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Cardiovascular ICU

Eric L Vu, Craig G Rusin, Dan J Penny, Kathy K Kibler, Ronald Blaine Easley, Brendan Smith, Dean Andropoulos, Ken Brady
OBJECTIVE: We evaluated ST-segment monitoring to detect clinical decompensation in infants with single ventricle anatomy. We proposed a signal processing algorithm for ST-segment instability and hypothesized that instability is associated with cardiopulmonary arrests. DESIGN: Retrospective, observational study. SETTING: Tertiary children's hospital 21-bed cardiovascular ICU and 36-bed step-down unit. PATIENTS: Twenty single ventricle infants who received stage 1 palliation surgery between January 2013 and January 2014...
October 13, 2016: Pediatric Critical Care Medicine
Guillaume Geri, Guillaume Savary, Stéphane Legriel, Florence Dumas, Sybille Merceron, Olivier Varenne, Bernard Livarek, Olivier Richard, Jean-Paul Mira, Jean-Pierre Bedos, Jean-Philippe Empana, Alain Cariou, David Grimaldi
BACKGROUND: Obesity prevalence has dramatically increased over recent years and is associated with cardiovascular diseases, but data are lacking on its prognostic impact in out-of-hospital cardiac arrest (OHCA) patients. METHODS: Data of all consecutive OHCA patients admitted in two cardiac arrest centers from Paris and suburbs between 2005 and 2012 were prospectively collected. Patients treated by therapeutic hypothermia (TH) were included in the analysis. Logistic and Cox regression analyses were used to quantify the association between Body Mass Index (BMI) at hospital admission and day-30 and 1-year mortality respectively...
October 12, 2016: Resuscitation
Maryse A Wiewel, Matthew B Harmon, Lonneke A van Vught, Brendon P Scicluna, Arie J Hoogendijk, Janneke Horn, Aeilko H Zwinderman, Olaf L Cremer, Marc J Bonten, Marcus J Schultz, Tom van der Poll, Nicole P Juffermans, W Joost Wiersinga
BACKGROUND: Hypothermia is associated with adverse outcome in patients with sepsis. The objective of this study was to characterize the host immune response in patients with hypothermic sepsis in order to determine if an excessive anti-inflammatory response could explain immunosuppression and adverse outcome. Markers of endothelial activation and integrity were also measured to explore potential alternative mechanisms of hypothermia. Finally we studied risk factors for hypothermia in an attempt to find new clues to the etiology of hypothermia in sepsis...
October 14, 2016: Critical Care: the Official Journal of the Critical Care Forum
Samuel M Brown, Jeffrey Sorensen, Michael J Lanspa, Matthew T Rondina, Colin K Grissom, Sajid Shahul, V J Mathews
BACKGROUND: Septic shock is a common and often devastating syndrome marked by severe cardiovascular dysfunction commonly managed with vasopressors. Whether markers of heart rate complexity before vasopressor up-titration could be used to predict success of the up-titration is not known. METHODS: We studied patients with septic shock requiring vasopressor, newly admitted to the intensive care unit. We measured the complexity of heart rate variability (using the ratio of fractal exponents from detrended fluctuation analysis) in the 5 min before all vasopressor up-titrations in the first 24 h of an intensive care unit (ICU) admission...
October 10, 2016: BMC Infectious Diseases
Aaron Heller, John Dollerschell, Joshua Burk, Hailey Haines, Jonathan Kozinn
BACKGROUND: In the past decade, the rate and utilization of veno-venous extracorporeal membrane oxygenation (VV-ECMO) has increased dramatically. A single catheter technique has recently come into favour for providing VV-ECMO. Although it has been shown that intensivists can safely place these catheters, the safety of decannulation by intensivists has not been reported. OBJECTIVE: We describe a technique for safely decannulating the Avalon Elite VV-ECMO catheter at the bedside and assess the safety of this technique, as compared with the standard technique of decannulation in the operating room by a surgeon...
September 30, 2016: Anaesthesiology Intensive Therapy
Junxin Wang, Fang Chen, Santiago J Arconada-Alvarez, James Hartanto, Li-Peng Yap, Ryan Park, Fang Wang, Ivetta Vorobyova, Grant Dagliyan, Peter S Conti, Jesse V Jokerst
Heparin anticoagulation therapy is an indispensable feature of clinical care yet has a narrow therapeutic window and is the second most common intensive care unit (ICU) medication error. The active partial thromboplastin time (aPTT) monitors heparin but suffers from long turnaround times, a variable reference range, limited utility with low molecular weight heparin, and poor correlation to dose. Here, we describe a photoacoustic imaging technique to monitor heparin concentration using methylene blue as a simple and Federal Drug Administration-approved contrast agent...
