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https://www.readbyqxmd.com/read/28880931/restrictive-intraoperative-fluid-optimisation-algorithm-improves-outcomes-in-patients-undergoing-pancreaticoduodenectomy-a-prospective-multicentre-randomized-controlled-trial
#1
Laurence Weinberg, Damian Ianno, Leonid Churilov, Ian Chao, Nick Scurrah, Clive Rachbuch, Jonathan Banting, Vijaragavan Muralidharan, David Story, Rinaldo Bellomo, Chris Christophi, Mehrdad Nikfarjam
We aimed to evaluate perioperative outcomes in patients undergoing pancreaticoduodenectomy with or without a cardiac output goal directed therapy (GDT) algorithm. We conducted a multicentre randomised controlled trial in four high volume hepatobiliary-pancreatic surgery centres. We evaluated whether the additional impact of a intraoperative fluid optimisation algorithm would influence the amount of fluid delivered, reduce fluid related complications, and improve length of hospital stay. Fifty-two consecutive adult patients were recruited...
2017: PloS One
https://www.readbyqxmd.com/read/28876693/continuation-of-feeds-in-the-unstable-burns-patient
#2
A L Rooi, A Muganza, E A Ndobe, M Nel
BACKGROUND: Early enteral nutrition (EEN) and the continuation of enteral nutrition (EN) are critical factors in burn patients, who typically have higher nutritional needs due to their post-injury hypercatabolic state and their additional need for nutrients to aid in the healing of wounds and skin grafts. In the critically ill patient, EN is the preferred mode of administration; however, controversy exists regarding the concomitant use of EN and intravenous vasopressor agents in the haemodynamically unstable patient...
June 2017: South African Journal of Surgery. Suid-Afrikaanse Tydskrif Vir Chirurgie
https://www.readbyqxmd.com/read/28876661/the-use-of-laparoscopy-in-managing-penetrating-thoracoabdominal-injuries-in-africa-83-cases-reviewed
#3
M Z Koto, F Mosai, O Y Matsevych
BACKGROUND: The use of laparoscopy in managing haemodynamically stable patients with penetrating thoracoabdominal injuries in developed countries is wildly practised, but in Africa the use of laparoscopy is still in its infancy stage. METHOD: A retrospective analysis of prospectively collected data of patients presenting with penetrating thoracoabdominal injuries was done. All patients offered laparoscopic exploration and repair from January 2012 to December 2015 at Dr George Mukhari Academic Hospital were analysed...
June 2017: South African Journal of Surgery. Suid-Afrikaanse Tydskrif Vir Chirurgie
https://www.readbyqxmd.com/read/28874243/central-regional-anaesthesia-in-patients-with-aortic-stenosis-a-systematic-review
#4
Sofia Johansson, Morten Nikolaj Lind
INTRODUCTION: Aortic stenosis is a valvular lesion that poses several haemodynamic challenges for the anaesthesiologist. The use of central regional anaesthesia is traditionally regarded as contraindicated in patients with severe aortic stenosis due to its sympatholytic effect, potentially causing loss of vascular tone and ultimately diminished cardiac output. The aim of this paper was to review current literature to find evidence for or against the use of neuroaxial blockade in patients with aortic stenosis...
September 2017: Danish Medical Journal
https://www.readbyqxmd.com/read/28831930/-pulmonary-embolism-response-teams-what-is-the-added-value-for-patients-with-acute-pulmonary-embolism
#5
M V Huisman, J M Montero Cabezas, F A Klok
Adequate triaging of patients presenting with acute pulmonary embolism (PE) is essential for appropriate treatment, especially for patients with severe PE. Optimal treatment for this latter group of patients includes pharmaco-mechanical reperfusion treatment for the minority of patients who present with haemodynamic instability, and standard anticoagulation and close monitoring on the ward for the intermediate-high risk patient. In the USA, pulmonary embolism response teams (PERT) have been introduced to coordinate triaging of these patients...
