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Weakness in the critically ill

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https://www.readbyqxmd.com/read/29771711/respiratory-muscle-effort-during-expiration-in-successful-and-failed-weaning-from-mechanical-ventilation
#1
Jonne Doorduin, Lisanne H Roesthuis, Diana Jansen, Johannes G van der Hoeven, Hieronymus W H van Hees, Leo M A Heunks
BACKGROUND: Respiratory muscle weakness in critically ill patients is associated with difficulty in weaning from mechanical ventilation. Previous studies have mainly focused on inspiratory muscle activity during weaning; expiratory muscle activity is less well understood. The current study describes expiratory muscle activity during weaning, including tonic diaphragm activity. The authors hypothesized that expiratory muscle effort is greater in patients who fail to wean compared to those who wean successfully...
May 16, 2018: Anesthesiology
https://www.readbyqxmd.com/read/29764321/the-patient-to-prisoner-pipeline-the-imd-exclusion-s-adverse-impact-on-mass-incarceration-in-united-states
#2
Michael E Onah
A component of the 1965 Medicaid Act, the Institutions for Mental Diseases ("IMD") Exclusion was supposed to be a remedy for the brutal, dysfunctional mental healthcare system run through state hospitals. In the years since Medicaid was created, the IMD Exclusion has instead barred thousands of those in need of intensive, inpatient treatment from receiving it. As a result, many severely mentally ill individuals are left without adequate care and without a home. They struggle in the street where they are otherized by those in their community and are susceptible to confrontational episodes with law enforcement...
March 2018: American Journal of Law & Medicine
https://www.readbyqxmd.com/read/29752826/post-polio-syndrome-and-the-late-effects-of-poliomyelitis-part-2-treatment-management-and-prognosis
#3
REVIEW
Julian K Lo, Lawrence R Robinson
Post-Polio Syndrome (PPS) is characterized by new muscle weakness and/or muscle fatigability that occurs many years following the initial poliomyelitis illness. An individualized approach to rehabilitation management is critical. Interventions may include rehabilitation management strategies, adaptive equipment, orthotic equipment, gait/mobility aids and a variety of therapeutic exercises. The progression of muscle weakness in PPS is typically slow and gradual; however, there is also variability in both the natural history of weakness and functional prognosis...
May 12, 2018: Muscle & Nerve
https://www.readbyqxmd.com/read/29739651/nurses-reflections-about-caring-for-critically-ill-non-sedated-and-mechanically-ventilated-critically-ill-patients
#4
Ranveig Lind, Hilde-Irén Liland, Berit S Brinchmann, Inga Akeren
OBJECTIVE: The objective was to explore ICU nurses' experiences of caring for non-sedated, critically ill mechanically ventilated patients, when following a study protocol as part of a clinical trial. DESIGN: The study had a qualitative design with twelve nurses participating in two focus groups. The interviews were analysed using a thematic approach. FINDINGS: One overall theme emerged, "Cautious optimism", which suggests positive experiences but with a negative undertone...
May 5, 2018: Intensive & Critical Care Nursing: the Official Journal of the British Association of Critical Care Nurses
https://www.readbyqxmd.com/read/29730622/early-rehabilitation-to-prevent-postintensive-care-syndrome-in-patients-with-critical-illness-a-systematic-review-and-meta-analysis
#5
Ryota Fuke, Toru Hifumi, Yutaka Kondo, Junji Hatakeyama, Tetsuhiro Takei, Kazuma Yamakawa, Shigeaki Inoue, Osamu Nishida
INTRODUCTION: We examined the effectiveness of early rehabilitation for the prevention of postintensive care syndrome (PICS), characterised by an impaired physical, cognitive or mental health status, among survivors of critical illness. METHODS: We performed a systematic literature search of several databases (Medline, Embase and Cochrane Central Register of Controlled Trials) and a manual search to identify randomised controlled trials (RCTs) comparing the effectiveness of early rehabilitation versus no early rehabilitation or standard care for the prevention of PICS...
