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Critically ill patients

Stacy A Voils, Mohamed H Shahin, Timothy J Garrett, Reginald F Frye
OBJECTIVE: Incidence of venous thromboembolism (VTE) in critically ill patients remains unacceptably high despite widespread use of thromboprophylaxis. A systems biology approach may be useful in understanding disease pathology and predicting response to treatment. Metabolite profile under specific environmental conditions provides the closest link to phenotype, but the relationship between metabolomics and risk of VTE in critically ill patients is unknown. In this study, metabolomics signatures are compared in patients with and without VTE...
March 8, 2018: Thrombosis Research
Fraser Magee, Michael Bailey, David V Pilcher, Johan Mårtensson, Rinaldo Bellomo
PURPOSE: To investigate the relationship between dysglycemia and hospital mortality in patients with and without a preadmission diagnosis of insulin treated diabetes mellitus (ITDM). MATERIALS AND METHODS: An observational multicentre cohort study using the ANZICS-APD database on adult patients admitted to ICU with sepsis between January 1st 2006 and December 31st 2015. Four domains of dysglycemia were investigated (highest, mean and lowest blood glucose levels and glycemic variability: the absolute difference between the highest and lowest level)...
March 3, 2018: Journal of Critical Care
Purva Sharma, Yash Jobanputra, Karen Lewin, Stuart Bagatell, Daniel Lichtstein
BACKGROUND: Diabetic ketoacidosis (DKA) is a serious complication of diabetes seen commonly in autoimmune Type 1 diabetes mellitus (DM), however patients with Type 2 diabetes are also at risk. Diabetic ketoacidosis may be precipitated by the catabolic stress of acute illness such as trauma, surgery, or infections. Recent studies have suggested that sodium glucose cotransporter-2 (SGLT-2) inhibitors precipitate DKA in Type 2 diabetes. We present a case series of four patients on SGLT-2 inhibitors who presented with DKA...
March 13, 2018: Reviews on Recent Clinical Trials
Sebastian J Klein, Anna K Brandtner, Georg F Lehner, Hanno Ulmer, Sean M Bagshaw, Christian J Wiedermann, Michael Joannidis
PURPOSE: Acute kidney injury (AKI) frequently occurs in critically ill patients and often precipitates use of renal replacement therapy (RRT). However, the ideal circumstances for whether and when to start RRT remain unclear. We performed evidence synthesis of the available literature to evaluate the value of biomarkers to predict receipt of RRT for AKI. METHODS: We conducted a PRISMA-guided systematic review and meta-analysis including all trials evaluating biomarker performance for prediction of RRT in AKI...
March 14, 2018: Intensive Care Medicine
Timothy S Walsh, Nicole P Juffermans
No abstract text is available yet for this article.
March 14, 2018: Intensive Care Medicine
Beatriz Paulina Ayala Quintanilla, Wendy E Pollock, Susan J McDonald, Angela J Taft
INTRODUCTION: Preventing and reducing violence against women (VAW) and maternal mortality are Sustainable Development Goals. Worldwide, the maternal mortality ratio has fallen about 44% in the last 25 years, and for one maternal death there are many women affected by severe acute maternal morbidity (SAMM) requiring management in the intensive care unit (ICU). These women represent the most critically ill obstetric patients of the maternal morbidity spectrum and should be studied to complement the review of maternal mortality...
March 14, 2018: BMJ Open
Jonathan V Martin, David M Liberati, Lawrence N Diebel
BACKGROUND: Hypernatremia is a common problem affecting critically ill patients, whether due to underlying pathology or the subsequent result of hypertonic fluid resuscitation. Numerous studies have been published suggesting that hypernatremia may adversely affect the vascular endothelial glycocalyx. Our study aimed to evaluate if high sodium concentration would impair the endothelial and glycocalyx barrier function and if stress conditions that simulate the shock microenvironment would exacerbate any observed adverse effects of hypernatremia...
