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Weakness in the critically ill patient

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https://www.readbyqxmd.com/read/28538441/hyperlactatemia-lactate-kinetics-and-prediction-of-citrate-accumulation-in-critically-ill-patients-undergoing-continuous-renal-replacement-therapy-with-regional-citrate-anticoagulation
#1
Dmytro Khadzhynov, Annette Dahlinger, Christin Schelter, Harm Peters, Detlef Kindgen-Milles, Klemens Budde, Lukas Johannes Lehner, Fabian Halleck, Oliver Staeck, Torsten Slowinski
OBJECTIVES: Citrate accumulation is a major complication of regional citrate anticoagulation during continuous renal replacement therapy. We studied the prediction of citrate accumulation during continuous veno-venous hemodialysis with regional citrate anticoagulation by initial lactate concentrations and lactate kinetics. DESIGN: A retrospective follow-up analysis from a cohort of critically ill patients. SETTING: Mixed medical-surgical ICUs at a university hospital...
May 22, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28518095/use-of-a-central-venous-line-for-fluids-drugs-and-nutrient-administration-in-a-mouse-model-of-critical-illness
#2
Sarah Derde, Steven Thiessen, Chloë Goossens, Thomas Dufour, Greet Van den Berghe, Lies Langouche
This protocol describes a centrally catheterized mouse model of prolonged critical illness. We combine the cecal ligation and puncture method to induce sepsis with the use of a central venous line for fluids, drugs and nutrient administration to mimic the human clinical setting. Critically ill patients require intensive medical support in order to survive. While the majority of patients will recover within a few days, about a quarter of the patients need prolonged intensive care and are at high risk of dying from non-resolving multiple organ failure...
May 2, 2017: Journal of Visualized Experiments: JoVE
https://www.readbyqxmd.com/read/28487184/symptom-assessment-in-non-vocal-or-cognitively-impaired-icu-patients-implications-for-practice-and-future-research
#3
REVIEW
JiYeon Choi, Margaret L Campbell, Céline Gélinas, Mary Beth Happ, Judith Tate, Linda Chlan
BACKGROUND: Symptom assessment in critically ill patients is challenging because many cannot provide a self-report. OBJECTIVES: To describe the state of the science on symptom communication and the assessment of selected physical symptoms in non-vocal ICU patients. METHODS: This paper summarizes a 2014 American Thoracic Society Annual International Conference symposium presenting current evidence on symptom communication, delirium, and the assessment of common physical symptoms (i...
May 6, 2017: Heart & Lung: the Journal of Critical Care
https://www.readbyqxmd.com/read/28461551/organizational-domains-and-variation-in-attitudes-of-intensive-care-providers-toward-the-abcde-bundle
#4
Leanne M Boehm, Eduard E Vasilevskis, Mary S Dietrich, Nancy Wells, E Wesley Ely, Pratik Pandharipande, Lorraine C Mion
BACKGROUND: The ABCDE interprofessional bundle (Awakening and Breathing Coordination, Delirium monitoring and management, and Early mobility) reduces delirium and weakness in critically ill patients. OBJECTIVE: To understand the relationship between organizational domains and provider attitudes. METHODS: A 1-time electronic survey of 315 care providers in 10 intensive care units across the country to examine associations between organizational domains (policy/protocol factors, unit milieu, tasks, labor quality, labor quantity, and physical environment) and provider attitudes about perceived ease of completion, perceived safety, confidence, and perceived strength of evidence regarding the ABCDE bundle...
May 2017: American Journal of Critical Care: An Official Publication, American Association of Critical-Care Nurses
https://www.readbyqxmd.com/read/28443595/evaluation-of-the-diagnostic-role-of-bedside-lung-ultrasonography-in-patients-with-suspected-pulmonary-embolism-in-the-emergency-department
#5
Hüseyin Acar, Serkan Yılmaz, Elif Yaka, Nurettin Özgür Doğan, Asım Enes Özbek, Murat Pekdemir
BACKGROUND: Despite the existence of detailed consensus guidelines, challenges continue to exist regarding efficient, appropriate and safe imaging methods for the diagnosis of suspected pulmonary embolism. AIMS: This study was conducted to investigate the role of wedge sign, B-lines and pleural effusion seen on bedside lung ultrasound in the diagnosis of pulmonary embolism. STUDY DESIGN: Diagnostic accuracy study. METHODS: During the first evaluation of patients with suspected pulmonary embolism, bedside lung ultrasound was performed, and the B-lines, wedge sign, and pleural effusion were investigated...
