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Goal directed hemodynamic therapy

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https://www.readbyqxmd.com/read/28365181/sudden-death-in-ischemic-heart-disease-2017
#1
Alfred E Buxton
At this time, we find ourselves with an abundance of guidelines for management of patients with manifest ventricular tachyarrhythmias, or at risk for such arrhythmias, in patients with coronary heart disease (CHD). The guidelines are focused primarily on the "appropriate use" of the implantable cardioverter/defibrillator (ICD). Unfortunately, the bulk of the guidelines have very little basis in the underlying pathophysiology responsible for sudden cardiac death (SCD) in patients with CHD. Rather, they are based primarily on the results of randomized clinical trials that merely sought to take broad populations at elevated total mortality risk and determining whether the ICD can reduce overall mortality...
March 10, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/28343684/fluid-therapy-recommendations-for-major-abdominal-surgery-via-rica-recommendations-revisited-part-ii-goal-directed-hemodynamic-therapy-rationale-for-optimising-intravascular-volume
#2
J Ripollés-Melchor, D Chappell, H D Aya, Á Espinosa, M G Mhyten, A Abad-Gurumeta, S D Bergese, R Casans-Francés, J M Calvo-Vecino
No abstract text is available yet for this article.
March 24, 2017: Revista Española de Anestesiología y Reanimación
https://www.readbyqxmd.com/read/28343682/fluid-therapy-recommendations-for-major-abdominal-surgery-via-rica-recommendations-revisited-part-iii-goal-directed-hemodynamic-therapy-rationale-for-maintaining-vascular-tone-and-contractility
#3
J Ripollés-Melchor, D Chappell, H D Aya, Á Espinosa, M G Mhyten, A Abad-Gurumeta, S D Bergese, R Casans-Francés, J M Calvo-Vecino
No abstract text is available yet for this article.
March 24, 2017: Revista Española de Anestesiología y Reanimación
https://www.readbyqxmd.com/read/28279695/categorization-of-survival-and-death-after-cardiac-arrest
#4
E A Matthews, J Magid-Bernstein, A Presciutti, A Rodriguez, D Roh, S Park, J Claassen, S Agarwal
BACKGROUND: Most cardiac arrest (CA) patients remain comatose post-resuscitation, prompting goals-of-care (GOC) conversations. The impact of these conversations on patient outcomes has not been well described. METHODS: Patients (n=385) treated for CA in Columbia University ICUs between 2008-2015 were retrospectively categorized into various modes of survival and death based on documented GOC discussions. Patients were deemed "medically unstable" if there was evidence of hemodynamic instability at the time of discussion...
March 6, 2017: Resuscitation
https://www.readbyqxmd.com/read/28187752/targeting-urine-output-and-30-day-mortality-in-goal-directed-therapy-a-systematic-review-with-meta-analysis-and-meta-regression
#5
Esther N van der Zee, Mohamud Egal, Diederik Gommers, A B Johan Groeneveld
BACKGROUND: Oliguria is associated with a decreased kidney- and organ perfusion, leading to organ damage and increased mortality. While the effects of correcting oliguria on renal outcome have been investigated frequently, whether urine output is a modifiable risk factor for mortality or simply an epiphenomenon remains unclear. We investigated whether targeting urine output, defined as achieving and maintaining urine output above a predefined threshold, in hemodynamic management protocols affects 30-day mortality in perioperative and critical care...
February 10, 2017: BMC Anesthesiology
https://www.readbyqxmd.com/read/28094478/fluid-management-in-cardiac-surgery-patients-pitfalls-challenges-and-solutions
#6
Elena Bignami, Marcello Guarnieri, Marco Gemma
Fluid administration is a powerful tool for hemodynamic stabilization as it increases preload and improves cardiac function in fluid-responsive patients. However, there are various types of fluid to choose from. The use of colloids and crystalloids in non-cardiac Intensive Care Units (ICU) has been reported, showing controversial results. Many trials on sepsis in a non-cardiac ICU setting show that colloids, in particular hydroxyethyl starches and gelatins, might have a detrimental effect on kidney function, and on major outcomes such as mortality...
January 17, 2017: Minerva Anestesiologica
https://www.readbyqxmd.com/read/28074802/goal-directed-therapy-improves-the-outcome-of-high-risk-cardiac-patients-undergoing-off-pump-coronary-artery-bypass
#7
RANDOMIZED CONTROLLED TRIAL
Poonam Malhotra Kapoor, Rohan Magoon, Rajinder Singh Rawat, Yatin Mehta, Sameer Taneja, R Ravi, Milind P Hote
BACKGROUND: There has been a constant emphasis on developing management strategies to improve the outcome of high-risk cardiac patients undergoing surgical revascularization. The performance of coronary artery bypass surgery on an off-pump coronary artery bypass (OPCAB) avoids the risks associated with extra-corporeal circulation. The preliminary results of goal-directed therapy (GDT) for hemodynamic management of high-risk cardiac surgical patients are encouraging. The present study was conducted to study the outcome benefits with the combined use of GDT with OPCAB as compared to the conventional hemodynamic management...
