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Weakness in the critically ill patient

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https://www.readbyqxmd.com/read/28102521/clinical-assessment-and-train-of-four-measurements-in-critically-ill-patients-treated-with-recommended-doses-of-cisatracurium-or-atracurium-for-neuromuscular-blockade-a-prospective-descriptive-study
#1
Pierre Bouju, Jean-Marc Tadié, Nicolas Barbarot, Julien Letheulle, Fabrice Uhel, Pierre Fillatre, Guillaume Grillet, Angélique Goepp, Yves Le Tulzo, Arnaud Gacouin
BACKGROUND: Despite few studies, a monitoring of a neuromuscular blockade with a train of four (TOF) is recommended in intensive care unit (ICU). Our objective was to compare the results of ulnar and facial TOF measurements with an overall clinical assessment for neuromuscular blockade in ICU patients treated with recommended doses of atracurium or cisatracurium, including patients with acute respiratory disease syndrome (ARDS). METHODS: We prospectively included in two ICUs 119 patients, 94 with ARDS, who required a neuromuscular blockade for more than 24 h...
December 2017: Annals of Intensive Care
https://www.readbyqxmd.com/read/28101605/surviving-sepsis-campaign-international-guidelines-for-management-of-sepsis-and-septic-shock-2016
#2
Andrew Rhodes, Laura E Evans, Waleed Alhazzani, Mitchell M Levy, Massimo Antonelli, Ricard Ferrer, Anand Kumar, Jonathan E Sevransky, Charles L Sprung, Mark E Nunnally, Bram Rochwerg, Gordon D Rubenfeld, Derek C Angus, Djillali Annane, Richard J Beale, Geoffrey J Bellinghan, Gordon R Bernard, Jean-Daniel Chiche, Craig Coopersmith, Daniel P De Backer, Craig J French, Seitaro Fujishima, Herwig Gerlach, Jorge Luis Hidalgo, Steven M Hollenberg, Alan E Jones, Dilip R Karnad, Ruth M Kleinpell, Younsuk Koh, Thiago Costa Lisboa, Flavia R Machado, John J Marini, John C Marshall, John E Mazuski, Lauralyn A McIntyre, Anthony S McLean, Sangeeta Mehta, Rui P Moreno, John Myburgh, Paolo Navalesi, Osamu Nishida, Tiffany M Osborn, Anders Perner, Colleen M Plunkett, Marco Ranieri, Christa A Schorr, Maureen A Seckel, Christopher W Seymour, Lisa Shieh, Khalid A Shukri, Steven Q Simpson, Mervyn Singer, B Taylor Thompson, Sean R Townsend, Thomas Van der Poll, Jean-Louis Vincent, W Joost Wiersinga, Janice L Zimmerman, R Phillip Dellinger
OBJECTIVE: To provide an update to "Surviving Sepsis Campaign Guidelines for Management of Sepsis and Septic Shock: 2012". DESIGN: A consensus committee of 55 international experts representing 25 international organizations was convened. Nominal groups were assembled at key international meetings (for those committee members attending the conference). A formal conflict-of-interest (COI) policy was developed at the onset of the process and enforced throughout. A stand-alone meeting was held for all panel members in December 2015...
