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Goal directed hemodynamic therapy

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https://www.readbyqxmd.com/read/27823892/practical-considerations-in-sepsis-resuscitation
#1
Brit Long, Alex Koyfman, Katharine L Modisett, Christian J Woods
BACKGROUND: Sepsis is a common condition managed in the emergency department, and the majority of patients respond to resuscitation measures, including antibiotics and i.v. fluids. However, a proportion of patients will fail to respond to standard treatment. OBJECTIVE: This review elucidates practical considerations for management of sepsis in patients who fail to respond to standard treatment. DISCUSSION: Early goal-directed therapy revolutionized sepsis management...
November 4, 2016: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27764870/-invasive-and-minimally-invasive-hemodynamic-monitoring
#2
Matthias Hansen
Advanced hemodynamic monitoring is necessary for adequate management of high-risk patients or patients with derangement of circulation. Studies demonstrate a benefit of early goal directed therapy in unstable cardiopulmonary situations. In these days we have different possibilities of minimally invasive or invasive hemodynamic monitoring. Minimally invasive measurements like pulse conture analysis or pulse wave analysis being less accurate under some circumstances, however only an artery catheter is needed for cardiac output monitoring...
October 2016: Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS
https://www.readbyqxmd.com/read/27761759/caring-for-critically-ill-oldest-old-patients-a-clinical-review
#3
Nicola Vargas, Loredana Tibullo, Emanuela Landi, Giovanni Carifi, Alfonso Pirone, Antonio Pippo, Immacolata Alviggi, Renato Tizzano, Elisa Salsano, Francesco Di Grezia, Maria Vargas
Despite technological advances, the mortality rate for critically ill oldest old patients remains high. The intensive caring should be able to combine technology and a deep humanity considering that the patients are living the last part of their lives. In addition to the traditional goals of ICU of reducing morbidity and mortality, of maintaining organ functions and restoring health, caring for seriously oldest old patients should take into account their end-of-life preferences, the advance or proxy directives if available, the prognosis, the communication, their life expectancy and the impact of multimorbidity...
October 19, 2016: Aging Clinical and Experimental Research
https://www.readbyqxmd.com/read/27748663/fluid-resuscitation-for-acute-kidney-injury-an-empty-promise
#4
Scott C Watkins, Andrew D Shaw
PURPOSE OF REVIEW: The past decade has seen more advances in our understanding of fluid therapy than the preceding decades combined. What was once thought to be a relatively benign panacea is increasingly being recognized as a potent pharmacological and physiological intervention that may pose as much harm as benefit. RECENT FINDINGS: Recent studies have clearly indicated that the amount, type, and timing of fluid administration have profound effects on patient morbidity and outcomes...
December 2016: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/27738801/goal-directed-fluid-therapy-decreases-postoperative-morbidity-but-not-mortality-in-major-non-cardiac-surgery-a-meta-analysis-and-trial-sequential-analysis-of-randomized-controlled-trials
#5
Anirban Som, Souvik Maitra, Sulagna Bhattacharjee, Dalim K Baidya
BACKGROUND AND AIMS: Optimum perioperative fluid administration may improve postoperative outcome after major surgery. This meta-analysis and systematic review has been aimed to determine the effect of dynamic goal directed fluid therapy (GDFT) on postoperative morbidity and mortality in non-cardiac surgical patients. MATERIAL AND METHODS: Meta-analysis of published prospective randomized controlled trials where GDFT based on non-invasive flow based hemodynamic measurement has been compared with a standard care...
October 13, 2016: Journal of Anesthesia
https://www.readbyqxmd.com/read/27720494/assessment-of-changes-in-hemodynamics-and-intrathoracic-fluid-using-electrical-cardiometry-during-autologous-blood-harvest
#6
Jitin Narula, Usha Kiran, Poonam Malhotra Kapoor, Minati Choudhury, Palleti Rajashekar, Ujjwal Kumar Chowdhary
OBJECTIVE: To evaluate the effect of autologous blood harvest (ABH)-induced volume shifts using electrical cardiometry (EC) in patients with pulmonary artery hypertension secondary to left heart disease. DESIGN: Prospective, randomized, controlled trial. SETTING: A tertiary care hospital. PARTICIPANTS: The study comprised 50 patients scheduled to undergo heart valve replacement. INTERVENTIONS: Patients were divided randomly into 2 experimental groups that were distinguished by whether ABH was performed...