2017: Nederlands Tijdschrift Voor Geneeskunde
https://www.readbyqxmd.com/read/28821512/protocol-for-an-economic-evaluation-of-the-randomised-controlled-trial-of-culprit-lesion-only-pci-versus-immediate-multivessel-pci-in-acute-myocardial-infarction-complicated-by-cardiogenic-shock-culprit-shock-trial
#6
Zahidul Quayyum, Andrew Briggs, Jose Robles-Zurita, Keith Oldroyd, Uwe Zeymer, Steffen Desch, Suzanne de Waha, Holger Thiele
INTRODUCTION: Emergency percutaneous coronary intervention (PCI) of the culprit lesion for patients with acute myocardial infarctions is an accepted practice. A majority of patients present with multivessel disease with additional relevant stenoses apart from the culprit lesion. In haemodynamically stable patients, there is increasing evidence from randomised trials to support the practice of immediate complete revascularisation. However, in the presence of cardiogenic shock, the optimal management strategy for additional non-culprit lesions is unknown...
August 18, 2017: BMJ Open
https://www.readbyqxmd.com/read/28797555/to-log-roll-or-not-to-log-roll-that-is-the-question-a-review-of-the-use-of-the-log-roll-for-patients-with-pelvic-fractures
#7
REVIEW
Inês Filipa da Cunha Rodrigues
Pelvic fractures are one of the most serious injuries in polytrauma - massive haemorrhage is a major complication and the leading cause of death. The assessment and early management of these injuries in the Emergency Department (ED) focuses on the recognition of haemodynamic instability and should follow Advanced Trauma Life Support (ATLS) guidelines. The log-roll technique, although an accepted practice in trauma care, has been reported to be inadvisable when a pelvic fracture is suspected. This paper, which includes a case study, briefly explains the pathophysiology and initial management of pelvic fractures...
May 10, 2017: International Journal of Orthopaedic and Trauma Nursing
https://www.readbyqxmd.com/read/28782399/use-of-bakri-balloon-tamponade-bbt-for-conservative-management-of-postpartum-haemorrhage-a-tertiary-referral-centre-case-series
#8
Manisha Mathur, Qiu Ju Ng, Shephali Tagore
The aim of this study was to investigate the efficacy of the Bakri balloon in the management of PPH. This was a retrospective review of 49 patients, who had Bakri balloon inserted for PPH in KK Hospital between April 2013 and December 2015. The main outcome measure was achievement of haemostasis by Bakri balloon tamponade (BBT). Our success rate was 81.6%. Out of the nine failures (18.0%), five (55.6%) had subtotal hysterectomies and four (44.4%) had total hysterectomies. The causes of PPH in these nine women were unsuspected or foci of placenta accreta (55...
August 6, 2017: Journal of Obstetrics and Gynaecology: the Journal of the Institute of Obstetrics and Gynaecology
https://www.readbyqxmd.com/read/28762172/mechanical-circulatory-support-for-decompensated-heart-failure
#9
REVIEW
Tarique Al Musa, Colin Dominic Chue, Hoong Sern Lim
PURPOSE OF REVIEW: Cardiogenic shock from decompensated heart failure is associated with significant morbidity and mortality. Mechanical circulatory support (MCS) improves haemodynamics and reverses organ dysfunction in critically ill patients with cardiogenic shock. This paper summarises the main modalities of mechanical support and their physiological impact, practical considerations, advantages and disadvantages to facilitate a holistic approach in managing a potentially lethal pathology...
July 31, 2017: Current Heart Failure Reports
https://www.readbyqxmd.com/read/28754139/evidence-of-altered-haemostasis-in-an-ovine-model-of-venovenous-extracorporeal-membrane-oxygenation-support
#10
Margaret R Passmore, Yoke L Fung, Gabriela Simonova, Samuel R Foley, Sara D Diab, Kimble R Dunster, Michelle M Spanevello, Charles I McDonald, John-Paul Tung, Natalie M Pecheniuk, Karen Hay, Kiran Shekar, John F Fraser
BACKGROUND: Extracorporeal membrane oxygenation (ECMO) is a life-saving modality used in the management of cardiopulmonary failure that is refractory to conventional medical and surgical therapies. The major problems clinicians face are bleeding and clotting, which can occur simultaneously. To discern the impact of pulmonary injury and ECMO on the host's haemostatic response, we developed an ovine model of smoke-induced acute lung injury (S-ALI) and ECMO. The aims of this study were to determine if the ECMO circuit itself altered haemostasis and if this was augmented in a host with pulmonary injury...