January 18, 2017: Intensive Care Medicine
https://www.readbyqxmd.com/read/28098591/surviving-sepsis-campaign-international-guidelines-for-management-of-sepsis-and-septic-shock-2016
#3
Andrew Rhodes, Laura E Evans, Waleed Alhazzani, Mitchell M Levy, Massimo Antonelli, Ricard Ferrer, Anand Kumar, Jonathan E Sevransky, Charles L Sprung, Mark E Nunnally, Bram Rochwerg, Gordon D Rubenfeld, Derek C Angus, Djillali Annane, Richard J Beale, Geoffrey J Bellinghan, Gordon R Bernard, Jean-Daniel Chiche, Craig Coopersmith, Daniel P De Backer, Craig J French, Seitaro Fujishima, Herwig Gerlach, Jorge Luis Hidalgo, Steven M Hollenberg, Alan E Jones, Dilip R Karnad, Ruth M Kleinpell, Younsuk Koh, Thiago Costa Lisboa, Flavia R Machado, John J Marini, John C Marshall, John E Mazuski, Lauralyn A McIntyre, Anthony S McLean, Sangeeta Mehta, Rui P Moreno, John Myburgh, Paolo Navalesi, Osamu Nishida, Tiffany M Osborn, Anders Perner, Colleen M Plunkett, Marco Ranieri, Christa A Schorr, Maureen A Seckel, Christopher W Seymour, Lisa Shieh, Khalid A Shukri, Steven Q Simpson, Mervyn Singer, B Taylor Thompson, Sean R Townsend, Thomas Van der Poll, Jean-Louis Vincent, W Joost Wiersinga, Janice L Zimmerman, R Phillip Dellinger
OBJECTIVE: To provide an update to "Surviving Sepsis Campaign Guidelines for Management of Sepsis and Septic Shock: 2012." DESIGN: A consensus committee of 55 international experts representing 25 international organizations was convened. Nominal groups were assembled at key international meetings (for those committee members attending the conference). A formal conflict-of-interest (COI) policy was developed at the onset of the process and enforced throughout. A stand-alone meeting was held for all panel members in December 2015...
January 17, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28091345/propofol-as-a-risk-factor-for-icu-acquired-weakness-in-septic-patients-with-acute-respiratory-failure
#4
Peter A Abdelmalik, Goran Rakocevic
BACKGROUND: Critical illness polyneuropathy (CIN) and critical illness myopathy (CIM), together "ICU-Acquired weakness (ICUAW)," occur frequently in septic patients. One of the proposed mechanisms for ICUAW includes prolonged inactivation of sodium channels. Propofol, used commonly in patients with acute respiratory failure (ARF), primarily acts via enhancement of GABAergic transmission but may also increase sodium channel inactivation, suggesting a potential interaction. METHODS: Electronic medical records and EMG reports of patients with ICUAW and a diagnosis of either sepsis, septicaemia, severe sepsis, or septic shock, concurrent with a diagnosis of acute respiratory failure (ARF), were retrospectively analyzed in a single center university hospital...
January 16, 2017: Canadian Journal of Neurological Sciences. le Journal Canadien des Sciences Neurologiques
https://www.readbyqxmd.com/read/28079708/parenteral-nutrition-in-the-critically-ill
#5
Jan Gunst, Greet Van den Berghe
PURPOSE OF REVIEW: Feeding guidelines have recommended early, full nutritional support in critically ill patients to prevent hypercatabolism and muscle weakness. Early enteral nutrition was suggested to be superior to early parenteral nutrition. When enteral nutrition fails to meet nutritional target, it was recommended to administer supplemental parenteral nutrition, albeit with a varying starting point. Sufficient amounts of amino acids were recommended, with addition of glutamine in subgroups...
January 11, 2017: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/28075489/cough-augmentation-techniques-for-extubation-or-weaning-critically-ill-patients-from-mechanical-ventilation
#6
REVIEW
Louise Rose, Neill Kj Adhikari, David Leasa, Dean A Fergusson, Douglas McKim
BACKGROUND: There are various reasons why weaning and extubation failure occur, but ineffective cough and secretion retention can play a significant role. Cough augmentation techniques, such as lung volume recruitment or manually- and mechanically-assisted cough, are used to prevent and manage respiratory complications associated with chronic conditions, particularly neuromuscular disease, and may improve short- and long-term outcomes for people with acute respiratory failure. However, the role of cough augmentation to facilitate extubation and prevent post-extubation respiratory failure is unclear...