July 26, 2016: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/27708007/the-physiology-of-early-goal-directed-therapy-for-sepsis
#7
Lindsay Lief, John Arbo, David A Berlin
In 2001, Rivers and colleagues published a randomized controlled trial of early goal-directed therapy (EGDT) for the treatment of sepsis. More than a decade later, it remains a landmark achievement. The study proved the benefits of early aggressive treatment of sepsis. However, many questions remain about specific aspects of the complex EGDT algorithm. Recently, 3 large trials attempted to replicate these results. None of the studies demonstrated a benefit of an EGDT protocol for sepsis. This review explores the physiologic basis of goal-directed therapy, including the hemodynamic targets and the therapeutic interventions...
October 5, 2016: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/27703980/advanced-hemodynamic-management-in-patients-with-septic-shock
#8
Bernd Saugel, Wolfgang Huber, Axel Nierhaus, Stefan Kluge, Daniel A Reuter, Julia Y Wagner
In patients with sepsis and septic shock, the hemodynamic management in both early and later phases of these "organ dysfunction syndromes" is a key therapeutic component. It needs, however, to be differentiated between "early goal-directed therapy" (EGDT) as proposed for the first 6 hours of emergency department treatment by Rivers et al. in 2001 and "hemodynamic management" using advanced hemodynamic monitoring in the intensive care unit (ICU). Recent large trials demonstrated that nowadays protocolized EGDT does not seem to be superior to "usual care" in terms of a reduction in mortality in emergency department patients with early identified septic shock who promptly receive antibiotic therapy and fluid resuscitation...
2016: BioMed Research International
https://www.readbyqxmd.com/read/27698733/role-of-picco-monitoring-for-the-integrated-management-of-neurogenic-pulmonary-edema-following-traumatic-brain-injury-a-case-report-and-literature-review
#9
Xiaoping Lin, Zhijun Xu, Pengfei Wang, Yan Xu, Gensheng Zhang
Neurogenic pulmonary edema (NPE) is occasionally observed in patients with traumatic brain injury (TBI); however, this condition is often underappreciated. NPE is frequently misdiagnosed due to its atypical clinical performance, thus delaying appropriate treatment. A comprehensive management protocol of NPE in patients with TBI has yet to be established. The current study reported the case of a 67-year-old man with severe TBI who was transferred to our intensive care unit (ICU). On day 7 after hospitalization, the patient suddenly suffered tachypnea, tachycardia, systemic hypertension and hypoxemia during lumbar cistern drainage...
October 2016: Experimental and Therapeutic Medicine
https://www.readbyqxmd.com/read/27668696/corrective-effect-of-norepinephrine-on-hypotension-induced-by-dexmedetomidine-in-critically-ill-patients
#10
Donghao Wang, Yongmei Cao, Yi Lyu, Yingchuan Li, Tao Han
PURPOSE: To evaluate the corrective effect of norepinephrine on hypotension induced by dexmedetomidine through monitoring sedation status, hemodynamics as well as oxygen metabolism. METHODS: 100 patients administered standard-dose dexmedetomidine therapy with RASS between -2 and 0 in the intensive care unit (ICU) were included in the study. According to the application of norepinephrine to correct hypotension after dexmedetomidine therapy, the patients were divided into two groups: group A and group B...
December 2016: International Journal of Clinical Pharmacology and Therapeutics
https://www.readbyqxmd.com/read/27620877/low-cardiac-index-and-stroke-volume-on-admission-are-associated-with-poor-outcome-in-critically-ill-burn-patients-a-retrospective-cohort-study
#11
Sabri Soussi, Benjamin Deniau, Axelle Ferry, Charlotte Levé, Mourad Benyamina, Véronique Maurel, Maïté Chaussard, Brigitte Le Cam, Alice Blet, Maurice Mimoun, Jêrome Lambert, Marc Chaouat, Alexandre Mebazaa, Matthieu Legrand
BACKGROUND: Impact of early systemic hemodynamic alterations and fluid resuscitation on outcome in the modern burn care remains controversial. We investigate the association between acute-phase systemic hemodynamics, timing of fluid resuscitation and outcome in critically ill burn patients. METHODS: Retrospective, single-center cohort study was conducted in a university hospital. Forty critically ill burn patients with total body surface area (TBSA) burn-injured >20 % with invasive blood pressure and cardiac output monitoring (transpulmonary thermodilution technique) within 8 h from trauma were included...