January 2017: Annals of Cardiac Anaesthesia
https://www.readbyqxmd.com/read/28067711/early-goal-directed-therapy-for-sepsis-a-novel-solution-for-discordant-survival-outcomes-in-clinical-trials
#8
Andre C Kalil, Daniel W Johnson, Steven J Lisco, Junfeng Sun
OBJECTIVES: Early goal-directed therapy has shown discordant survival outcomes in sepsis studies. We aim to find the reasons for this discordance. DESIGN: Random-effects and Bayesian hierarchical analyses. SETTING: Studies that evaluated early goal-directed therapy. SUBJECTS: Patients with severe sepsis and/or septic shock. INTERVENTIONS: Early goal-directed therapy. MEASUREMENTS AND MAIN RESULTS: A total of 19,998 patients were included in the main analysis: 31 observational (n = 15,656) and six randomized (n = 4,342) studies...
April 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28054902/novel-goal-directed-hemodynamic-optimization-therapy-based-on-major-vasopressor-during-corrective-cardiac-surgery-in-patients-with-severe-pulmonary-arterial-hypertension-a-pilot-study
#9
Shuwen Li, Qing Ma, Yanwei Yang, Jiakai Lu, Zhiquan Zhang, Mu Jin, Weiping Cheng
INTRODUCTION: Pulmonary arterial hypertension (PAH) is a common and fatal complication of congenital heart disease (CHD). PAH-CHD increases the risk for postoperative complications. Recent evidence suggests that perioperative goal-directed hemodynamic optimization therapy (GDHOT) significantly improves outcomes in surgery patients. Standard GDHOT is based on major solution volume, vasodilators and inotropic therapy, while novel GDHOT is based on major vasopressor and inotropic therapy...
December 22, 2016: Heart Surgery Forum
https://www.readbyqxmd.com/read/27968811/a-review-of-central-venous-pressure-and-its-reliability-as-a-hemodynamic-monitoring-tool-in-veterinary-medicine
#10
REVIEW
Kristen M Hutchinson, Scott P Shaw
OBJECTIVE: To review the current literature regarding central venous pressure (CVP) in veterinary patients pertaining to placement (of central line), measurement, interpretation, use in veterinary medicine, limitations, and controversies in human medicine. ETIOLOGY: CVP use in human medicine is a widely debated topic, as numerous sources have shown poor correlation of CVP measurements to the volume status of a patient. Owing to the ease of placement and monitoring in veterinary medicine, CVP remains a widely used modality for evaluating the hemodynamic status of a patient...
September 2016: Topics in Companion Animal Medicine
https://www.readbyqxmd.com/read/27936959/significance-of-perioperative-goal-directed-hemodynamic-approach-in-preventing-postoperative-complications-in-patients-after-cardiac-surgery-a-meta-analysis-and-systematic-review
#11
Peng Li, Li-Ping Qu, Dong Qi, Bo Shen, Yi-Mei Wang, Jia-Rui Xu, Wu-Hua Jiang, Hao Zhang, Xiao-Qiang Ding, Jie Teng
PURPOSE: Goal-directed hemodynamic therapy (GDT) is used to prevent hypoperfusion resulting from surgery. The objective of this study was to analyze the efficacy and importance of perioperative GDT. METHODS: PUBMED, MEDLINE, CENTRAL, and Google Scholar databases were searched until 17 June 2016 using the search terms: cardiac output, cardiac surgical procedures, hemodynamics, goal-directed therapy, and intraoperative. Randomized-controlled trials with pre-emptive hemodynamic intervention for cardiac surgical population versus standard hemodynamic therapy were included...
June 2017: Annals of Medicine
https://www.readbyqxmd.com/read/27823892/practical-considerations-in-sepsis-resuscitation
#12
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...
April 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27764870/-invasive-and-minimally-invasive-hemodynamic-monitoring
#13
REVIEW
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
#14
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
#15
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
#16
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...
February 2017: Journal of Anesthesia
https://www.readbyqxmd.com/read/27720494/assessment-of-changes-in-hemodynamics-and-intrathoracic-fluid-using-electrical-cardiometry-during-autologous-blood-harvest
#17
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
#18
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
#19
REVIEW
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
#20
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
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