March 12, 2018: Journal of Trauma and Acute Care Surgery
Matthew C Hernandez, Brandon R Bruns, Nadeem Haddad, Margaret Lauerman, David S Morris, Kristen Arnold, Herb A Phelan, David Turay, Jason Murry, John S Oh, Toby Enniss, Matthew M Carrick, Thomas M Scalea, Martin Zielinski
INTRODUCTION: Threatened, perforated, and infarcted bowel is managed with conventional resection and anastomosis (hand sewn (HS) or stapled (ST)). The SHAPES analysis demonstrated equivalence between HS and ST techniques, yet surgeons appeared to prefer (HS) for the critically ill. We hypothesized that HS is more frequent in patients with higher disease severity as measured by the AAST EGS grading system. METHODS: We performed a post hoc analysis of the SHAPES database...
March 12, 2018: Journal of Trauma and Acute Care Surgery
Shunsuke Taito, Daisuke Okada, Shuhei Ishida
No abstract text is available yet for this article.
April 2018: Critical Care Medicine
Edmund Burke, Sanjeev A Datar
PURPOSE OF REVIEW: The essential role of the lymphatic system in fluid homeostasis, nutrient transport, and immune trafficking is well recognized; however, there is limited understanding of the mechanisms that regulate lymphatic function, particularly in the setting of critical illness. The lymphatics likely affect disease severity and progression in every condition, from severe systemic inflammatory states to respiratory failure. Here, we review structural and functional disorders of the lymphatic system, both congenital and acquired, as they relate to care of the pediatric patient in the intensive care setting, including novel areas of research into medical and procedural therapeutic interventions...
March 13, 2018: Current Opinion in Pediatrics
Seung Hee Choi, Roxane R Chan, Rebecca H Lehto
BACKGROUND: While much research and practice resources have addressed smoking cessation among cancer patients, less emphasis has been placed on personal psychological and environment factors associated with smoking at the time of diagnosis. OBJECTIVE: The aim of this study was to examine differences in psychological distress, optimism, and perceptions of the health environment/illness experience based on smoking status in patients with current, former, and no smoking history with newly diagnosed suspected or actual lung cancer...
March 13, 2018: Cancer Nursing
Xiaoyan Wen, Liyan Cui, Seth Morrisroe, Donald Maberry, David R Emlet, Simon C Watkins, Neil A Hukriede, John A Kellum
Sepsis-associated acute kidney injury (S-AKI) independently predicts mortality among critically ill patients. The role of innate immunity in this process is unclear, and there is an unmet need for S-AKI models to delineate the pathophysiological response. Mammals and zebrafish (Danio rerio) share a conserved nephron structure and homologous innate immune systems, making the latter suitable for sepsis-associated AKI research. We introduced Edwardsiella tarda (E.tarda) to the zebrafish. Systemic E. tarda bacteremia resulted in sustained bacterial infection and dose-dependent mortality...
March 14, 2018: American Journal of Physiology. Renal Physiology
Nicole Schulz, Arne Güssow, Natali Bauer, Andreas Moritz
Magnesium is the second most abundant intracellular cation after potassium. It plays a vital role in almost every metabolic process in the body and is important for bone mineralization, muscle contraction and relaxation, and neuronal signal transduction. Because of its expanding role in intensivecare medicine, there has been a significant increase in knowledge during recent years regarding the functions of magnesium in the body, problems leading to magnesium disorders, and limitations of laboratory testing...
February 2018: Tierärztliche Praxis. Ausgabe K, Kleintiere/Heimtiere
Hari R Desu, Laura A Thoma, George C Wood
PURPOSE: Acute lung injury (ALI) is a fatal syndrome in critically ill patients. It is characterized by lung edema and inflammation. Numerous pro-inflammatory mediators are released into alveoli. Among them, interleukin-1beta (IL-1β) causes an increase in solute permeability across the alveolar-capillary barrier leading to edema. It activates key effector cells (alveolar epithelial and endothelial cells) releasing inflammatory chemokines and cytokines. The purpose of the study was to demonstrate that nebulized liposomes inhibit ALI in vivo...
