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https://www.readbyqxmd.com/read/29447297/development-of-a-decision-aid-for-cardiopulmonary-resuscitation-and-invasive-mechanical-ventilation-in-the-intensive-care-unit-employing-user-centered-design-and-a-wiki-platform-for-rapid-prototyping
#1
Ariane Plaisance, Holly O Witteman, Annie LeBlanc, Jennifer Kryworuchko, Daren Keith Heyland, Mark H Ebell, Louisa Blair, Diane Tapp, Audrey Dupuis, Carole-Anne Lavoie-Bérard, Carrie Anna McGinn, France Légaré, Patrick Michel Archambault
BACKGROUND: Upon admission to an intensive care unit (ICU), all patients should discuss their goals of care and express their wishes concerning life-sustaining interventions (e.g., cardiopulmonary resuscitation (CPR)). Without such discussions, interventions that prolong life at the cost of decreasing its quality may be used without appropriate guidance from patients. OBJECTIVES: To adapt an existing decision aid about CPR to create a wiki-based decision aid individually adapted to each patient's risk factors; and to document the use of a wiki platform for this purpose...
2018: PloS One
https://www.readbyqxmd.com/read/29440830/impact-of-intensive-care-unit-attending-physician-training-background-on-outcomes-in-children-undergoing-heart-operations
#2
Priya Bhaskar, Mallikarjuna Rettiganti, Jeffrey M Gossett, Punkaj Gupta
Background: The existing training pathways to become a pediatric cardiac intensivist are very variable with physicians coming from varied training backgrounds of pediatric critical care, pediatric cardiology, neonatology, or pediatric anesthesia. Aim: To evaluate the impact of cardiac Intensive Care Unit (ICU) attending physician training background on outcomes in children undergoing heart operations. Setting and Design: Patients in the age group from 1 day to 18 years undergoing heart operation at a Pediatric Health Information System database participating hospital were included (2010-2015)...
January 2018: Annals of Pediatric Cardiology
https://www.readbyqxmd.com/read/29433829/acute-mesenteric-ischemia-a-critical-role-for-the-radiologist
#3
P Copin, M Zins, A Nuzzo, Y Purcell, S Beranger-Gibert, L Maggiori, O Corcos, V Vilgrain, M Ronot
Acute mesenteric ischemia is defined as an inadequate blood supply to the gastrointestinal tract resulting in ischemic and inflammatory injury that may progress to necrosis of the bowel wall. Prognosis is poor with a mortality rate greater than 95% without treatment, dropping to around 70% when surgical treatment is performed. Contrast-enhanced computed tomography (CT) has become the cornerstone of the diagnosis by showing features of vascular disorders (occlusion and/or insufficient blood supply) and features of intestinal ischemic injury...
February 9, 2018: Diagnostic and Interventional Imaging
https://www.readbyqxmd.com/read/29432382/association-between-macroscopic-tongue-ischemia-and-enterocyte-injury-and-poor-outcome-in-patients-with-septic-shock-a-preliminary-observational-study
#4
Motohiro Sekino, Hiroyuki Funaoka, Shuntaro Sato, Kyoko Okada, Haruka Inoue, Rintaro Yano, Sojiro Matsumoto, Taiga Ichinomiya, Ushio Higashijima, Shuhei Matsumoto, Tetsuya Hara
A correlation between sublingual and intestinal mucosa microcirculation, and ischemic necrosis of the tongue as a sign of poor prognosis has been reported. However, an association between tongue ischemia and intestinal health and subsequent outcome has never been studied. This preliminary prospective observational study evaluated the association between macroscopic tongue ischemia and enterocyte injury and poor outcome in patients with septic shock. In this study, 57 adults with septic shock on mechanical ventilators were enrolled...
February 9, 2018: Shock
https://www.readbyqxmd.com/read/29431046/intermediate-care-units-a-survey-of-organization-practices-across-the-united-states
#5
Blair Wendlandt, Thomas Bice, Shannon Carson, Lydia Chang
PURPOSE: Intermediate care units (IMCUs) represent an alternative care setting with nurse staffing levels between those of the general ward and the intensive care unit (ICU). Despite rising prevalence, little is known about IMCU practices across US hospitals. The purpose of this study is to characterize utilization patterns and assess for variation. MATERIALS AND METHODS: A 14-item survey was distributed to a random nationwide sample of pulmonary and critical care physicians between January and April 2017...
