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https://www.readbyqxmd.com/read/28229241/acquired-prolongation-of-qt-interval-as-a-risk-factor-for-torsade-de-pointes-ventricular-tachycardia-a-narrative-review-for-the-anesthesiologist-and-intensivist
#1
REVIEW
Arsen Uvelin, Jasmina Pejaković, Vesna Mijatović
More than 70% of intensive care unit (ICU) patients experience heart rhythm disturbances, and these patients have correspondingly higher mortality rates. Consequently, one of the standards of care in ICUs is continuous electrocardiography monitoring. One of the potentially preventable dysrhythmic events is the occurrence of torsade de pointes ventricular tachycardia in the setting of acquired prolonged QT interval. This type of ventricular tachycardia can be malignant because it often progresses to ventricular fibrillation...
February 22, 2017: Journal of Anesthesia
https://www.readbyqxmd.com/read/28220224/what-do-sepsis-induced-coagulation-test-result-abnormalities-mean-to-intensivists
#2
EDITORIAL
Marcel Levi, Marcus J Schultz
No abstract text is available yet for this article.
February 20, 2017: Intensive Care Medicine
https://www.readbyqxmd.com/read/28190429/the-scope-of-neurology-of-critical-illness
#3
E F M Wijdicks
Critical illness increases the probability of a neurologic complication. There are many reasons to consult a neurologist in a critically ill patient and most often it is altered alertness with no intuitive plausible explanation. Other common clinical neurologic problems facing the intensive care specialist and consulting neurologist in everyday decisions are coma following prolonged cardiovascular surgery, newly perceived motor asymmetry, seizures or other abnormal movements, and generalized muscle weakness...
2017: Handbook of Clinical Neurology
https://www.readbyqxmd.com/read/28183375/translating-clinical-trials-into-clinical-practice-a-survey-assessing-the-potential-impact-of-the-pediatric-heart-network-infant-single-ventricle-trial
#4
Victor Zak, Daphne T Hsu, Victoria L Pemberton, Jami C Levine, Andrew M Atz, James F Cnota, Chitra Ravishankar, Piers Barker, Linda M Lambert, Brian W McCrindle, Michele A Frommelt, Karen Altmann, Shan Chen, Richard V Williams
BACKGROUND: A few studies have evaluated the impact of clinical trial results on practice in paediatric cardiology. The Infant Single Ventricle (ISV) Trial results published in 2010 did not support routine use of the angiotensin-converting enzyme inhibitor enalapril in infants with single-ventricle physiology. We sought to assess the influence of these findings on clinical practice. METHODS: A web-based survey was distributed via e-mail to over 2000 paediatric cardiologists, intensivists, cardiothoracic surgeons, and cardiac advance practice nurses during three distribution periods...
February 10, 2017: Cardiology in the Young
https://www.readbyqxmd.com/read/28182021/procedural-moderate-sedation-with-ketamine-in-pediatric-critical-care-unit
#5
Tarek R Hazwani, Hala Al-Alem
OBJECTIVE: To evaluate the safety and efficacy of moderate sedation in the Pediatric Intensive Care Unit (PICU) settings according to moderate sedation protocol using ketamine and midazolam and to determine areas for the improvement in our clinical practice. SETTINGS AND DESIGN: A retrospective study was conducted in the PICU. MATERIALS AND METHODS: Retrospective chart review was performed for patients who had received moderate sedation between January and the end of December 2011 and who are eligible to inclusion criteria...
January 2017: Avicenna Journal of Medicine
https://www.readbyqxmd.com/read/28178729/re-examining-physical-findings-with-point-of-care-ultrasound-a-narrative-review
#6
William Diprose, Francois Verster, Cameron Schauer
The art of physical examination has continued to be practised by physicians largely unchanged for over 200 years. Ultrasound, once the domain of the radiologist, is now being increasingly used by emergency physicians and intensivists to make rapid, accurate diagnoses at the point-of-care. We review the growing body of evidence supporting point-of-care ultrasound (PoCUS) as the preferred alternative to many aspects of the cardiovascular, respiratory, abdominal and neurological examinations in internal medicine...