April 6, 2017: Balkan Medical Journal
https://www.readbyqxmd.com/read/28428892/a-comparison-of-earlier-and-enhanced-rehabilitation-of-mechanically-ventilated-patients-in-critical-care-compared-to-standard-care-rehab-study-protocol-for-a-single-site-randomised-controlled-feasibility-trial
#6
Catherine Snelson, Charlotte Jones, Gemma Atkins, James Hodson, Tony Whitehouse, Tonny Veenith, David Thickett, Emma Reeves, Aisling McLaughlin, Lauren Cooper, David McWilliams
BACKGROUND: Mortality from critical illness is improving, but survivors suffer from prolonged weakness and psychological and cognitive impairments. Maximising the recovery after critical illness has been highlighted as a research priority, especially in relation to an ageing population who present with higher rates of pre-morbid disability. Small studies have shown that starting rehabilitation early within the intensive care unit (ICU) improves short-term outcomes. Systematic reviews have highlighted the need for robust multicentre randomised controlled trials with longer term follow-up...
2017: Pilot and Feasibility Studies
https://www.readbyqxmd.com/read/28412382/use-of-nebulized-antimicrobials-for-the-treatment-of-respiratory-infections-in-invasively-mechanically-ventilated-adults-a-position-paper-from-the-european-society-of-clinical-microbiology-and-infectious-diseases
#7
Jordi Rello, Candela Solé-Lleonart, Jean-Jacques Rouby, Jean Chastre, Stijn Blot, Garyfallia Poulakou, Charles-Edouard Luyt, Jordi Riera, Lucy B Palmer, Jose M Pereira, Tim Felton, Jayesh Dhanani, Matteo Bassetti, Tobias Welte, Jason A Roberts
With an established role in cystic fibrosis and bronchiectasis, nebulized antibiotics are increasingly being used to treat respiratory infections in critically ill invasively mechanically ventilated adult patients. Although there is limited evidence describing their efficacy and safety, in an era of need for new strategies to enhance antibiotic effectiveness because of a shortage of new agents and increases in antibiotic resistance, the potential of nebulization of antibiotics to optimize therapy is considered of high interest, particularly in patients infected with multidrug-resistant (MDR) pathogens...
April 13, 2017: Clinical Microbiology and Infection
https://www.readbyqxmd.com/read/28387014/weak-by-the-machines-muscle-motor-protein-dysfunction-a-side-effect-of-intensive-care-unit-treatment
#8
REVIEW
O Friedrich, S Diermeier, L Larsson
Intensive care interventions involve periods of mechanical ventilation, sedation and complete mechanical silencing of patients. Critical illness myopathy (CIM) is an ICU-acquired myopathy that is associated with limb muscle weakness, muscle atrophy, electrical silencing of muscle and motor proteinopathy. The hallmark of CIM is a preferential muscle myosin loss due to increased catabolic and reduced anabolic activity. The ubiquitin proteasome pathway plays an important role, apart from recently identified novel mechanisms affecting non-lysosomal protein degradation or autophagy...
April 7, 2017: Acta Physiologica
https://www.readbyqxmd.com/read/28375722/the-link-between-mental-illness-and-firearm-violence-implications-for-social-policy-and-clinical-practice
#9
John S Rozel, Edward P Mulvey
The United States has substantially higher levels of firearm violence than most other developed countries. Firearm violence is a significant and preventable public health crisis. Mental illness is a weak risk factor for violence despite popular misconceptions reflected in the media and policy. That said, mental health professionals play a critical role in assessing their patients for violence risk, counseling about firearm safety, and guiding the creation of rational and evidence-based public policy that can be effective in mitigating violence risk without unnecessarily stigmatizing people with mental illness...