January 1, 2018: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/29426703/methodological-update-in-medicina-intensiva
#6
J L García Garmendia
Research in the critically ill is complex by the heterogeneity of patients, the difficulties to achieve representative sample sizes and the number of variables simultaneously involved. However, the quantity and quality of records is high as well as the relevance of the variables used, such as survival. The methodological tools have evolved to offering new perspectives and analysis models that allow extracting relevant information from the data that accompanies the critically ill patient. The need for training in methodology and interpretation of results is an important challenge for the intensivists who wish to be updated on the research developments and clinical advances in Intensive Medicine...
February 6, 2018: Medicina Intensiva
https://www.readbyqxmd.com/read/29409439/hematopoietic-stem-cell-transplant-in-facilities-without-intensive-care-units-in-japan
#7
Tadashi Kamio, Masamitsu Sanui, Sho Horikita, Tatsuya Fujii, Toshiomi Kawagishi, Alan K Lefor
OBJECTIVES: Substantial numbers of patients after hematopoietic stem cell transplant need critical care. In Japan, however, data regarding the availability of an intensive care unit and intensivists at hospitals performing hematopoietic stem cell transplant are lacking. We aimed to investigate this issue using data from the 2014 Hematopoietic Cell Transplantation in Japan Annual Report of Nationwide Survey. MATERIALS AND METHODS: We examined whether hospitals have intensive care unit facilities and whether these hospitals are authorized by the Japanese Society of Intensive Care Medicine to provide intensivist training...
February 2018: Experimental and Clinical Transplantation
https://www.readbyqxmd.com/read/29406894/neurologic-illness-in-zambia-a-neurointensivist-s-experience
#8
Merritt W Brown, Katie Ellen Foy, Christopher Chanda, Jacqueline Mulundika, Igor J Koralnik, Omar K Siddiqi
INTRODUCTION: Management of critically ill patients in dedicated intensive care units (ICUs) is the standard of care in high income countries (HICs), but remains uncommon in low and middle-income countries (LMICs). We sought to determine the prevalence of neurologic disorders in the ICU of a LMIC and examine if resource appropriate specialized neurocritical care training could benefit these patients. METHODS: From February to March 2017, a trained neurocritical care intensivist recorded encounters in the sole ICU at the University Teaching Hospital (UTH) in Lusaka, Zambia...
February 15, 2018: Journal of the Neurological Sciences
https://www.readbyqxmd.com/read/29405671/light-sedation-with-dexmedetomidine-a-practical-approach-for-the-intensivist-in-different-icu-patients
#9
Stefano Romagnoli, Angela Amigoni, Ilaria Blangetti, Giampaolo Casella, Cosimo Chelazzi, Francesco Forfori, Cristiana Garisto, Maria C Mondardini, Marco Moltrasio, Daniela Pasero, Tiziana Principi, Zaccaria Ricci, Fabio Tarantino, Giorgio Conti
Light sedation, corresponding to a Richmond AgitationSedation Scale between 0 and 1 is a priority of modern critical care practice. Dexmedetomidine, a highly selective, central, 2adrenoceptor agonist, is increasingly administered in the intensive care units (ICUs) as an effective drug to induce light sedation, analgesia and a quasiphysiological sleep in critically ill patients. Although in general dexmedetomidine is well tolerated, side effects as bradycardia, hypertension, and hypotension may occur. Although a general dosing range is suggested, different ICU patients may require different and highly precise titration that may significantly vary due to neurological status, cardiorespiratory function, baseline blood pressure, heart rate, liver efficiency, age and coadministration of other sedatives...
February 5, 2018: Minerva Anestesiologica
https://www.readbyqxmd.com/read/29401174/autophagy-should-it-play-a-role-in-icu-management
#10
Martin D Rosenthal, Phil Carrott, Frederick A Moore
: The purpose of this review is to discuss the role of autophagy in the critically ill patient population. As the understanding of autophagy continues to expand and evolve, there are certain controversies surrounding whether intensivist should allow the benefit of autophagy to supersede gold standard of insulin therapy or early nutritional support. This review is relevant as the current literature seems to support under-feeding patients, and perhaps the reason these studies were positive could be prescribed to the mechanisms of autophagy...