March 13, 2018: Pharmaceutical Research
Caroline Sut, Sofiane Tariket, Cécile Aubron, Chaker Aloui, Hind Hamzeh-Cognasse, Philippe Berthelot, Sandrine Laradi, Andreas Greinacher, Olivier Garraud, Fabrice Cognasse
Platelets transfusion is a safe process, but during or after the process, the recipient may experience an adverse reaction and occasionally a serious adverse reaction (SAR). In this review, we focus on the inflammatory potential of platelet components (PCs) and their involvement in SARs. Recent evidence has highlighted a central role for platelets in the host inflammatory and immune responses. Blood platelets are involved in inflammation and various other aspects of innate immunity through the release of a plethora of immunomodulatory cytokines, chemokines, and associated molecules, collectively termed biological response modifiers that behave like ligands for endothelial and leukocyte receptors and for platelets themselves...
2018: Frontiers in Medicine
I-Ling Chen, Chen-Hsiang Lee, Shih-Wen Ting, Lily Yu-Chin Wang
Objectives: The increasing number of reports on infections due to carbapenem-resistant Gram-negative bacilli (GNB) has raised concerns, because they have complicated empiric or guided antibiotic therapy for critically ill patients. We aimed to develop a scoring system to predict nosocomial imipenem-resistant GNB (IR-GNB) septicemia among the critically ill patients. Materials and methods: The study included critically ill adult patients with nosocomial GNB septicemia at Kaohsiung Chang Gung Memorial Hospital (CGMH) in 2013-2015, and the scoring system for predicting IR-GNB septicemia was developed, followed by prospective validation conducted among patients at Linkou CGMH and Kaohsiung CGMH between January and June, 2016...
2018: Infection and Drug Resistance
Maureen Campion, Gail Scully
Appropriate antimicrobial therapy is essential to ensuring positive patient outcomes. Inappropriate or suboptimal utilization of antibiotics can lead to increased length of stay, multidrug-resistant infections, and mortality. Critically ill intensive care patients, particularly those with severe sepsis and septic shock, are at risk of antibiotic failure and secondary infections associated with incorrect antibiotic use. Through the initiation of active empiric antibiotic therapy based upon local susceptibilities, daily evaluation of signs and symptoms of infection and narrowing of antibiotic therapy when feasible, providers can streamline the treatment of common intensive care unit (ICU) infections...
January 1, 2018: Journal of Intensive Care Medicine
Lindsay J Blazin, Cherilyn Cecchini, Catherine Habashy, Erica C Kaye, Justin N Baker
Effective communication is essential to the practice of pediatric oncology. Clear and empathic delivery of diagnostic and prognostic information positively impacts the ways in which patients and families cope. Honest, compassionate discussions regarding goals of care and hopes for patients approaching end of life can provide healing when other therapies have failed. Effective communication and the positive relationships it fosters also can provide comfort to families grieving the loss of a child. A robust body of evidence demonstrates the benefits of optimal communication for patients, families, and healthcare providers...
March 11, 2018: Children
(no author information available yet)
Trace elements are dietary elements which are needed in very minute quantities for the proper growth, development, and physiology of the organism, which play a crucial part in energy metabolism and material transformation. It's generally agreed that trace elements are essential components of parenteral nutrition. These societies for parenteral and enteral nutrition in Europe, the United States and Australia proposed that various trace elements should be provided daily from commencement for all patients receiving parenteral nutrition and published some guidelines on adult trace elements recommendations for parenteral nutrition...
March 1, 2018: Zhonghua Wai Ke za Zhi [Chinese Journal of Surgery]
Patricia G Rosenstein, Brett S Tennent-Brown, Dez Hughes
OBJECTIVE: To review the current literature with respect to the physiology, pathophysiology, and measurement of lactate. DATA SOURCES: Data were sourced from veterinary and human clinical trials, retrospective studies, experimental studies, and review articles. Articles were retrieved without date restrictions and were sourced primarily via PubMed, Scopus, and CAB Abstracts as well as by manual selection. HUMAN AND VETERINARY DATA SYNTHESIS: Lactate is an important energy storage molecule, the production of which preserves cellular energy production and mitigates the acidosis from ATP hydrolysis...
March 2018: Journal of Veterinary Emergency and Critical Care
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