January 27, 2017: New Zealand Medical Journal
https://www.readbyqxmd.com/read/28171804/hemodynamic-and-neuro-monitoring-for-neurocritically-ill-patients-an-international-survey-of-intensivists
#7
Sanjeev Sivakumar, Fabio S Taccone, Mohammed Rehman, Holly Hinson, Neeraj Naval, Christos Lazaridis
PURPOSE: To investigate multimodality systemic and neuro-monitoring practices in acute brain injury (ABI) and to analyze differences among "neurointensivists" (NI; clinical practice comprised >1/3 by neurocritical care), and other intensivists (OI). METHODS: Anonymous 22-question Web-based survey among physician members of SCCM and ESICM. RESULTS: Six hundred fifty-five responded (66% completion rate); 422 (65%) were OI, and 226 (35%) were NI...
January 21, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/28169858/central-nervous-system-infections-in-immunocompromised-patients
#8
Romain Sonneville, Eric Magalhaes, Geert Meyfroidt
PURPOSE OF REVIEW: Although rare, central nervous system (CNS) infections are increasingly being recognized in immunocompromised patients. The goal of the present review is to provide a practical diagnostic approach for the intensivist, and to briefly discuss some of the most prevalent conditions. RECENT FINDINGS: Immunocompromised patients presenting with new neurological symptoms should always be suspected of a CNS infection. These infections carry a poor prognosis, especially if intracranial hypertension, severely altered mental status or seizures are present...
February 4, 2017: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/28168038/echocardiography-for-patients-undergoing-extracorporeal-cardiopulmonary-resuscitation-a-primer-for-intensive-care-physicians
#9
REVIEW
Zhongheng Zhang
Echocardiography is an invaluable tool in the management of patients with extracorporeal cardiopulmonary resuscitation (ECPR) and subsequent extracorporeal membrane oxygenation (ECMO) support and weaning. At the very beginning, echocardiography can identify the etiology of cardiac arrest, such as massive pulmonary embolism and cardiac tamponade. Eliminating these culprits saves life and may avoid the initiation of extracorporeal cardiopulmonary resuscitation. If the underlying causes are not identified or intrinsic to the heart (e...
2017: Journal of Intensive Care
https://www.readbyqxmd.com/read/28165347/google-glass-for-residents-dealing-with-pediatric-cardiopulmonary-arrest-a-randomized-controlled-simulation-based-study
#10
David Drummond, Cécile Arnaud, Romain Guedj, Alexandre Duguet, Nathalie de Suremain, Arnaud Petit
OBJECTIVES: To determine whether real-time video communication between the first responder and a remote intensivist via Google Glass improves the management of a simulated in-hospital pediatric cardiopulmonary arrest before the arrival of the ICU team. DESIGN: Randomized controlled study. SETTING: Children's hospital at a tertiary care academic medical center. SUBJECTS: Forty-two first-year pediatric residents. INTERVENTIONS: Pediatric residents were evaluated during two consecutive simulated pediatric cardiopulmonary arrests with a high-fidelity manikin...
February 2017: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/28157820/high-frequency-oscillatory-ventilation-still-a-role
#11
Jensen Ng, Niall D Ferguson
PURPOSE OF REVIEW: In light of emerging data from clinical trials, the place of high-frequency oscillatory ventilation (HFOV) in the management of acute respiratory distress syndrome (ARDS) is uncertain. This review provides an overview of these new clinical data and also explores new areas of investigation for HFOV in adults. RECENT FINDINGS: While prior meta-analyses suggested benefit for HFOV, updated systematic reviews published this year, which include two large recent clinical trials, now show no statistically significant impact of HFOV on mortality in adults with ARDS...
