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Pulmonary Critical Care

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https://www.readbyqxmd.com/read/29908152/reducing-readmissions-in-patients-with-both-heart-failure-and-chronic-obstructive-pulmonary-disease
#1
REVIEW
Ravi Kalhan, R Kannan Mutharasan
Patients with both chronic obstructive pulmonary disease (COPD) and heart failure (HF) pose particularly high costs to the healthcare system. These diseases arise from similar root causes, have overlapping symptoms, and share similar clinical courses. Because of these strong parallels, strategies to reduce readmissions in patients with both conditions share synergies. Here we present 10 practical tips to reduce readmissions in this challenging population. 1: Diagnose the population accurately. 2: Detect admissions for exacerbations early and consider risk-stratification...
June 13, 2018: Chest
https://www.readbyqxmd.com/read/29907209/using-artificial-intelligence-to-predict-prolonged-mechanical-ventilation-and-tracheostomy-placement
#2
Joshua Parreco, Antonio Hidalgo, Jonathan J Parks, Robert Kozol, Rishi Rattan
BACKGROUND: Early identification of critically ill patients who will require prolonged mechanical ventilation (PMV) has proven to be difficult. The purpose of this study was to use machine learning to identify patients at risk for PMV and tracheostomy placement. MATERIALS AND METHODS: The Multiparameter Intelligent Monitoring in Intensive Care III database was queried for all intensive care unit (ICU) stays with mechanical ventilation. PMV was defined as ventilation >7 d...
August 2018: Journal of Surgical Research
https://www.readbyqxmd.com/read/29903693/mechanical-circulatory-support-in-patients-with-cardiogenic-shock-in-intensive-care-units-a-position-paper-of-the-unit%C3%A3-de-soins-intensifs-de-cardiologie-group-of-the-french-society-of-cardiology-endorsed-by-the-groupe-ath%C3%A3-rome-et-cardiologie-interventionnelle
#3
REVIEW
Laurent Bonello, Clement Delmas, Guillaume Schurtz, Guillaume Leurent, Eric Bonnefoy, Nadia Aissaoui, Patrick Henry
Cardiogenic shock (CS) is a major challenge in contemporary cardiology. Despite a better understanding of the pathophysiology of CS, its management has only improved slightly. The prevalence of CS has remained stable over the past decade, but its outcome has seen few improvements, with the 1-month mortality rate still in the range of 40-60%. Inotropes and vasopressors are the first-line therapies for CS, but they are associated with significant hazards, and have well-known deleterious effects. Furthermore, a significant number of patients develop refractory CS with haemodynamic instability, causing critical organ hypoperfusion and/or pulmonary congestion, despite increasing doses of catecholamines...
June 11, 2018: Archives of Cardiovascular Diseases
https://www.readbyqxmd.com/read/29902954/intra-abdominal-hypertension-is-a-risk-factor-for-increased-vap-incidence-a-prospective-cohort-study-in-the-icu-of-a-tertiary-hospital
#4
Eleni Papakrivou, Demosthenes Makris, Efstratios Manoulakas, Marios Karvouniaris, Epaminondas Zakynthinos
BACKGROUND: Ventilator-associated pneumonia (VAP) might be increased in cases with intra-abdominal hypertension (IAH). However, despite animal experimentation and physiological studies on humans in favor of this hypothesis, there is no definitive clinical data that IAH is associated with VAP. We therefore aimed to study whether IAH is a risk factor for increased incidence of VAP in critical care patients. This 1-center prospective observational cohort study was conducted in the intensive care unit of the University Hospital of Larissa, Greece, during 2013 to 2015...
January 1, 2018: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/29899670/-perspective-review-type-2-diabetes-and-readmission-for-heart-failure
#5
Merlin C Thomas
Heart failure is a leading cause for hospitalisation and for readmission, especially in patients over the age of 65. Diabetes is an increasingly common companion to heart failure. The presence of diabetes and its associated comorbidity increases the risk of adverse outcomes and premature mortality in patients with heart failure. In particular, patients with diabetes are more likely to be readmitted to hospital soon after discharge. This may partly reflect the greater severity of heart disease in these patients...