September 28, 2016: Nano Letters
Guangfa Zhu, Yan Huang, Dong Wei, Yingxin Shi
BACKGROUND: Noninvasive ventilation (NIV) is a promising therapeutic strategy after cardiothoracic surgery. This study aimed to meta-analyze the efficacy and safety of NIV as compared to conventional management after cardiothoracic surgery. METHODS: PubMed, EMBASE, and Cochrane Library databases were searched for randomized controlled trials (RCTs) comparing NIV with conventional management after cardiothoracic surgery. Relative risk (RR), standard mean difference (SMD), and 95% confidence intervals (CIs) were used to measure the efficacy and safety of NIV using random-effects model...
September 2016: Medicine (Baltimore)
Taylor S Howard, Brian T Kalish, Daniel Wigmore, Meena Nathan, Thomas J Kulik, Aditya K Kaza, Kathryn Williams, Ravi R Thiagarajan
OBJECTIVES: There is a paucity of data regarding the impact of extracorporeal membrane oxygenation support, adequacy of surgical repair, and timing of intervention for residual structural lesions in neonates cannulated to extracorporeal membrane oxygenation after cardiac surgery. Our goal was to determine how these factors were associated with survival. DESIGN: Retrospective study. SETTING: Cardiovascular ICU. SUBJECTS: Neonates (≤ 28 d old) with congenital heart disease cannulated to extracorporeal membrane oxygenation after cardiac surgery during 2006-2013...
September 19, 2016: Pediatric Critical Care Medicine
Sebastien Tanaka, Etienne Escudier, Sophie Hamada, Anatole Harrois, Pierre Etienne Leblanc, Eric Vicaut, Jacques Duranteau
OBJECTIVES: The effects of RBC transfusion on microvascular perfusion are not well documented. We investigated the effect of RBC transfusion on sublingual microcirculation in hemorrhagic shock patients. DESIGN: Prospective, preliminary observational study. SETTINGS: A 28-bed, surgical ICU in a university hospital. PATIENTS: Fifteen hemorrhagic shock patients requiring RBC transfusion. INTERVENTION: Transfusion of one unit of RBCs...
September 15, 2016: Critical Care Medicine
Tomasz Gaszynski
INTRODUCTION: We report on the anesthetic management using opioid-free method of a patient with Steinert syndrome (myotonic dystrophy, MD), autosomal dominant dystrophy which is characterized by consistent contracture of muscle following stimulation. A myotonic crisis can be induced by numerous factors including hypothermia, shivering, and mechanical or electrical stimulation. In patients with MD, hypersensitivity to anesthetic drugs, especially muscle relaxants and opioids, may complicate postoperative management...
September 2016: Medicine (Baltimore)
Aditi Jain, Sanjeev Palta, Richa Saroa, Anshu Palta, Sonu Sama, Satinder Gombar
BACKGROUND AND AIMS: The objective was to determine the accuracy of sequential organ failure assessment (SOFA) score in predicting outcome of patients in Intensive Care Unit (ICU). MATERIAL AND METHODS: Forty-four consecutive patients between 15 and 80 years admitted to ICU over 8 weeks period were studied prospectively. Three patients were excluded. SOFA score was determined 24 h postadmission to ICU and subsequently every 48 h for the first 10 days. Patients were followed till discharge/death/transfer from the ICU...
July 2016: Journal of Anaesthesiology, Clinical Pharmacology
L A Rütter, G Keyßer, M Winkler, S Rütter
BACKGROUND AND OBJECTIVE: Very little is known about the outcome of patients with inflammatory rheumatic diseases in intensive care units (ICU). This retrospective study investigated the results of intensive medical treatment in these patients and the reliability of scoring systems used for the prediction of survival. MATERIAL AND METHODS: A case group consisting of 50 patients suffering from inflammatory rheumatic diseases was generated by analysis of patient records from the ICU at the University Hospital for Internal Medicine in Halle (Saale) in the years 2001-2010...
September 13, 2016: Zeitschrift Für Rheumatologie
Alexander Koch, Ralf Weiskirchen, Sebastian Ludwig, Lukas Buendgens, Jan Bruensing, Eray Yagmur, Christer Baeck, Ulf Herbers, Christian Trautwein, Frank Tacke
PURPOSE: Sclerostin is a negative regulator of bone metabolism and associated with chronic morbidities. We investigated circulating sclerostin in critically ill patients. METHODS: A total of 264 patients (170 with sepsis) were studied prospectively upon admission to the medical intensive care unit (ICU) and on day 7. Patients' survival was followed for up to 3 years. RESULTS: Sclerostin serum levels were significantly elevated in critically ill patients at ICU admission compared with 99 healthy controls...