February 2, 2017: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/28157386/fifty-years-of-research-in-ards-the-epidemiology-of-ards-a-fiftieth-birthday-review
#12
Tài Pham, Gordon D Rubenfeld
Since its first description 50 years ago, no other ICU syndrome has been as extensively studied as ARDS. Nevertheless intensivists' favorite darling has not revealed all its secrets yet and many epidemiological questions remain unsolved. The lack of gold standard tests jeopardizes accurate diagnosis, leading to uncertainties in the actual incidence of this syndrome across different areas with reported ranges as wide as 3.65 to 81 cases per 100,000 persons-year. Likewise evaluation of its evolution over time is difficult due to changes in ARDS definition and under-recognition by clinicians...
February 3, 2017: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/28151822/clinical-significance-of-portal-hypertension-diagnosed-with-bedside-ultrasound-after-cardiac-surgery
#13
André Y Denault, William Beaubien-Souligny, Mahsa Elmi-Sarabi, Roberto Eljaiek, Ismail El-Hamamsy, Yoan Lamarche, Alexandra Chronopoulos, Jean Lambert, Josée Bouchard, Georges Desjardins
BACKGROUND: Portal venous flow pulsatility detected by Doppler ultrasound is a sign of congestive heart failure in noncritically ill patients. The assessment of portal and splenic venous flows has never been reported in patients undergoing cardiac surgery. METHODS: This is a case series performed in patients undergoing cardiac surgery between February 2014 and February 2015 in which portal and/or splenic venous flows were assessed by the attending anesthesiologist during surgery or by the intensivist after surgery using transthoracic echography in 9 patients or transesophageal echocardiography in 5 patients...
February 1, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28145766/an-official-american-thoracic-society-systematic-review-the-effect-of-nighttime-intensivist-staffing-on-mortality-and-length-of-stay-among-intensive-care-unit-patients
#14
Meeta Prasad Kerlin, Neill K J Adhikari, Louise Rose, M Elizabeth Wilcox, Cassandra J Bellamy, Deena Kelly Costa, Hayley B Gershengorn, Scott D Halpern, Jeremy M Kahn, Meghan B Lane-Fall, David J Wallace, Curtis H Weiss, Hannah Wunsch, Colin R Cooke
BACKGROUND: Studies of nighttime intensivist staffing have yielded mixed results. GOALS: To review the association of nighttime intensivist staffing with outcomes of intensive care unit (ICU) patients. METHODS: We searched five databases (2000-2016) for studies comparing in-hospital nighttime intensivist staffing with other nighttime staffing models in adult ICUs and reporting mortality or length of stay. We abstracted data on staffing models, outcomes, and study characteristics and assessed study quality, using standardized tools...
February 1, 2017: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/28144779/focused-cardiac-ultrasound-in-the-early-resuscitation-of-severe-sepsis-and-septic-shock-a-prospective-pilot-study
#15
Hiroshi Sekiguchi, Yohei Harada, Hector R Villarraga, Sunil V Mankad, Ognjen Gajic
PURPOSE: Point-of-care ultrasonography has been increasingly used in the care of critically ill patients; however, reports on its use during active resuscitation are limited. The aim of this study was to investigate the true impact of focused cardiac ultrasound (FCU) during the management of sepsis with early (6-h) resuscitation. METHODS: A prospective pilot observational study was conducted at an academic medical center from March 2011 through July 2012. Patients undergoing resuscitation for severe sepsis or septic shock were prospectively enrolled at medical and combined medical-surgical intensive care units...