2018: Clinical Medicine Insights. Cardiology
https://www.readbyqxmd.com/read/29891258/epidemiology-of-lower-extremity-deep-venous-thrombosis-in-critically-ill-adolescents
#6
Edward Vincent S Faustino, Veronika Shabanova, Matthew G Pinto, Simon Li, Erin Trakas, Michael Miksa, Shira Gertz, Lee A Polikoff, Massimo Napolitano, Adele R Brudnicki, Joana A Tala, Cicero T Silva
OBJECTIVE: To determine the epidemiology of lower extremity deep venous thrombosis (DVT) in critically ill adolescents, which currently is unclear. STUDY DESIGN: We performed a multicenter, prospective, cohort study. Adolescents aged 13-17 years who were admitted to 6 pediatric intensive care units and were anticipated to receive cardiopulmonary support for at least 48 hours were eligible, unless they were admitted with DVT or pulmonary embolism or were receiving or anticipated to receive therapeutic anticoagulation...
June 8, 2018: Journal of Pediatrics
https://www.readbyqxmd.com/read/29882415/acute-kidney-injury-in-children-with-acute-respiratory-failure
#7
Sindy M Villacrés, Shivanand S Medar, Scott I Aydin
BACKGROUND: Acute kidney injury (AKI) is common in critically ill children and develops in association with organ system dysfunction, with acute respiratory failure (ARF) one of the most common. We aim to study AKI in the pediatric ARF population. METHODS: Data were retrospectively collected on children aged 1 day to 18 years admitted to the pediatric intensive care unit (PICU) with ARF between 2010 and 2013. Descriptive statistics and multivariate analyses utilizing Mann-Whitney U, Wilcoxon signed rank, χ2 , or Fisher's exact tests were performed to identify risk factors associated with AKI...
June 1, 2018: Clinical Pediatrics
https://www.readbyqxmd.com/read/29879852/predictors-of-extubation-failure-after-open-chest-cardiac-surgery-based-on-routinely-collected-data-the-importance-of-a-shared-interprofessional-clinical-assessment
#8
Gianfranco Sanson, Massimiliano Sartori, Lorella Dreas, Roberta Ciraolo, Adam Fabiani
BACKGROUND: Extubation failure (ExtF) is associated with prolonged hospital length of stay and mortality in adult cardiac surgery patients postoperatively. In this population, ExtF-related variables such as the arterial partial pressure of oxygen to fraction of inspired oxygen ratio (PaO2 /FiO2 ), rapid shallow breathing index, cough strength, endotracheal secretions and neurological function have been sparsely researched. AIM: To identify variables that are predictive of ExtF and related outcomes...
June 1, 2018: European Journal of Cardiovascular Nursing
https://www.readbyqxmd.com/read/29872632/catheter-directed-thrombolysis-combined-with-ecmo-for-massive-pulmonary-emboli
#9
J Lauren Lindsey, Rajay Jain, Vidula Vachharajani
This case report discusses a previously healthy young male who suffered an in hospital cardiac arrest, found to be secondary to massive pulmonary emboli (PE). This patient was not a candidate for PE dosing of tPA, but continued to have worsening cardiogenic shock and acute hypoxic respiratory failure. The decision was made to initiate venoarterial extracorporeal membrane oxygenation (VA ECMO) in combination with catheter assisted thrombolysis. With time, the sequelae of his disease process changed. Although his cardiogenic shock improved, the hypoxemia worsened, and the patient was transitioned from VA to venovenous (VV) ECMO, while managing further complications due to multiple episodes of cardiac arrest and severe coagulopathy with multiple, acute, life-threatening bleeding events...