May 5, 2018: BMJ Open
https://www.readbyqxmd.com/read/29729659/improving-health-care-for-critically-ill-patients-using-an-evidence-based-collaborative-approach-to-abcdef-bundle-dissemination-and-implementation
#6
Mary Ann Barnes-Daly, Brenda T Pun, Lori A Harmon, Diane G Byrum, Vishakha K Kumar, John W Devlin, Joanna L Stollings, Kathleen A Puntillo, Heidi J Engel, Patricia J Posa, Juliana Barr, William D Schweickert, Cheryl L Esbrook, Ken D Hargett, Shannon S Carson, J Matthew Aldrich, E Wesley Ely, Michele C Balas
BACKGROUND: Patients admitted to intensive care units (ICUs) often experience pain, oversedation, prolonged mechanical ventilation, delirium, and weakness. These conditions are important in that they often lead to protracted physical, neurocognitive, and mental health sequelae now termed postintensive care syndrome. Changing current ICU practice will not only require the adoption of evidence-based interventions but the development of effective and reliable teams to support these new practices...
May 5, 2018: Worldviews on Evidence-based Nursing
https://www.readbyqxmd.com/read/29672230/diaphragm-plasticity-in-aging-and-disease-therapies-for-muscle-weakness-go-from-strength-to-strength
#7
Sarah M Greising, Coen A C Ottenheijm, Ken D O'Halloran, Esther Barreiro
The diaphragm is the main inspiratory muscle and is required to be highly active throughout the lifespan. The diaphragm muscle must be able to produce and sustain various behaviors that range from ventilatory to non-ventilatory such as those required for airway maintenance and clearance. Throughout the lifespan various circumstances and conditions may affect the ability of the diaphragm muscle to generate requisite forces and in turn the diaphragm muscle may undergo significant weakness and dysfunction. For example, hypoxic stress, critical illness, cancer cachexia, chronic obstructive pulmonary disorder (COPD), and age-related sarcopenia all represent conditions in which significant diaphragm muscle dysfunction exits...
April 19, 2018: Journal of Applied Physiology
https://www.readbyqxmd.com/read/29671836/children-s-experience-of-symptoms-narratives-through-words-and-images
#8
REVIEW
Barbara M Sourkes
Children who live with a complex chronic or life-threatening illness face extraordinary challenges. Whether they are receiving disease-oriented treatment (aimed at potential cure or prolongation of life) or palliative treatment-or both concurrently-our challenge is to enhance their comfort and minimize their distress. Symptom management is thus a critical component of pediatric palliative care. Symptoms may be either physical or psychological in nature (or a confluence of both) and their effective management has a direct impact on the child's quality of life...
April 19, 2018: Children
https://www.readbyqxmd.com/read/29670404/evaluation-of-vancomycin-therapy-in-the-adult-icus-of-a-teaching-hospital-in-southern-iran
#9
Afsaneh Vazin, Motahare Mahi Birjand, Masoud Darake
Background: Vancomycin resistance in intensive care units (ICUs) accounts for significant morbidity and excess costs. The objective of the present study was to determine the appropriateness of vancomycin use in the various ICUs of Nemazee Hospital, Shiraz, Iran. Methods: This prospective study was performed on 95 critically ill patients (48 males and 47 females) who were treated with vancomycin for at least 3 subsequent doses in 6 ICUs during 12 months. Required demographic, clinical, and paraclinical data were collected by a pharmacist...
2018: Drug, Healthcare and Patient Safety
https://www.readbyqxmd.com/read/29665131/autophagy-and-its-implications-against-early-full-nutrition-support-in-critical-illness
#10
Lisa Van Dyck, Michaël P Casaer, Jan Gunst
The timing, dose, and route of early nutrition support in critically ill patients have been highly controversial for years. Despite the association of a caloric deficit with adverse outcome, several recent large, randomized, controlled trials have demonstrated a prolongation of organ failure and increased muscle weakness with increasing doses of nutrition in the acute phase of critical illness. A potential explanation for the negative impact of early, full feeding on outcome is feeding-induced suppression of autophagy, a cellular repair process that is necessary to clear intracellular damage...
April 17, 2018: Nutrition in Clinical Practice
https://www.readbyqxmd.com/read/29659093/oral-intake-evaluation-in-patients-following-critical-illness-an-icu-cohort-study
#11
Rebecca J Jarden, Lynsey Sutton-Smith, Catherine Boulton
Timely and adequate nutrition improves health outcomes for the critically ill patient. Despite clinical guidelines recommending early oral nutrition, survivors of critical illness experience significant nutritional deficits. This cohort study evaluates the oral nutrition intake in intensive care unit (ICU) patients who have experienced recent critical illness. The oral nutrition intake of a convenience sample of ICU patients post-critical illness was observed during a 1-month period. Data pertaining to both the amount of oral nutrition intake and factors impacting optimal oral nutrition intake were collected and analysed...