January 11, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28065165/whole-body-vibration-to-prevent-intensive-care-unit-acquired-weakness-safety-feasibility-and-metabolic-response
#7
Tobias Wollersheim, Kurt Haas, Stefan Wolf, Knut Mai, Claudia Spies, Elisabeth Steinhagen-Thiessen, Klaus-D Wernecke, Joachim Spranger, Steffen Weber-Carstens
BACKGROUND: Intensive care unit (ICU)-acquired weakness in critically ill patients is a common and significant complication affecting the course of critical illness. Whole-body vibration is known to be effective muscle training and may be an option in diminishing weakness and muscle wasting. Especially, patients who are immobilized and not available for active physiotherapy may benefit. Until now whole-body vibration was not investigated in mechanically ventilated ICU patients. We investigated the safety, feasibility, and metabolic response of whole-body vibration in critically ill patients...
January 9, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/28034871/how-i-evaluate-and-treat-thrombocytopenia-in-the-intensive-care-unit-patient
#8
REVIEW
Andreas Greinacher, Sixten Selleng
Multiple causes (pseudothrombocytopenia, hemodilution, increased consumption, decreased production, increased sequestration, and immune-mediated destruction of platelets) alone or in combination make thrombocytopenia very common in intensive care unit (ICU) patients. Persisting thrombocytopenia in critically ill patients is associated with, but not causative of, increased mortality. Identification of the underlying cause is key for management decisions in individual patients. While platelet transfusion might be indicated in patients with impaired platelet production or increased platelet destruction, it could be deleterious in patients with increased intravascular platelet activation...
December 29, 2016: Blood
https://www.readbyqxmd.com/read/27997678/tetraparetic-critically-ill-patients-show-electrophysiological-signs-of-myopathy
#9
Clarissa Crone
INTRODUCTION: Critically ill patients often develop tetraparesis. It has been debated whether this is caused by neuropathy, myopathy, or both. The aim was to determine the incidence of myopathy and neuropathy in weak patients in the intensive care unit by performing several electrophysiological examinations, including quantitative EMG. METHODS: Forty-nine patients referred for electrophysiological examination because of suspected critical illness-related weakness underwent electromyography (EMG), nerve conduction studies, and direct muscle stimulation...
December 20, 2016: Muscle & Nerve
https://www.readbyqxmd.com/read/27993937/validity-of-the-manchester-triage-system-in-patients-with-sepsis-presenting-at-the-ed-a-first-assessment
#10
Ingo Gräff, Bernd Goldschmidt, Procula Glien, Ramona C Dolscheid-Pommerich, Rolf Fimmers, Daniel Grigutsch
BACKGROUND: The Manchester Triage System (MTS) does not have a specific presentational flow chart for sepsis. The goal of this investigation was to determine adequacy of acuity assignment for patients with sepsis presenting at the ED and triaged using the MTS. MATERIALS AND METHODS: This retrospective analysis included patients >16 presenting to an ED in Bonn, Germany, on the first 12 days of each month between June 2012 and March 2014. Patients were classified into one of three septic groups, or no sepsis...
December 19, 2016: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/27993157/early-phase-cumulative-hypotension-duration-and-severe-stage-progression-in-oliguric-acute-kidney-injury-with-and-without-sepsis-an-observational-study
#11
Junichi Izawa, Tetsuhisa Kitamura, Taku Iwami, Shigehiko Uchino, Masanori Takinami, John A Kellum, Takashi Kawamura
BACKGROUND: Managing blood pressure in patients with acute kidney injury (AKI) could effectively prevent severe-stage progression. However, the effect of hypotension duration in the early phase of AKI remains poorly understood. This study investigated the association between early-phase cumulative duration of hypotension below threshold mean arterial pressure (MAP) and severe-stage progression of oliguric AKI in critically ill patients, and assessed the difference in association with presence of sepsis...