July 29, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/28750885/regional-cerebral-saturation-monitoring-during-withdrawal-of-life-support-until-death
#11
Cornelia Genbrugge, Ward Eertmans, Frank Jans, Willem Boer, Jo Dens, Cathy De Deyne
AIMS: The aim of this pilot study was to explore the regional cerebral oxygen saturation (rSO2) during the process of dying in Intensive Care Unit (ICU) patients in whom it was decided to withdraw life support. METHODS: Regional cerebral saturation was measured from the moment active treatment was stopped until the moment of death, defined as the onset of asystole. Simultaneously, heart rate and arterial blood pressure were recorded using a radial arterial catheter...
July 24, 2017: Resuscitation
https://www.readbyqxmd.com/read/28730296/early-computed-tomography-or-focused-assessment-with-sonography-in-abdominal-trauma-what-are-the-leading-opinions
#12
L Grünherz, K O Jensen, V Neuhaus, L Mica, C M L Werner, B Ciritsis, C Michelitsch, G Osterhoff, H-P Simmen, K Sprengel
PURPOSE: The initial assessment of severely injured patients in the resuscitation room requires a systematic and quickly performed survey. Whereas the Advanced Trauma Life Support (ATLS(®))-based algorithm recommends focused assessment with sonography in trauma (FAST) among others, recent studies report a survival advantage of early whole-body computed tomography (WBCT) in haemodynamically stable as well as unstable patients. This study assessed the opinions of trauma surgeons about the early use of WBCT in severely injured patients with abdominal trauma, and abdominal CT in patients with isolated abdominal trauma, during resuscitation room treatment...
July 20, 2017: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
https://www.readbyqxmd.com/read/28729141/effects-of-transjugular-intrahepatic-portosystemic-shunt-tips-on-blood-volume-distribution-in-patients-with-cirrhosis
#13
Troels M Busk, Flemming Bendtsen, Jens H Henriksen, Stefan Fuglsang, Jens O Clemmesen, Fin S Larsen, Søren Møller
BACKGROUND: Cirrhosis is accompanied by portal hypertension with splanchnic and systemic arterial vasodilation, and central hypovolaemia. A transjugular intrahepatic portosystemic shunt (TIPS) alleviates portal hypertension, but also causes major haemodynamic changes. AIMS: To investigate effects of TIPS on regional blood volume distribution, and systemic haemodynamics. METHODS: Thirteen cirrhotic patients had their regional blood volume distribution determined with gamma-camera technique before and after TIPS...
June 27, 2017: Digestive and Liver Disease
https://www.readbyqxmd.com/read/28722077/invasive-haemodynamic-evaluation-of-the-pulmonary-circulation-in-pulmonary-hypertension
#14
Alberto Pagnamenta, Andrea Azzola, Maurice Beghetti, Frédéric Lador, On Behalf Of The Swiss Society Of Pulmonary Hypertension
The term pulmonary hypertension refers to a serious condition characterised by high pulmonary vascular pressure, mainly as a consequence of various cardiac and respiratory diseases. Current clinical classification of pulmonary hypertension considers five distinct groups. Transthoracic echocardiography represents the first and most important noninvasive screening tool for estimating the probability of pulmonary hypertension. The diagnostic approach to pulmonary hypertension is supported by a proposed algorithm, which identifies the underlying cause...
July 19, 2017: Swiss Medical Weekly
https://www.readbyqxmd.com/read/28720602/a-reminder-of-escherichia-coli-sepsis-induced-reversible-cardiomyopathy
#15
Aung Naing Lin, Atif Shaikh, Sithu Lin, Deepika Misra
Cardiomyopathy is a progressive disease of myocardium causing either mechanical or electrical disturbances. Sepsis-induced cardiomyopathy (SICM) is an entity of cardiomyopathy which is reversible in 1â€"2 weeks after recovery from sepsis or septic shock. SICM is thought to have unpredictable cumulative mortality towards sepsis but its exact mechanism remains elusive. We report a case of Escherichia coli SICM in a 63-year-old woman presented with sudden onset of dyspnoea on exertion and orthopnoea following nausea, vomiting and diarrhoea after consuming Chinese foods...