April 16, 2018: Nursing in Critical Care
https://www.readbyqxmd.com/read/29615090/adolescent-mental-health-education-inscied-out-a-case-study-of-an-alternative-middle-school-population
#12
Joanna Yang, Roberto Lopez Cervera, Susannah J Tye, Stephen C Ekker, Chris Pierret
BACKGROUND: Mental illness contributes substantially to global disease burden, particularly when illness onset occurs during youth and help-seeking is delayed and/or limited. Yet, few mental health promotion interventions target youth, particularly those with or at high risk of developing mental illness ("at-risk" youth). Community-based translational research has the capacity to identify and intervene upon barriers to positive health outcomes. This is especially important for integrated care in at-risk youth populations...
April 3, 2018: Journal of Translational Medicine
https://www.readbyqxmd.com/read/29611254/oxytocin-levels-in-saliva-correlate-better-than-plasma-levels-with-concentrations-in-the-cerebrospinal-fluid-of-patients-in-neurocritical-care
#13
Jan Martin, Simone M Kagerbauer, Jens Gempt, Armin Podtschaske, Alexander Hapfelmeier, Gerhard Schneider
In the converging fields of neuroendocrinology and behavioural neuroscience, the interaction between peripheral secretion and central release of oxytocin in humans has not yet been comprehensively assessed. As the human brain is not directly accessible and as the collection of human cerebrospinal fluid (CSF) usually requires invasive procedures, easier accessible compartments such as blood or saliva attract increasing attention. In this study, we prospectively determined oxytocin concentrations in the three compartments plasma, CSF and saliva of fifty critically ill patients with neurological and neurosurgical diseases...
April 3, 2018: Journal of Neuroendocrinology
https://www.readbyqxmd.com/read/29605239/looking-for-light-in-the-din-an-examination-of-the-circadian-disrupting-properties-of-a-medical-intensive-care-unit
#14
Samantha J Danielson, Charles A Rappaport, Michael K Loher, Brian K Gehlbach
OBJECTIVE: Critically ill patients exhibit profound disturbances of circadian rhythmicity, most commonly in the form of a phase delay. We investigated the specific zeitgeber properties of a medical intensive care unit to develop a model that explained these abnormalities. RESEARCH METHODOLOGY: Prospective, observational study conducted during 2013-2014. Twenty-four-hour ambient light (lux, 672 hours) and sound pressure levels (dBA, 504 hours) were measured in patient rooms...
March 28, 2018: Intensive & Critical Care Nursing: the Official Journal of the British Association of Critical Care Nurses
https://www.readbyqxmd.com/read/29604150/neurophysiological-study-of-critical-illness-polyneuropathy-and-myopathy-in-mechanically-ventilated-children-additional-aspect-into-pediatric-critical-illness-comorbidities
#15
Ahmed Thabet Mahmoud, Maha A M Tawfik, Sameh Abdallah Abd El Naby, Wafaa Moustafa M Abo El Fotoh, Nagwan Yossery Saleh, Nahla M Said Abd El Hady
BACKGROUND: Critical illness polyneuropathy and myopathy (CIP/CIM) is being increasingly recognized as a significant clinical problem in critically ill children especially who have spent long periods in the intensive care unit. So we aimed to determine the frequency of CIP/CIM among mechanically ventilated children and to analyze the associated risk factors and drawbacks frequently encountered in this cohort. METHODS: The study included 105 patients admitted to the pediatric intensive care unit and underwent mechanical ventilation for ≥7 days...
March 31, 2018: European Journal of Neurology: the Official Journal of the European Federation of Neurological Societies
https://www.readbyqxmd.com/read/29584447/inspiratory-muscle-rehabilitation-in-critically-ill-adults-a-systematic-review-and-meta-analysis
#16
Stefannie Vorona, Umberto Sabatini, Sulaiman Al-Maqbali, Michele Bertoni, Martin Dres, Bernie Bissett, Frank Van Haren, A Daniel Martin, Cristian Urrea, Debbie Brace, Matteo Parotto, Margaret S Herridge, Neill Kj Adhikari, Eddy Fan, Luana T Melo, W Darlene Reid, Laurent J Brochard, Niall D Ferguson, Ewan C Goligher
BACKGROUND: Respiratory muscle weakness is common in critically ill patients; the role of targeted inspiratory muscle training (IMT) in ICU rehabilitation strategies remains poorly defined. OBJECTIVES: The primary objective was to describe the range and tolerability of published methods for IMT. The secondary objectives were to determine whether IMT improves respiratory muscle strength and clinical outcomes in critically ill patients. DATA SOURCES: We conducted a systematic review to identify randomized and non-randomized studies of physical rehabilitation interventions intended to strengthen the respiratory muscles in critically ill adults...