December 19, 2016: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/27990831/-clinical-evaluation-of-acid-base-status-henderson-hasselbalch-or-stewart-fencl-approach
#12
Karel Matoušovic, Jan Havlín, Otto Schück
Two approaches have been used in clinical evaluation the acid-base status: traditional (bicarbonate-centered) is based on the Henderson-Hasselbalch equation complemented by calculation of the anion gap, and more recent quantitative approach proposed by Stewart and Fencl. The latter method defines the three independent variables, which regulate pH. These include: the difference between the sum of charges carried by strong plasma cations and anions termed the strong ion difference - SID (decrease causes acidosis, and vice versa); the total concentration of the weak non-volatile acids [Atot] (inorganic phosphate and albumin, decrease causes alkalosis and vice versa), and pCO2...
2016: Casopís Lékar̆ů C̆eských
https://www.readbyqxmd.com/read/27984278/guidelines-for-family-centered-care-in-the-neonatal-pediatric-and-adult-icu
#13
Judy E Davidson, Rebecca A Aslakson, Ann C Long, Kathleen A Puntillo, Erin K Kross, Joanna Hart, Christopher E Cox, Hannah Wunsch, Mary A Wickline, Mark E Nunnally, Giora Netzer, Nancy Kentish-Barnes, Charles L Sprung, Christiane S Hartog, Maureen Coombs, Rik T Gerritsen, Ramona O Hopkins, Linda S Franck, Yoanna Skrobik, Alexander A Kon, Elizabeth A Scruth, Maurene A Harvey, Mithya Lewis-Newby, Douglas B White, Sandra M Swoboda, Colin R Cooke, Mitchell M Levy, Elie Azoulay, J Randall Curtis
OBJECTIVE: To provide clinicians with evidence-based strategies to optimize the support of the family of critically ill patients in the ICU. METHODS: We used the Council of Medical Specialty Societies principles for the development of clinical guidelines as the framework for guideline development. We assembled an international multidisciplinary team of 29 members with expertise in guideline development, evidence analysis, and family-centered care to revise the 2007 Clinical Practice Guidelines for support of the family in the patient-centered ICU...
January 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/27978819/the-experiences-of-high-school-students-with-pulmonary-tuberculosis-in-china-a-qualitative-study
#14
Shaoru Zhang, Xiaohong Li, Tianhua Zhang, Yahui Fan, Yuelu Li
BACKGROUND: Clustered tuberculosis (TB) still occurred nationally in Chinese schools every year, where high school students patients accounts for the highest proportion. These young TB patients are in a critical period of physical and psychological growth. Research on their illness experience and analysis of underlying causes remains blank. The purpose of this study is to explore the overall illness experience of Chinese high school TB patients and to investigate the individual and social causes of such experience...
December 15, 2016: BMC Infectious Diseases
https://www.readbyqxmd.com/read/27942240/impact-of-the-health-insurance-scheme-for-stateless-people-on-inpatient-utilization-in-kraburi-hospital-thailand
#15
Rapeepong Suphanchaimat, Phusit Prakongsai, Supon Limwattananon, Anne Mills
OBJECTIVES: This study sought to investigate the impact of the Thai "Health Insurance for People with Citizenship Problems" (HI-PCP) on access to care for stateless patients, compared to Universal Coverage Scheme patients and the uninsured, using inpatient utilization as a proxy for impact. METHODS: Secondary data analysis of inpatient records of Kraburi Hospital, Ranong province, between 2009 (pre-policy) and 2012 (post-policy) was employed. Descriptive statistics and multivariate analysis by difference-in-difference model were performed...
2016: Risk Management and Healthcare Policy
https://www.readbyqxmd.com/read/27932182/recovery-after-critical-illness-polyneuropathy-in-a-patient-with-orthotopic-liver-transplantation-a-case-report
#16
J Watanabe, E Ito, M Hatano, T Tohyama, Y Okada, Y Takada
After liver transplantation, some patients show neuromuscular abnormalities. A 43-year-old man with liver cirrhosis due to hepatitis C virus underwent living-donor liver transplantation. He developed severe neuromuscular dysfunction after sepsis, and acute respiratory distress syndrome. After the inflammatory reaction gradually improved, we observed bilateral weakness of the extremities and foot drop. Electrophysiological studies indicated primary axonal degeneration of peripheral motor and sensory fibers without inflammation...
