescribed as a first line therapy in critically ill patients with severe sepsis. We aimed to assess the appropriateness of prescribing imipenem/colistin as EAMT in ICU patients. METHODS: A 3-year observational prospective study included ICU patients that required imipenem/colistin as EAMT. The EAMT was assessed according to microbiological and clinical outcomes. The outcomes were: delay in apyrexia, delay in the decrease of the biological inflammatory parameters (BIP), the requirement for vasoactive agents, bacteriological eradication, length of stay, ventilator days and 30-day mortality...
November 16, 2018: Annals of Clinical Microbiology and Antimicrobials
https://www.readbyqxmd.com/read/30443059/continuous-spinal-anaesthesia-a-retrospective-analysis-of-318-cases
#20
Zhi Yuen Beh, Phui Sze Au Yong, Siyu Lye, Sneha Elizabeth Eapen, Chee Seng Yoong, Kwee Lian Woon, Jimmy Guan Cheng Lim
Background and Aims: Continuous spinal anaesthesia (CSA) is an underutilised anaesthetic technique. Our objectives were to evaluate the use of CSA in our institution, its efficacy, ease to use and safety. Methods: This was a retrospective analysis conducted in a tertiary centre. Records of all patients who underwent surgery and received CSA between December 2008 and July 2017 were reviewed. Their demographic profiles, type and duration of surgery were analysed. The outcomes measured were the success of CSA, technical evaluation and difficulties encountered, intraoperative haemodynamics, usage of vasopressors and any reported complications...
October 2018: Indian Journal of Anaesthesia
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