March 27, 2018: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/29582429/early-intervention-mobilization-or-active-exercise-for-critically-ill-adults-in-the-intensive-care-unit
#17
REVIEW
Katherine A Doiron, Tammy C Hoffmann, Elaine M Beller
BACKGROUND: Survivors of critical illness often experience a multitude of problems that begin in the intensive care unit (ICU) or present and continue after discharge. These can include muscle weakness, cognitive impairments, psychological difficulties, reduced physical function such as in activities of daily living (ADLs), and decreased quality of life. Early interventions such as mobilizations or active exercise, or both, may diminish the impact of the sequelae of critical illness. OBJECTIVES: To assess the effects of early intervention (mobilization or active exercise), commenced in the ICU, provided to critically ill adults either during or after the mechanical ventilation period, compared with delayed exercise or usual care, on improving physical function or performance, muscle strength and health-related quality of life...
March 27, 2018: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/29578749/positive-end-expiratory-pressure-ventilation-induces-longitudinal-atrophy-in-diaphragm-fibers
#18
Johan Lindqvist, Marloes van den Berg, Robbert van der Pijl, Pleuni E Hooijman, Albertus Beishuizen, Judith Elshof, Monique de Waard, Armand Girbes, Angelique Spoelstra-de Man, Zhong-Hua Shi, Charissa van den Brom, Sylvia Bogaards, Shengyi Shen, Joshua Strom, Henk Granzier, Jeroen Kole, René J P Musters, Marinus A Paul, Leo M A Heunks, Coen A C Ottenheijm
RATIONALE: Diaphragm weakness in critically ill patients prolongs ventilator dependency and duration of hospital stay, and increases mortality and health care costs. The mechanisms underlying diaphragm weakness include cross-sectional fiber atrophy and contractile protein dysfunction, but whether additional mechanisms are at play is unknown. OBJECTIVES: To test the hypothesis that mechanical ventilation with positive end-expiratory pressure (PEEP) induces longitudinal atrophy by displacing the diaphragm in caudal direction and reducing the length of fibers...
March 26, 2018: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/29576356/thickness-of-the-adductor-pollicis-muscle-accuracy-in-predicting-malnutrition-and-length-of-intensive-care-unit-stay-in-critically-ill-surgical-patients-thickness-of-the-adductor-pollicis-muscle-in-surgical-critically-patients
#19
Thainá Gattermann Pereira, Jaqueline da Silva Fink, Flávia Moraes Silva
BACKGROUNDS & AIMS: new techniques for assessment of nutritional status of critically ill and surgical patients have been investigated to overcome inherent limitations of conventional method. The current study aimed to evaluate the ability of thickness of the adductor pollicis muscle (TAPM) in detecting malnutrition and predicting morbidity and mortality in critically ill surgical patients. METHODS: cohort study of adult patients, assessed within the 48 h of admission to the surgical intensive care unit (ICU) of a public hospital...
April 2018: Clinical Nutrition ESPEN
https://www.readbyqxmd.com/read/29574340/assessing-frailty-in-the-intensive-care-unit-a-reliability-and-validity-study
#20
Melissa Shears, Alyson Takaoka, Bram Rochwerg, Sean M Bagshaw, Jennie Johnstone, Amanda Holding, Surenthar Tharmalingam, Tina Millen, France Clarke, Kenneth Rockwood, Guowei Li, Lehana Thabane, John Muscedere, Henry T Stelfox, Deborah J Cook
PURPOSE: To describe pre-ICU frailty in critically ill patients using the Clinical Frailty Scale (CFS). METHODS: We included patients ≥18years admitted to 2 ICUs in Hamilton, Canada. The ICU Research Coordinator (RC) generated 3 CFS scores using: 1) chart review, 2) family interview, 3) patient interview. Subsequently, an overall impression was captured in a final score. Mean differences were calculated to assess the RC intra-rater reliability and inter-rater reliability of chart reviews by the RC, Occupational Therapist (OT), and Geriatrics Resident (GR)...
June 2018: Journal of Critical Care
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