December 2016: Annals of Intensive Care
https://www.readbyqxmd.com/read/27602898/early-goal-directed-treatment-versus-standard-care-in-management-of-early-septic-shock-meta-analysis-of-randomized-trials
#12
Federico Coccolini, Massimo Sartelli, Fausto Catena, Marco Ceresoli, Giulia Montori, Luca Ansaloni
BACKGROUND: Since the incorporation of the early hemodynamic resuscitation in septic shock according to the early goal-directed therapy (EGDT) protocol among the 6-hour resuscitation bundle of the Surviving Sepsis Campaign guidelines, a great debate has been raised about the issue. The present meta-analysis aims to determine whether the resuscitative phase really takes advantages by being performed with EGDT. METHODS: A systematic review with meta-analysis of randomized controlled trials (RCTs) of EGDT versus usual care in patients with early septic shock was performed...
November 2016: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/27591466/intraoperative-goal-directed-hemodynamic-therapy-in-noncardiac-surgery-a-systematic-review-and-meta-analysis
#13
Javier Ripollés, Angel Espinosa, Eugenio Martínez-Hurtado, Alfredo Abad-Gurumeta, Rubén Casans-Francés, Cristina Fernández-Pérez, Francisco López-Timoneda, José María Calvo-Vecino
BACKGROUND: The goal directed hemodynamic therapy is an approach focused on the use of cardiac output and related parameters as end-points for fluids and drugs to optimize tissue perfusion and oxygen delivery. Primary aim: To determine the effects of intraoperative goal directed hemodynamic therapy on postoperative complications rates. METHODS: A meta-analysis was carried out of the effects of goal directed hemodynamic therapy in adult noncardiac surgery on postoperative complications and mortality using Preferred Reporting Items for Systematic Reviews and Meta-Analyses methodology...
September 2016: Brazilian Journal of Anesthesiology
https://www.readbyqxmd.com/read/27543141/optimizing-outcomes-for-mechanically-ventilated-patients-in-an-era-of-endovascular-acute-ischemic-stroke-therapy
#14
Shouri Lahiri, Konrad Schlick, Tapan Kavi, Shlee Song, Asma Moheet, Taizoon Yusufali, Axel Rosengart, Michael J Alexander, Patrick D Lyden
Endovascular mechanical thrombectomy is a new standard of care for acute ischemic stroke (AIS). The majority of these patients receive mechanical ventilation (MV), which has been associated with poor outcomes. The implication of this is significant, as most neurointerventionalists prefer general compared to local anesthesia during the procedure. Consequences of hemodynamic and respiratory perturbations during general anesthesia and MV are thought to contribute significantly to the poor outcomes that are encountered...
August 19, 2016: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/27532782/intraoperative-fluid-management-guided-by-esophageal-doppler-monitoring-in-major-abdominal-surgery-utilizing-the-enhanced-recovery-after-surgery-program-a-systematic-review-protocol
#15
Lindsay Wuellner, Lisa Sutton
The objectives of this review are to identify the effectiveness of esophageal Doppler monitoring (EDM) for goal-directed fluid therapy on postoperative outcomes during abdominal surgery when an enhanced recovery after surgery (ERAS) program is implemented.The specific question of this review is: does the guidance of fluid management by EDM versus fluid management without EDM affect the length of hospital stay, occurrence of postoperative infection, hemodynamic stability and 30-day postoperative complication rate in adult patients undergoing major abdominal surgery with ERAS or similar programs?...
July 2016: JBI Database of Systematic Reviews and Implementation Reports
https://www.readbyqxmd.com/read/27466988/anaesthesiological-strategies-to-improve-outcome-in-liver-transplantation-recipients
#16
V Perilli, P Aceto, T Sacco, C Modesti, P Ciocchetti, F Vitale, A Russo, G Fasano, A Dottorelli, L Sollazzi
Graft and patients survival are the main goal of anesthesiological management in patients undergoing liver transplantation (LT). Even if anesthesiological practice sustained major developments over time, some evidence-based intraoperative strategies have not yet been widely applied. The aim of this review was to summarize intraoperative anesthesiological strategies which could have the potential to improve LT graft and/or recipient survival. Monitoring must be as accurate as possible in order to manage intraoperative hemodynamic changes...