November 2016: Transplantation Proceedings
https://www.readbyqxmd.com/read/27922495/toxic-and-endocrine-myopathies
#17
Hans D Katzberg, Charles D Kassardjian
PURPOSE OF REVIEW: This article discusses the clinical features, pathophysiology, and management of toxic and endocrine myopathies. RECENT FINDINGS: Early detection and expeditious correction of metabolic disturbances in endocrinopathies such as Cushing syndrome, thyroid and parathyroid diseases, and acromegaly can minimize and prevent neurologic complications including myopathy. Recently proposed mechanisms of injury in patients with critical illness myopathy include inhibition of protein synthesis, mitochondrial dysfunction, disruption of the ubiquitin-proteasome system, oxidative stress, and disruption of intramuscular calcium homeostasis, which can cause a myosin-loss myopathy...
December 2016: Continuum: Lifelong Learning in Neurology
https://www.readbyqxmd.com/read/27897405/premorbid-obesity-but-not-nutrition-prevents-critical-illness-induced-muscle-wasting-and-weakness
#18
Chloë Goossens, Mirna Bastos Marques, Sarah Derde, Sarah Vander Perre, Thomas Dufour, Steven E Thiessen, Fabian Güiza, Thomas Janssens, Greet Hermans, Ilse Vanhorebeek, Katrien De Bock, Greet Van den Berghe, Lies Langouche
BACKGROUND: The 'obesity paradox' of critical illness refers to better survival with a higher body mass index. We hypothesized that fat mobilized from excess adipose tissue during critical illness provides energy more efficiently than exogenous macronutrients and could prevent lean tissue wasting. METHODS: In lean and premorbidly obese mice, the effect of 5 days of sepsis-induced critical illness on body weight and composition, muscle wasting, and weakness was assessed, each with fasting and parenteral feeding...
July 20, 2016: Journal of Cachexia, Sarcopenia and Muscle
https://www.readbyqxmd.com/read/27894277/human-limb-skeletal-muscle-wasting-and-architectural-remodeling-during-five-to-ten-days-intubation-and-ventilation-in-critical-care-an-observational-study-using-ultrasound
#19
Peter Turton, Richard Hay, Jonathon Taylor, Jamie McPhee, Ingeborg Welters
BACKGROUND: Critically ill patients frequently suffer muscle weakness whilst in critical care. Ultrasound can reliably track loss of muscle size, but also quantifies the arrangement of the muscle fascicles, known as the muscle architecture. We sought to measure both pennation angle and fascicle length, as well as tracking changes in muscle thickness in a population of critically ill patients. METHODS: On days 1, 5 and 10 after admission to critical care, muscle thickness was measured in ventilated critically ill patients using bedside ultrasound...
November 29, 2016: BMC Anesthesiology
https://www.readbyqxmd.com/read/27891297/exercise-rehabilitation-following-intensive-care-unit-discharge-for-recovery-from-critical-illness-executive-summary-of-a-cochrane-collaboration-systematic-review
#20
REVIEW
Bronwen Connolly, Lisa Salisbury, Brenda O'Neill, Louise Geneen, Abdel Douiri, Michael P W Grocott, Nicholas Hart, Timothy S Walsh, Bronagh Blackwood
Skeletal muscle wasting and weakness are major complications of critical illness and underlie the profound physical and functional impairments experienced by survivors after discharge from the intensive care unit (ICU). Exercise-based rehabilitation has been shown to be beneficial when delivered during ICU admission. This review aimed to determine the effectiveness of exercise rehabilitation initiated after ICU discharge on primary outcomes of functional exercise capacity and health-related quality of life...
December 2016: Journal of Cachexia, Sarcopenia and Muscle
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