January 31, 2017: Journal of Anesthesia
https://www.readbyqxmd.com/read/28126152/impact-of-a-multidisciplinary-team-approach-including-an-intensivist-on-the-outcomes-of-critically-ill-patients-in-the-cardiac-care-unit
#16
Zaher Fanari, Armin Barekatain, Roger Kerzner, Sumaya Hammami, William S Weintraub, Vinay Maheshwari
OBJECTIVE: To investigate the impact of integrating a medical intensivist into a cardiac care unit (CCU) multidisciplinary team on the outcomes of CCU patients. PATIENTS AND METHODS: We conducted a retrospective cohort study of 2239 CCU admissions between July 1, 2011, and July 1, 2013, which constituted patients admitted in the 12 months before and 12 months after the introduction of intensivists into the CCU multidisciplinary team. This team included a cardiologist, a medical intensivist, medical house staff, nurses, a pharmacist, a dietitian, and physical and respiratory therapists...
December 2016: Mayo Clinic Proceedings
https://www.readbyqxmd.com/read/28118657/association-of-intensive-care-unit-patient-to-intensivist-ratios-with-hospital-mortality
#17
Hayley B Gershengorn, David A Harrison, Allan Garland, M Elizabeth Wilcox, Kathryn M Rowan, Hannah Wunsch
Importance: The patient-to-intensivist ratio (PIR) across intensive care units (ICUs) is not standardized and the association of PIR with patient outcome is not well established. Understanding the impact of PIR on outcomes is necessary to optimize senior medical staffing and deliver high-quality care. Objective: To test the hypotheses that: (1) there is significant variation in the PIR across ICUs and (2) higher PIRs are associated with higher hospital mortality for ICU patients...
January 24, 2017: JAMA Internal Medicine
https://www.readbyqxmd.com/read/28118655/toward-the-ideal-ratio-of-patients-to-intensivists-finding-a-reasonable-balance
#18
Elizabeth M Viglianti, Theodore J Iwashyna
No abstract text is available yet for this article.
January 24, 2017: JAMA Internal Medicine
https://www.readbyqxmd.com/read/28110840/use-of-fresh-frozen-plasma-from-the-2012-french-guidelines-to-recent-advances
#19
REVIEW
Samy Figueiredo, Dan Benhamou
Fresh frozen plasma (FFP) is widely used by anesthetists and/or intensivists managing bleeding patients. In this context, two clinical situations with different benefit/risk ratio for FFP transfusion should be distinguished: moderate or controlled hemorrhage on one side, and massive hemorrhage on the other. In the former situation, administration of FFP is most often ineffective, associated with potential side effects (pulmonary complications, product shortage) and should therefore be restricted. In case of massive hemorrhage, transfusion of FFP, red blood cells and platelets using a ratio close to 1:1:1 is recommended based on a large number of studies...
December 30, 2016: Transfusion and Apheresis Science
https://www.readbyqxmd.com/read/28107822/does-training-improve-diagnostic-accuracy-and-inter-rater-agreement-in-applying-the-berlin-radiographic-definition-of-acute-respiratory-distress-syndrome-a-multicenter-prospective-study
#20
Jin-Min Peng, Chuan-Yun Qian, Xiang-You Yu, Ming-Yan Zhao, Shu-Sheng Li, Xiao-Chun Ma, Yan Kang, Fa-Chun Zhou, Zhen-Yang He, Tie-He Qin, Yong-Jie Yin, Li Jiang, Zhen-Jie Hu, Ren-Hua Sun, Jian-Dong Lin, Tong Li, Da-Wei Wu, You-Zhong An, Yu-Hang Ai, Li-Hua Zhou, Xiang-Yuan Cao, Xi-Jing Zhang, Rong-Qing Sun, Er-Zhen Chen, Bin Du
BACKGROUND: Poor inter-rater reliability in chest radiograph interpretation has been reported in the context of acute respiratory distress syndrome (ARDS), although not for the Berlin definition of ARDS. We sought to examine the effect of training material on the accuracy and consistency of intensivists' chest radiograph interpretations for ARDS diagnosis. METHODS: We conducted a rater agreement study in which 286 intensivists (residents 41.3%, junior attending physicians 35...
January 20, 2017: Critical Care: the Official Journal of the Critical Care Forum
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