May 8, 2017: Annual Review of Clinical Psychology
https://www.readbyqxmd.com/read/28364678/effect-of-neuromuscular-stimulation-and-individualized-rehabilitation-on-muscle-strength-in-intensive-care-unit-survivors-a-randomized-trial
#10
Irini Patsaki, Vasiliki Gerovasili, Georgios Sidiras, Eleftherios Karatzanos, Georgios Mitsiou, Emmanuel Papadopoulos, Anna Christakou, Christina Routsi, Anastasia Kotanidou, Serafim Nanas
PURPOSE: Intensive Care Unit (ICU) survivors experience muscle weakness leading to restrictions in functional ability. Neuromuscular electrical stimulation (NMES) has been an alternative to exercise in critically ill patients. The aim of our study was to investigate its effects along with individualized rehabilitation on muscle strength of ICU survivors. MATERIAL AND METHODS: Following ICU discharge, 128 patients (age: 53±16years) were randomly assigned to daily NMES sessions and individualized rehabilitation (NMES group) or to control group...
March 22, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/28361079/ultrasound-to-assess-diaphragmatic-function-in-the-critically-ill-a-critical-perspective
#11
EDITORIAL
Mark Haaksma, Pieter Roel Tuinman, Leo Heunks
Ultrasound of the diaphragm in critically ill patients has become a diagnostic technique of emerging interest among clinicians and scientists. The advantages include that it is widely available, non-invasive and examination can be performed after relatively short training and at low costs. It is used to estimate muscle mass by measurement of muscle thickness and diagnose weakness by the assessment of diaphragm movement during unassisted breathing. Thickening of the muscle during inspiration has been used to quantify force generation...
March 2017: Annals of Translational Medicine
https://www.readbyqxmd.com/read/28350642/increased-early-systemic-inflammation-in-icu-acquired-weakness-a-prospective-observational-cohort-study
#12
Esther Witteveen, Luuk Wieske, Tom van der Poll, Marike van der Schaaf, Ivo N van Schaik, Marcus J Schultz, Camiel Verhamme, Janneke Horn
OBJECTIVES: To investigate whether patients who develop ICU-acquired weakness have a different pattern of systemic inflammatory markers compared with critically ill patients who do not develop ICU-acquired weakness. DESIGN: Prospective observational cohort study. SETTING: Mixed medical-surgical ICU of a tertiary care hospital in the Netherlands. PATIENTS: Newly admitted critically ill patients, greater than or equal to 48 hours on mechanical ventilation with a nonneurologic ICU admission diagnosis, were included...
June 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28343681/ultrasound-evaluation-of-diaphragm-function-and-its-application-in-critical-patients-mechanical-ventilation-and-brachial-plexus-block
#13
F de B de la Quintana Gordon, B Nacarino Alcorta, M Fajardo Pérez
Before diaphragm ultrasonography, assessment of diaphragm function was very difficult due to the complex nature of its exploration. The use of this new technique has shed light on diagnostic problems and treatment with an improvement in final outcomes for critically ill patients, in whom the incidence of diaphragm weakness or dysfunction has been underestimated. Better knowledge of diaphragm function enables us earlier diagnosis by quantification of diaphragm contractile activity or evaluation of functional status after delivery of plexus block anaesthesia, facilitating therapeutic decisions...
March 23, 2017: Revista Española de Anestesiología y Reanimación
https://www.readbyqxmd.com/read/28331624/comparison-of-hydroxyethyl-starch-regulatory-summaries-from-the-food-and-drug-administration-and-the-european-medicines-agency
#14
Christian J Wiedermann, Klaus Eisendle
This article aims to highlight the positions of the Food and Drug Administration and the European Medicines Agency regarding use and marketing of hydroxyethyl starch (HES) products, and how these have changed over recent years. In 2013, warnings from both agencies advised against use of HES in critically ill patients, including patients with sepsis, when several large randomized controlled trials on volume resuscitation in critical illness failed to observe clinically beneficial effects of HES. In areas such as patient monitoring and requirements for further clinical trials, the FDA and EMA are very much in agreement in their recommendations...
2017: Journal of Pharmaceutical Policy and Practice
https://www.readbyqxmd.com/read/28325097/regaining-water-swallowing-function-in-the-rehabilitation-of-critically-ill-patients-with-intensive-care-unit-acquired-muscle-weakness
#15
Simone Thomas, Wolfgang Sauter, Ulrike Starrost, Marcus Pohl, Jan Mehrholz
PURPOSE: Treatment in intensive care units (ICUs) often results in swallowing dysfunction. Recent longitudinal studies have described the recovery of critically ill people, but we are not aware of studies of the recovery of swallowing function in patients with ICU-acquired muscle weakness. This paper aims to describe the time course of regaining water swallowing function in patients with ICU-acquired weakness in the post-acute phase and to describe the risks of regaining water swallowing function and the risk factors involved...
