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Eric Ehieli, Suraj Yalamuri, Charles S Brudney, Srinivas Pyati
Critically ill patients are a heterogeneous group with diverse comorbidities and physiological derangements. The management of pain in the critically ill population is emerging as a standard of care in the intensive care unit (ICU). Pain control of critically ill patients in the ICU presents numerous challenges to intensivists. Inconsistencies in pain assessment, analgesic prescription and variation in monitoring sedation and analgesia result in suboptimal pain management. Inadequate pain control can have deleterious effects on several organ systems in critically ill patients...
October 24, 2016: Postgraduate Medical Journal
Ricardo Ferrer, Rafael Zaragoza, Alejandro H Rodríguez, Emilio Maseda, Pedro Llinares, Santiago Grau, Francisco Álvarez-Lerma, Guillermo Quindós, Miguel Salavert, Rafael Huarte
BACKGROUND: Although the management of invasive fungal infection (IFI) has improved, a number of controversies persist regarding the approach to invasive fungal infection in non-neutropenic medical ward patients. AIMS: To identify the essential clinical knowledge to elaborate a set of recommendations with a high level of consensus necessary for the management of IFI in non-neutropenic medical ward patients. METHODS: A prospective, Spanish questionnaire, which measures consensus through the Delphi technique, was anonymously answered and e-mailed by 30 multidisciplinary national experts, all specialists (intensivists, anesthesiologists, microbiologists, pharmacologists and specialists in infectious diseases) in IFI and belonging to six scientific national societies...
October 18, 2016: Revista Iberoamericana de Micología
C Roehrig, M Govier, J Robinson, A Aneman
BACKGROUND: It remains unclear whether measuring carotid arterial flow by the time velocity integral using vascular Doppler ultrasound can be used to monitor cardiac output and volume responsiveness. METHODS: The carotid Doppler flow (time velocity integral and peak flow velocity variation) was assessed in triplicate by an intensivist with formal vascular ultrasound training. Thirty-three patients admitted following coronary by-pass surgery were studied before and after a passive leg-raising manoeuvre to investigate volume responsiveness (more than 10% increase in cardiac output) along with indices of arterial load measuring cardiac output by thermodilution...
October 21, 2016: Acta Anaesthesiologica Scandinavica
Joseph E Cruz, Zachariah Thomas, David Lee, David M Moskowitz, Jeff Nemeth
BACKGROUND: Generic price inflation has resulted in rising acquisition costs for sodium nitroprusside (SNP), an agent historically described as the drug of choice for the treatment of perioperative hypertension in cardiac surgery. PURPOSE: To describe the implementation and cost avoidance achieved by utilizing clevidipine as an alternative to SNP in cardiac surgery patients at a 520-bed community teaching hospital that performs more than 300 cardiac surgeries each year...
October 2016: P & T: a Peer-reviewed Journal for Formulary Management
Pedro Llinares, Isabel Ruiz, Rafael Zaragoza, Ricard Ferrer, Alejandro H Rodríguez, Emilio Maseda, Santiago Grau
BACKGROUND: Although in the past decade the management of invasive fungal infections has improved, a number of controversies persist regarding empirical antifungal treatment in critically-ill hematology patients. AIMS: To identify key clinical knowledge to elaborate a set of recommendations, with a high level of consensus, necessary for the approach to fungal infections in critically-ill hematology patients. METHODS: A Spanish prospective questionnaire, which measures consensus through the Delphi technique, was anonymously answered and e-mailed by 30 multidisciplinary national experts, all specialists in fungal invasive infections from six scientific national societies; intensivists, anesthesiologists, microbiologists, pharmacologists and specialists in infectious diseases...
October 14, 2016: Revista Iberoamericana de Micología
Judith Barasche, Fabiola Stollar, Marcel M Bergmann, Jean-Christoph Caubet
In infants, the causes of acute repetitive vomiting and severely altered-consciousness status include a broad differential diagnosis, that is, primarly sepsis, infectious gastroenteritis, head injury, and intoxication, as well as neurologic, metabolic, and cardiologic condition diseases. In patients developing such symptoms, allergy as an etiological cause is often not considered by primary care physicians. With this case report, we aim to draw the attention of general pediatricians, emergency physicians, and intensivists to the fact that non-immunoglobulin E-mediated food allergic gastrointestinal disorders such as food protein-induced enterocolitis syndrome should be considered in patients with sepsis-like symptoms...
October 6, 2016: Pediatric Emergency Care
Márcia Oliveira Staffa Tironi, José Mário Meira Teles, Dalton de Souza Barros, Débora Feijó Villas Bôas Vieira, Colbert Martins da Silva Filho, Davi Felix Martins Júnior, Marcos Almeida Matos, Carlito Lopes Nascimento Sobrinho
OBJECTIVE: To estimate the prevalence of burnout in intensivist doctors working in adult, pediatric and neonatal intensive care units in five Brazilian capitals. METHODS: Descriptive epidemiological study with a random sample stratified by conglomerate with 180 intensivist doctors from five capitals representing the Brazilian geographic regions: Porto Alegre (RS), Sao Paulo (SP), Salvador (BA), Goiania (GO) and Belem (PA). A self-administered questionnaire examining sociodemographic data and the level of burnout was evaluated through the Maslach Burnout Inventory...
September 2016: Revista Brasileira de Terapia Intensiva
Fernando Godinho Zampieri
No abstract text is available yet for this article.
September 2016: Revista Brasileira de Terapia Intensiva
Mark T Keegan, Marcio Soares
No abstract text is available yet for this article.