August 22, 2016: Journal of Critical Care
Jonathan Messika, David Hajage, Nataly Panneckoucke, Serge Villard, Yolaine Martin, Emilie Renard, Annie Blivet, Jean Reignier, Natacha Maquigneau, Annabelle Stoclin, Christelle Puechberty, Stéphane Guétin, Aline Dechanet, Amandine Fauquembergue, Stéphane Gaudry, Didier Dreyfuss, Jean-Damien Ricard
BACKGROUND: Non-invasive ventilation (NIV) tolerance is a key factor of NIV success. Hence, numerous sedative pharmacological or non-pharmacological strategies have been assessed to improve NIV tolerance. Music therapy in various health care settings has shown beneficial effects. In invasively ventilated critical care patients, encouraging results of music therapy on physiological parameters, anxiety, and agitation have been reported. We hypothesize that a musical intervention improves NIV tolerance in comparison to conventional care...
2016: Trials
Zohreh Ghazivakili, Razieh Lotfi, Kourosh Kabir, Roohangiz Norouzi Nia, Masoumeh Rajabi Naeeni
OBJECTIVE: the maternal near miss approach has been developed by World Health Organization for assessing and improving the quality of care. This study aimed to examine the incidence, characteristics, and features of the care provided for maternal near-miss cases in public and private hospitals in Alborz province, Iran. METHODS: a cross sectional, facility-based study was conducted in all 13 public and private hospitals of Alborz province between April 2012 and December 2012...
October 2016: Midwifery
A Fehrenbach, T Werner, A Demirci, P K Zahn, C Grüneberg
OBJECTIVE: Respiratory physiotherapy is an integral part of the care of patients in intensive care units (ICU) after cardiac surgery. One of the most commonly used techniques in ICU to prevent pulmonary complications are mechanical vibrations, which can be applied with a tool called Vibrax.The aim of this study was to investigate the effects of Vibrax (mechanical vibrations) on the arterial blood gases of patients in ICU during the 1. or 2. day after cardiac surgery. METHODS: A randomized controlled pilot study was conducted with 23 patients...
September 2016: Pneumologie
Federico Coccolini, Massimo Sartelli, Fausto Catena, Marco Ceresoli, Giulia Montori, Luca Ansaloni
BACKGROUND: Since the incorporation of the early hemodynamic resuscitation in septic shock according to the early goal-directed therapy (EGDT) protocol among the 6-hour resuscitation bundle of the Surviving Sepsis Campaign guidelines, a great debate has been raised about the issue. The present meta-analysis aims to determine whether the resuscitative phase really takes advantages by being performed with EGDT. METHODS: A systematic review with meta-analysis of randomized controlled trials (RCTs) of EGDT versus usual care in patients with early septic shock was performed...
November 2016: Journal of Trauma and Acute Care Surgery
M Cardona-Morrell, M Prgomet, R M Turner, M Nicholson, K Hillman
BACKGROUND: Vital signs monitoring is an old hospital practice for patient safety but evaluation of its effectiveness is not widespread. We aimed to identify strategies to improve intermittent or continuous vital signs monitoring in general wards; and their effectiveness in preventing adverse events on general hospital wards. METHODS: Publications searched between 1980 and June 2014 in five databases. Main outcome measures were in-hospital death, cardiac arrest, intensive care unit (ICU) transfers, length of stay, identification of physiological deterioration and activation of rapid response systems...
October 2016: International Journal of Clinical Practice
Hany Dabbous, Mohammad Sakr, Sara Abdelhakam, Iman Montasser, Mohamed Bahaa, Hany Said, Mahmoud El-Meteini
AIM: To assess the impact of model for end-stage liver disease (MELD) score on patient survival and morbidity post living donor liver transplantation (LDLT). METHODS: A retrospective study was performed on 80 adult patients who had LDLT from 2011-2013. Nine patients were excluded and 71 patients were divided into two groups; Group 1 included 38 patients with a MELD score < 20, and Group 2 included 33 patients with a MELD score > 20. Comparison between both groups was done regarding operative time, intra-operative blood requirement, intensive care unit (ICU) and hospital stay, infection, and patient survival...
August 8, 2016: World Journal of Hepatology
Graham Nichol, Siobhan P Brown, Gavin D Perkins, Francis Kim, Fritz Sterz, Jo Ann Broeckel Elrod, Spyros Mentzelopoulos, Richard Lyon, Yaseen Arabi, Maaret Castren, Peter Larsen, Terence Valenzuela, Jan-Thorsten Graesner, Scott Youngquist, Nalinas Khunkhlai, Henry E Wang, Franek Ondrej, Juan Manuel Fraga Sastrias, Anders Barasa, Michael R Sayre
BACKGROUND: Efficient trials of interventions for patients with out-of-hospital cardiac arrest (OHCA) should have adequate but not excess power to detect a difference in outcomes. The minimum clinically important difference (MCID) is the threshold value in outcomes observed in a trial at which providers should choose to adopt a treatment. There has been limited assessment of MCID for outcomes after OHCA. Therefore, we conducted an international survey of individuals interested in cardiac resuscitation to define the MCID for a range of outcomes after OHCA...
October 2016: Resuscitation
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