February 3, 2018: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/29397452/update-on-the-treatment-of-spontaneous-intraparenchymal-hemorrhage-medical-and-interventional-management
#11
REVIEW
Thomas J Cusack, J Ricardo Carhuapoma, Wendy C Ziai
PURPOSE OF REVIEW: Spontaneous intraparenchymal hemorrhage (IPH) is a prominent challenge faced globally by neurosurgeons, neurologists, and intensivists. Over the past few decades, basic and clinical research efforts have been undertaken with the goal of delineating biologically and evidence-based practices aimed at decreasing mortality and optimizing the likelihood of meaningful functional outcome for patients afflicted with this devastating condition. Here, the authors review the medical and surgical approaches available for the treatment of spontaneous intraparenchymal hemorrhage, identifying areas of recent progress and ongoing research to delineate the scope and scale of IPH as it is currently understood and treated...
February 3, 2018: Current Treatment Options in Neurology
https://www.readbyqxmd.com/read/29394155/remote-presence-robotic-technology-reduces-need-for-pediatric-interfacility-transportation-from-an-isolated-northern-community
#12
Tanya Holt, Nazmi Sari, Gregory Hansen, Matthew Bradshaw, Michael Prodanuk, Veronica McKinney, Rachel Johnson, Ivar Mendez
BACKGROUND: Providing acutely ill children in isolated communities access to specialized care is challenging. This study aimed to evaluate remote presence robotic technology (RPRT) for enhancing pediatric remote assessments, expediting initiation of treatment, refining triaging, and reducing the need for transport. METHODS: We conducted a pilot prospective observational study at a primary/urgent care clinic in an isolated northern community. Participants (n = 38) were acutely ill children <17 years presenting to the clinic, whom local healthcare professionals had considered for interfacility transportation (IFT)...
February 2, 2018: Telemedicine Journal and E-health: the Official Journal of the American Telemedicine Association
https://www.readbyqxmd.com/read/29383966/antero-posterior-elongation-of-midbrain-in-traumatic-brain-injury-significant-sign-yet-a-mistaken-entity
#13
Raghunath Avanali, Biju Bhadran, Sunil Panchal, Krishna Kumar P, Abhishek V, Kshitij Gulhane, Harison G
BACKGROUND: Antero posterior elongation of the midbrain is observed occasionally in severe traumatic brain injury and generally implies a bad outcome. The objective of the study was to document midbrain elongation and identify the implications of this finding. METHODS: This prospective study included 100 patients with traumatic intracranial haematoma of more than 20 cc in volume. Key measurements were taken in the midbrain and pontine regions and the status of perimesencephalic basal cisterns was noted...
January 31, 2018: British Journal of Neurosurgery
https://www.readbyqxmd.com/read/29373802/peep-lower-than-the-ards-network-protocol-is-associated-with-higher-pediatric-ards-mortality
#14
Robinder G Khemani, Kaushik Parvathaneni, Nadir Yehya, Anoopindar K Bhalla, Neal J Thomas, Christopher J L Newth
RATIONALE: The ARDS Network used a Positive End-Expiratory Pressure (PEEP)/FiO2 model in many studies. In general, pediatric intensivists use less PEEP and higher FiO2 than this model. OBJECTIVES: To evaluate whether children managed with PEEP lower than recommended by the ARDSNet PEEP/FiO2 model had higher mortality. METHODS: Multi-center, retrospective analysis of patients with Pediatric ARDS (PARDS), managed without a formal PEEP/FiO2 protocol...