September 2016: Revista Brasileira de Terapia Intensiva
Pietro Bertini, Fabio Guarracino
No abstract text is available yet for this article.
October 13, 2016: Minerva Anestesiologica
C Raspé, L Flöther, R Schneider, M Bucher, P Piso
Due to the significantly improved outcome and quality of life of patients with different tumor entities after cytoreductive surgery (CRS) and HIPEC, there is an increasing number of centers performing CRS and HIPEC procedures. As this procedure is technically challenging with potential high morbidity and mortality, respectively, institutional experience also in the anesthetic and intensive care departments is essential for optimal treatment and prevention of adverse events. Clinical pathways have to be developed to achieve also good results in more comorbid patients with border line indications and extensive surgical procedures...
September 28, 2016: European Journal of Surgical Oncology
Luc Morin, Samiran Ray, Clare Wilson, Solenn Remy, Mohamed Rida Benissa, Nicolaas J G Jansen, Etienne Javouhey, Mark J Peters, Martin Kneyber, Daniele De Luca, Simon Nadel, Luregn Jan Schlapbach, Graeme Maclaren, Pierre Tissieres
PURPOSE: Although overall paediatric septic shock mortality is decreasing, refractory septic shock (RSS) is still associated with high mortality. A definition for RSS is urgently needed to facilitate earlier identification and treatment. We aim to establish a European society of paediatric and neonatal intensive care (ESPNIC) experts' definition of paediatric RSS. METHODS: We conducted a two-round Delphi study followed by an observational multicentre retrospective study...
October 5, 2016: Intensive Care Medicine
Heloisa Amaral Gaspar, Werther Brunow de Carvalho, Artur Figueiredo Delgado
No abstract text is available yet for this article.
October 2016: Pediatric Critical Care Medicine
Lindsay E Jubelt, Amy I Elitzer, Jonathan P Kyriacou, David L Reich
No abstract text is available yet for this article.
July 7, 2016: Journal of Cardiothoracic and Vascular Anesthesia
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
Aditya Lyall, Supradip Ghosh, Kirtee Mishra
Training in echocardiography is essential for an intensivist. We present a rapidly fatal case of obstructive shock where a vigilant intensivist could diagnose left atrial mass obstructing the mitral inflow as the etiology of shock.
September 2016: Indian Journal of Critical Care Medicine
Li Weng, Xu Huang, Lie Chen, Li-Qin Feng, Wei Jiang, Xiao-Yun Hu, Jin-Min Peng, Chun-Yao Wang, Qing-Yuan Zhan, Bin Du
BACKGROUND: Pneumocystis jiroveci pneumonia (PJP) in non-HIV patients is still a challenge for intensivists. The aim of our study was to evaluate mortality predictors of PJP patients requiring Intensive care unit (ICU) admission. METHODS: Retrospectively review medical records of patients with diagnosis of PJP admitted to four ICUs of two academic medical centers from October 2012 to October 2015. RESULTS: Eighty-two patients were enrolled in the study...
September 29, 2016: BMC Infectious Diseases
Tiphaine Bourseau, Flavie Fremondière, Valérie Dubus, Bénédicte Gohier, Dewi Le Gal, Fabien Cave, Isabelle Richard, Nicolas Lerolle
OBJECTIVE: After critical illness, some survivors experience long-term physical, functional, neurocognitive and/or mental health impairments, which has been termed "Post-Intensive Care syndrome" (PICS) [1]. A specific follow-up is required and many specialized follow-up clinics have been created both abroad and in France. The aim of this study is to evaluate long-term outcomes after critical illness, through the International Classification of Functioning, Disability and Health, and to analyse rehabilitation needs after intensive care unit (ICU) discharge...
September 2016: Annals of Physical and Rehabilitation Medicine
J J Dalal, P Amin, A S Ansari, A Bhave, R G Bhagwat, A Challani, A V Ganeshkumar, R Gupta, A Hegde, P Karnik, Z Khan, S Mehta, H Ravat, S Rajan, C Tulsigiri
: Pulmonary embolism (PE) is an important cause of morbidity and mortality among hospitalized patients. Although the exact epidemiology of PE is not known in India, Some of the studies show that more frequently it is missed and not managed appropriately leading to significant cardiovascular morbidity and mortality. Justification and purpose: Indian guidelines for the diagnosis and treatment of acute PE are not yet formulated. The objective of this consensus statement is to propose a diagnostic and management approach for acute PE in India...
December 2015: Journal of the Association of Physicians of India
Marie Cécile Fevre, Caroline Vincent, Julien Picard, Arnaud Vighetti, Claire Chapuis, Maxime Detavernier, Benoit Allenet, Jean François Payen, Jean Luc Bosson, Pierre Albaladejo
Ultrasound (US) guided needle positioning is safer than anatomical landmark techniques for central venous access. Hand-eye coordination and execution time depend on the professional's ability, previous training and personal skills. Needle Guidance Positioning Systems (GPS) may theoretically reduce execution time and facilitate needle positioning in specific targets, thus improving patient comfort and safety. Three groups of healthcare professionals (41 anaesthesiologists and intensivists, 41 residents in anaesthesiology and intensive care, 39 nurse anaesthetists) were included and required to perform 3 tasks (positioning the tip of a needle in three different targets in a silicon phantom) by using successively a conventional US-guided needle positioning and a needle GPS...
September 19, 2016: Anaesthesia, Critical Care & Pain Medicine
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