2018: Respiratory Medicine Case Reports
https://www.readbyqxmd.com/read/29851160/point-of-care-lung-ultrasound-in-paediatric-critical-and-emergency-care
#10
REVIEW
Anna Dominguez, Heloisa A Gaspar, Marcela Preto, Fernanda E Ejzenberg
Ultrasound techniques have been developed since the past century and are becoming more useful in different areas of medical knowledge. More recently, lung ultrasound gained importance throughout artefacts analysis to help clinical evaluation at bedside and became subject of interest in the paediatric intensive care and emergency department settings for both procedural and diagnostic purposes. The normal pattern of lung ultrasound is defined by the presence of lung sliding associated with A-lines whereas B-lines may be representative of pathologic findings...
May 31, 2018: Journal of Paediatrics and Child Health
https://www.readbyqxmd.com/read/29850401/issues-in-the-management-of-invasive-pulmonary-aspergillosis-in-non-neutropenic-patients-in-the-intensive-care-unit-a-role-for-isavuconazole
#11
Matteo Bassetti, Alessia Carnelutti, Elda Righi
Background: Almost half of all cases of invasive aspergillosis (IA) occur in the intensive care unit (ICU), with mortality rates of 70-80% for probable or proven cases. IA has become a major concern among non-neutropenic patients in the ICU with chronic obstructive pulmonary disease (COPD) but although prompt, appropriate antifungal therapy is crucial, diagnosis in this situation is challenging. Criteria for a probable diagnosis in critically ill patients have been proposed to help to expedite therapy...
2018: IDCases
https://www.readbyqxmd.com/read/29850272/unique-ecg-findings-in-acute-pulmonary-embolism-ste-with-reciprocal-changes-and-pathologic-q-wave
#12
Amanda Grant-Orser, Brennan Ballantyne, Wael Haddara
A 68-year-old male presented to the emergency department with retrosternal chest pain, presyncope, and then a pulseless electrical activity cardiac arrest. An ECG prior to his arrest revealed ST elevations in leads V1-V3, Q waves in lead V2, and reciprocal ST depressions in the lateral and inferior leads. He received thrombolytic therapy for a presumptive diagnosis of ST elevation myocardial infarction. Return of spontaneous circulation was achieved and he underwent a coronary angiogram. No critical disease was found and his left ventriculogram showed normal contraction...
2018: Case Reports in Critical Care
https://www.readbyqxmd.com/read/29845957/functional-echocardiography-in-the-neonatal-intensive-care-unit
#13
Yogen Singh, Anup Katheria, Cecile Tissot
The role of functional echocardiography in neonatal intensive care unit is rapidly evolving, and increasingly neonatologists are using it in making clinical decisions in sick infants. Functional echocardiography can provide a direct assessment of hemodynamics on bedside, and may be considered as an extension of the clinical examination to evaluate cardiovascular wellbeing in the critically-ill infant. The physiological information may be used in targeting specific intervention based upon the underlying pathophysiology...
May 15, 2018: Indian Pediatrics
https://www.readbyqxmd.com/read/29845759/pressure-decay-testing-of-pleural-air-leaks-in-intact-murine-lungs-evidence-for-peripheral-airway-regulation
#14
Andrew B Servais, Cristian D Valenzuela, Alexandra B Ysasi, Willi L Wagner, Arne Kienzle, Stephen H Loring, Akira Tsuda, Maximilian Ackermann, Steven J Mentzer
The critical care management of pleural air leaks can be challenging in all patients, but particularly in patients on mechanical ventilation. To investigate the effect of central airway pressure and pleural pressure on pulmonary air leaks, we studied orotracheally intubated mice with pleural injuries. We used clinically relevant variables - namely, airway pressure and pleural pressure - to investigate flow through peripheral air leaks. The model studied the pleural injuries using a pressure-decay maneuver. The pressure-decay maneuver involved a 3 sec ramp to 30 cmH2 0 followed by a 3 sec breath hold...