January 26, 2018: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/29371274/role-of-organisational-factors-on-the-weekend-effect-in-critically-ill-patients-in-brazil-a-retrospective-cohort-analysis
#15
Fernando G Zampieri, Thiago C Lisboa, Thiago D Correa, Fernando A Bozza, Marcus Ferez, Haggeas S Fernandes, André M Japiassú, Juan Carlos R Verdeal, Ana Cláudia P Carvalho, Marcos F Knibel, Bruno F Mazza, Fernando Colombari, José Mauro Vieira, William N Viana, Roberto Costa, Michele M Godoy, Marcelo O Maia, Eliana B Caser, Jorge I F Salluh, Marcio Soares
INTRODUCTION: Higher mortality for patients admitted to intensive care units (ICUs) during the weekends has been occasionally reported with conflicting results that could be related to organisational factors. We investigated the effects of ICU organisational and staffing patterns on the potential association between weekend admission and outcomes in critically ill patients. METHODS: We included 59 614 patients admitted to 78 ICUs participating during 2013. We defined 'weekend admission' as any ICU admission from Friday 19:00 until Monday 07:00...
January 24, 2018: BMJ Open
https://www.readbyqxmd.com/read/29360422/management-of-acute-respiratory-failure-in-the-patient-with-sepsis-or-septic-shock
#16
Sarah Moore, Brian Weiss, Jose L Pascual, Lewis J Kaplan
Sepsis and septic shock are each commonly accompanied by acute respiratory failure and the need for invasive as well as non-invasive ventilation throughout a patient's intensive care unit course. We explore the underpinnings of acute respiratory failure of pulmonary as well as non-pulmonary origin in the context of invasive and non-invasive management approaches. Both pharmacologic and non-pharmacologic adjuncts to ventilatory and oxygenation support are highlighted as well. Finally, rescue modalities are positioned within the intensivist's armamentarium for global care of support of the critically ill or injured patient with sepsis or septic shock...
January 23, 2018: Surgical Infections
https://www.readbyqxmd.com/read/29352416/point-of-care-ultrasound-in-pediatric-anesthesiology-and-critical-care-medicine
#17
REVIEW
Erik Su, Nicholas Dalesio, Aliaksei Pustavoitau
Ultrasound has increasingly become a clinical asset in the hands of the anesthesiologist and intensivist who cares for children. Though many applications for ultrasound parallel adult modalities, children as always are not simply small adults and benefit from the application of ultrasound to their management in various ways. Body composition and size are important factors that affect ultrasound performance in the child, as are the pathologies that may uniquely afflict children and aspects of procedures unique to this patient population...
January 19, 2018: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
https://www.readbyqxmd.com/read/29341963/role-of-the-anesthesiologist-intensivist-outside-the-icu-opportunity-to-add-value-for-the-hospital-or-an-unnecessary-distraction
#18
Suzanne Bennett, Erin Grawe, Courtney Jones, Sean A Josephs, Maggie Mechlin, William E Hurford
PURPOSE OF REVIEW: Given the extremely expensive nature of critical care medicine, it seems logical that intensivists should play an active role in designing efficient systems of care. The true value of intensivists, however, is not well defined. RECENT FINDINGS: Anesthesiologists have taken key roles in improving patient safety in the operating room. Anesthesia-related mortality rates have decreased from 20 deaths per 100 000 anesthetics in the early 1980s to less than one death per 100 000 currently...
January 15, 2018: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/29340535/prevalence-of-cytomegalovirus-disease-in-kidney-transplant-patients-in-an-intensive-care-unit
#19
Sanmya Danielle Rodrigues Dos Santos, Antonio Tonete Bafi, Flávio Geraldo Rezende de Freitas, Luciano César Pontes de Azevedo, Flávia Ribeiro Machado
OBJECTIVES: To define the frequency of cytomegalovirus disease among kidney transplant patients in an intensive care unit in which this complication was suspected and to identify predisposing factors and their possible impact on clinical outcome. METHODS: Retrospective observational study in which kidney transplant patients over the age of 18 years were hospitalized for any reason in an intensive care unit with at least one collection of samples to test for the presence of antigenemia or cytomegalovirus via polymerase chain reaction during hospitalization...
October 2017: Revista Brasileira de Terapia Intensiva
https://www.readbyqxmd.com/read/29340534/what-every-intensivist-should-know-about-intensive-care-unit-admission-criteria
#20
Seth T White, Yenny R Cardenas, Joseph L Nates
No abstract text is available yet for this article.
October 2017: Revista Brasileira de Terapia Intensiva
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