July 18, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28716039/extra-corporeal-membrane-oxygenation-for-refractory-cardiogenic-shock-after-adult-cardiac-surgery-a-systematic-review-and-meta-analysis
#16
Maziar Khorsandi, Scott Dougherty, Omar Bouamra, Vasudev Pai, Philip Curry, Steven Tsui, Stephen Clark, Stephen Westaby, Nawwar Al-Attar, Vipin Zamvar
BACKGROUND: Postcardiotomy cardiogenic shock (PCCS) refractory to inotropic support and intra-aortic balloon pump (IABP) occurs rarely but is almost universally fatal without mechanical circulatory support. In this systematic review and meta-analysis we looked at the evidence behind the use of veno-arterial extra-corporeal membrane oxygenation (VA ECMO) in refractory PCCS from a patient survival rate and determinants of outcome viewpoint. METHODS: A systematic review was performed in January 2017 using PubMed (with no defined time period) using the keywords "postcardiotomy", "cardiogenic shock", "extracorporeal membrane oxygenation" and "cardiac surgery"...
July 17, 2017: Journal of Cardiothoracic Surgery
https://www.readbyqxmd.com/read/28710899/effects-of-dobutamine-dopamine-phenylephrine-and-noradrenaline-on-systemic-haemodynamics-and-intestinal-perfusion-in-isoflurane-anaesthetised-horses
#17
C Dancker, K Hopster, K Rohn, S B Kästner
BACKGROUND: In the horse, effects of cardiovascular-active drugs on local perfusion of the gastrointestinal tract are poorly understood. OBJECTIVES: To determine the effect of drugs commonly used to support blood pressure, on local intestinal blood flow and tissue oxygenation under isoflurane anaesthesia. STUDY DESIGN: In vivo randomised crossover experiment METHODS: Ten horses were anaesthetised with isoflurane. After 90 minutes of equilibration three doses (μg/kg bwt/min) of dobutamine (DOB 0...
July 15, 2017: Equine Veterinary Journal
https://www.readbyqxmd.com/read/28655186/catheter-related-right-internal-jugular-vein-thrombosis-after-chest-surgery
#18
P-T Chen, K-C Chang, K-L Hu, C-K Ting, K-H Chan, W-K Chang
Background: Central venous catheters (CVCs) are frequently used for monitoring haemodynamic status and rapidly delivering fluid therapy during the peri- and postoperative periods. Indwelling CVCs are typically used 7-14 days postoperatively for additional monitoring and treatment, but patients may develop asymptomatic catheter-related thrombosis, leading to life-threatening pulmonary embolism and death. Early detection helps to avoid such complications. Methods: This prospective observational study investigated the risk factors associated with catheter-related right internal jugular vein thrombosis in patients undergoing chest surgery...
August 1, 2017: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/28637199/first-ex-vivo-and-preliminary-sheep-model-results-of-the-new-tribio-aortic-valve-bioprosthesis-in-small-aortic-annuli
#19
Sina Stock, Hans-Hinrich Sievers, Doreen Richardt, Michael Scharfschwerdt
OBJECTIVES: : Small aortic annuli are challenging in aortic valve replacement. Prosthesis-patient mismatch, accompanied by high transvalvular gradients and small orifice area, is an often faced problem impairing postoperative outcome. The new TRIBIO bioprosthesis aims to enable enhanced haemodynamics, being increasingly important with decreasing annular size. This study compares ex vivo hydrodynamics of TRIBIO with 2 established bioprostheses in small annuli at different stroke volumes, simulating 'rest' and 'exercise', and evaluates haemodynamics of TRIBIO in a sheep model...
June 20, 2017: Interactive Cardiovascular and Thoracic Surgery
https://www.readbyqxmd.com/read/28631348/updating-of-working-memory-in-ecstasy-polydrug-users-findings-from-fnirs
#20
Catharine Montgomery, John E Fisk, Carl A Roberts
AIMS/OBJECTIVES: Cognitive deficits are now well documented in ecstasy (MDMA) users with type and relative demand of task emerging as important factors. The updating component of executive processes appears to be particularly affected. The study reported here used functional near infrared spectroscopy imaging to investigate changes in cortical haemodynamics during memory updating. METHOD: Twenty ecstasy users and 20 non-users completed verbal and spatial memory updating tasks and brain blood oxygenation and deoxygenation change was measured using functional near infrared spectroscopy...
June 19, 2017: Human Psychopharmacology
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