May 2018: Physiological Reports
https://www.readbyqxmd.com/read/29806509/a-pilot-study-of-ultrasonography-na%C3%A3-ve-operators-ability-to-use-tele-ultrasonography-to-assess-the-heart-and-lung
#15
Peter P Olivieri, Avelino C Verceles, Julie M Hurley, Marc T Zubrow, Jean Jeudy, Michael T McCurdy
INTRODUCTION: Remotely tele-mentored ultrasound (RTMUS) involves the real-time guidance of US-naïve providers as they perform point-of-care ultrasound (POCUS) by remotely located, US-proficient providers via telemedicine. The concordance between RTMUS and POCUS in the evaluation of critically ill patients has not been reported. This study sought to evaluate the concordance between RTMUS and POCUS for the cardiopulmonary evaluation of patients in acute respiratory insufficiency and/or shock...
January 1, 2018: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/29796275/eosinophilia-as-a-treatable-trait-in-three-patients-with-asthma-and-copd
#16
James Michael Ramsahai, Jodie Simpson, Peter Wark
The combination of asthma and chronic obstructive pulmonary disease (COPD) in an individual can present significant challenges to achieving satisfactory outcomes. More recently, the concepts of precision medicine and treatable traits have arisen as promising tools to improve care for this group. In this series, we present three cases of patients with features of both asthma and COPD in addition to peripheral blood eosinophilia. The novel implementation of personalized management of the individual based on this treatable trait (eosinophilia) resulted in significant benefits...
April 2018: Respirology Case Reports
https://www.readbyqxmd.com/read/29795623/-we-are-doing-it-together-the-integral-role-of-caregivers-in-a-patients-transition-home-from-the-medicine-unit
#17
Shoshana Hahn-Goldberg, Lianne Jeffs, Amy Troup, Rasha Kubba, Karen Okrainec
BACKGROUND: An admission to hospital for acute illness can be difficult for patients and lead to high levels of anxiety. Patients are given a lot of information throughout their hospital stay and instructions at discharge to follow when they get home. For complex medical patients, the ability to retain, understand, and adhere to these instructions is a critical marker of a successful transition. This study was undertaken to explore factors impacting the ability of patients to understand and adhere to instructions...
2018: PloS One
https://www.readbyqxmd.com/read/29779927/patent-ductus-arteriosus-the-physiology-of-transition
#18
REVIEW
Poorva Deshpande, Michelle Baczynski, Patrick J McNamara, Amish Jain
The transition from intrauterine to extrauterine life represents a critical phase of physiological adaptation which impacts many organ systems, most notably the heart and the lungs. The majority of term neonates complete this transition without complications; however, dysregulation of normal postnatal adaptation may lead to acute cardiopulmonary instability, necessitating advanced intensive care support. Although not as well appreciated as changes in vascular resistances, the shunt across the DA plays a crucial physiologic role in the adaptive processes related to normal transitional circulation...
May 5, 2018: Seminars in Fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/29774649/end-of-life-trajectory-of-coping-and-self-care-of-patients-with-idiopathic-pulmonary-fibrosis-a-meta-synthesis-using-meta-ethnography
#19
Yasuko Igai
AIM: This study aimed to extract patient narratives regarding the end-of-life trajectory of their self-care and coping experiences as patients with idiopathic pulmonary fibrosis and to use meta-ethnography to discover common metaphors of their experience in order to inform the development of nursing interventions. METHODS: A comprehensive search of qualitative research using electronic databases, in English and Japanese, regarding patients with IPF, identified four articles...
May 17, 2018: Japan Journal of Nursing Science: JJNS
https://www.readbyqxmd.com/read/29755170/patient-education-provided-by-physiotherapists-for-patients-with-chronic-obstructive-pulmonary-disease-results-of-a-scoping-review
#20
REVIEW
Judy King, Sarah Tessier, Marie-Josée Charette, Danica Gaudet
Purpose: Physiotherapists have been acknowledged as playing a vital role in the care of people living with chronic obstructive pulmonary disease (COPD), and this care includes providing patient education (PE). Yet very little is known about the issues critical to providing this PE. The purpose of this scoping review was to identify and map out the current knowledge about the content, processes, and overall effectiveness of the PE provided by physiotherapists for people living with COPD. Method: Using the guidelines developed by Arksey and O'Malley in 2005 and by Levac in 2010, key databases were searched...
2018: Physiotherapy Canada. Physiothérapie Canada
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