July 2016: European Review for Medical and Pharmacological Sciences
https://www.readbyqxmd.com/read/27445258/-intraoperative-goal-directed-hemodynamic-therapy-in-noncardiac-surgery-a-systematic-review-and-meta-analysis
#17
Javier Ripollés, Angel Espinosa, Eugenio Martínez-Hurtado, Alfredo Abad-Gurumeta, Rubén Casans-Francés, Cristina Fernández-Pérez, Francisco López-Timoneda, José María Calvo-Vecino
BACKGROUND: The goal directed hemodynamic therapy is an approach focused on the use of cardiac output and related parameters as end-points for fluids and drugs to optimize tissue perfusion and oxygen delivery. Primary aim: To determine the effects of intraoperative goal directed hemodynamic therapy on postoperative complications rates. METHODS: A meta-analysis was carried out of the effects of goal directed hemodynamic therapy in adult noncardiac surgery on postoperative complications and mortality using Preferred Reporting Items for Systematic Reviews and Meta-Analyses methodology...
September 2016: Revista Brasileira de Anestesiologia
https://www.readbyqxmd.com/read/27434283/implementation-and-effects-of-pulse-contour-automated-svv-ci-guided-goal-directed-fluid-therapy-algorithm-for-the-routine-management-of-pancreatic-surgery-patients
#18
Thomas Kratz, Christina Simon, Volker Fendrich, Ralph Schneider, Hinnerk Wulf, Caroline Kratz, Turgay Efe, Karl F Schüttler, Martin Zoremba
BACKGROUND: Goal directed fluid management in major abdominal surgery has shown to reduce perioperative complications. The approach aims to optimize the intravascular fluid volume by use of minimally invasive devices which calculate flow-directed variables such as stroke volume (SV) and stroke volume variation (SVV). OBJECTIVE: We aimed to show the feasibility of routinely implementing this type of hemodynamic monitoring during pancreatic surgery, and to evaluate its effects in terms of perioperative fluid management and postoperative outcomes...
July 8, 2016: Technology and Health Care: Official Journal of the European Society for Engineering and Medicine
https://www.readbyqxmd.com/read/27411453/hepatic-perfusion-alterations-in-septic-shock-patients-impact-of-early-goal-directed-therapy
#19
Xi-Wen Zhang, Jian-Feng Xie, Ai-Ran Liu, Ying-Zi Huang, Feng-Mei Guo, Cong-Shan Yang, Yi Yang, Hai-Bo Qiu
BACKGROUND: Early goal-directed therapy (EGDT) has become an important therapeutic management in early salvage stage of septic shock. However, splenic organs possibly remained hypoperfused and hypoxic despite fluid resuscitation. This study aimed to evaluate the effect of EGDT on hepatic perfusion in septic shock patients. METHODS: A prospective observational study was carried out in early septic shock patients who were admitted to Intensive Care Unit within 24 h after onset and who met all four elements of the EGDT criteria after treatment with the standard EGDT procedure within 6 h between December 1, 2012 and November 30, 2013...
July 20, 2016: Chinese Medical Journal
https://www.readbyqxmd.com/read/27364620/early-goal-directed-therapy-in-severe-sepsis-and-septic-shock-insights-and-comparisons-to-process-promise-and-arise
#20
REVIEW
H Bryant Nguyen, Anja Kathrin Jaehne, Namita Jayaprakash, Matthew W Semler, Sara Hegab, Angel Coz Yataco, Geneva Tatem, Dhafer Salem, Steven Moore, Kamran Boka, Jasreen Kaur Gill, Jayna Gardner-Gray, Jacqueline Pflaum, Juan Pablo Domecq, Gina Hurst, Justin B Belsky, Raymond Fowkes, Ronald B Elkin, Steven Q Simpson, Jay L Falk, Daniel J Singer, Emanuel P Rivers
Prior to 2001 there was no standard for early management of severe sepsis and septic shock in the emergency department. In the presence of standard or usual care, the prevailing mortality was over 40-50 %. In response, a systems-based approach, similar to that in acute myocardial infarction, stroke and trauma, called early goal-directed therapy was compared to standard care and this clinical trial resulted in a significant mortality reduction. Since the publication of that trial, similar outcome benefits have been reported in over 70 observational and randomized controlled studies comprising over 70,000 patients...
July 1, 2016: Critical Care: the Official Journal of the Critical Care Forum
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