March 21, 2017: Disability and Rehabilitation
https://www.readbyqxmd.com/read/28236389/early-mobilization-of-mechanically-ventilated-patients
#16
REVIEW
Pam Hruska
Critically ill patients requiring mechanical ventilation are least likely to be mobilized and, as a result, are at-risk for prolonged complications from weakness. The use of bed rest and sedation when caring for mechanically ventilated patients is likely shaped by historical practice; however, this review demonstrates early mobilization, with little to no sedation, is possible and safe. Assessing readiness for mobilization in context of progressing patients from passive to active activities can lead to long-term benefits and has been achievable with resource-efficient implementations and team work...
December 2016: Critical Care Nursing Clinics of North America
https://www.readbyqxmd.com/read/28236156/antimalarial-myopathy-in-a-systemic-lupus-erythematosus-patient-with-quadriparesis-and-seizures-a-case-based-review
#17
REVIEW
Kashif Jafri, Hengameh Zahed, Katherine D Wysham, Sarah Patterson, Amber L Nolan, Matthew D Bucknor, R Krishna Chaganti
Weakness, seizures, and encephalopathy have a broad differential diagnosis in patients with systemic lupus erythematosus (SLE). We present a case of a 26-year-old female with a recent diagnosis of SLE who experienced a clinical deterioration with quadriparesis, seizures, and encephalopathy. Her quadriparesis was found to be secondary to biopsy-proven hydroxychloroquine-induced myopathy with concomitant inflammatory myopathy. Her seizures and encephalopathy were suspected to be multifactorial in the setting of sepsis and critical illness with possible contributions from neuropsychiatric manifestations of SLE and macrophage activation syndrome...
February 24, 2017: Clinical Rheumatology
https://www.readbyqxmd.com/read/28210771/factors-influencing-physical-activity-and-rehabilitation-in-survivors-of-critical-illness-a-systematic-review-of-quantitative-and-qualitative-studies
#18
REVIEW
Selina M Parry, Laura D Knight, Bronwen Connolly, Claire Baldwin, Zudin Puthucheary, Peter Morris, Jessica Mortimore, Nicholas Hart, Linda Denehy, Catherine L Granger
PURPOSE: To identify, evaluate and synthesise studies examining the barriers and enablers for survivors of critical illness to participate in physical activity in the ICU and post-ICU settings from the perspective of patients, caregivers and healthcare providers. METHODS: Systematic review of articles using five electronic databases: MEDLINE, CINAHL, EMBASE, Cochrane Library, Scopus. Quantitative and qualitative studies that were published in English in a peer-reviewed journal and assessed barriers or enablers for survivors of critical illness to perform physical activity were included...
April 2017: Intensive Care Medicine
https://www.readbyqxmd.com/read/28190446/prognosis-of-neurologic-complications-in-critical-illness
#19
REVIEW
M Van Der Jagt, E J O Kompanje
Neurologic complications of critical illness require extensive clinical and neurophysiologic evaluation to establish a reliable prognosis. Many sequelae of intensive care unit (ICU) treatment, such as delirium and ICU-acquired weakness, although highly associated with adverse outcomes, are less suitable for prognostication, but should rather prompt clinicians to seek previously unnoticed persisting underlying illnesses. Prognostication can be confounded by drug administration particularly because its clearance is abnormal in critical illness...
2017: Handbook of Clinical Neurology
https://www.readbyqxmd.com/read/28190440/neurologic-complications-in-critically-ill-pregnant-patients
#20
W L Wright
Neurologic complications in a critically ill pregnant woman are uncommon but some of the complications (such as eclampsia) are unique to pregnancy and the puerperal period. Other neurologic complications (such as seizures in the setting of epilepsy) may worsen during pregnancy. Clinical signs and symptoms such as seizure, headache, weakness, focal neurologic deficits, and decreased level of consciousness require careful consideration of potential causes to ensure prompt treatment measures are instituted to prevent ongoing neurologic injury...
2017: Handbook of Clinical Neurology
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