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Pulmonary Critical Care

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https://www.readbyqxmd.com/read/28213377/interventional-treatment-of-pulmonary-embolism
#1
David M Dudzinski, Jay Giri, Kenneth Rosenfield
Pulmonary embolism (PE) is a serious and prevalent cause of vascular disease. Nevertheless, optimal treatment for many phenotypes of PE remains uncertain. Treating PE requires appropriate risk stratification as a first step. For the highest-risk PE, presenting as shock or arrest, emergent systemic thrombolysis or embolectomy is reasonable, while for low-risk PE, anticoagulation alone is often chosen. Normotensive patients with PE but with indicia of right heart dysfunction (by biomarkers or imaging) constitute an intermediate-risk group for whom there is controversy on therapeutic strategy...
February 2017: Circulation. Cardiovascular Interventions
https://www.readbyqxmd.com/read/28204834/-pulmonary-embolism
#2
M Hecker, N Sommer, A Hecker, D Bandorski, M A Weigand, G A Krombach, E Mayer, D Walmrath
Pulmonary embolism is a potentially fatal disorder and frequently seen in critical care and emergency medicine. Due to a high mortality rate within the first few hours, the accurate initiation of rational diagnostic pathways in patients with suspected pulmonary embolism and timely consecutive treatment is essential. In this review, the current European guidelines on the diagnosis and therapy of acute pulmonary embolism are presented. Special focus is put on a structured patient management based on the individual risk of early mortality...
February 15, 2017: Der Anaesthesist
https://www.readbyqxmd.com/read/28197788/self-care-of-people-with-chronic-obstructive-pulmonary-disease-a-meta-synthesis
#3
REVIEW
Marco Clari, Maria Matarese, Dhurata Ivziku, Maria Grazia De Marinis
BACKGROUND: Self-care in people with chronic obstructive pulmonary disease (COPD) can improve health-related quality of life, reduce hospital admissions and decrease dyspnoea. OBJECTIVE: This review aimed to systematically identify, evaluate and synthesise the qualitative literature on the self-care behaviours and strategies used by people with COPD. METHODS: The Joanna Briggs Institute (JBI) meta-aggregative method was followed. An electronic search of six relevant databases was conducted...
February 14, 2017: Patient
https://www.readbyqxmd.com/read/28178063/detecting-pulmonary-edema-in-obstetric-patients-through-point-of-care-lung-ultrasonography
#4
Sarah Pachtman, Seth Koenig, Natalie Meirowitz
BACKGROUND: Point-of-care lung ultrasonography is used in critical care settings for evaluating respiratory symptoms. Lung ultrasonography is sensitive and specific for the diagnosis of pulmonary edema in nonpregnant patients but is not well-studied in pregnancy. TECHNIQUE: Lung ultrasonography was performed using a portable ultrasound machine with a 2- to 5-MHz curvilinear probe that is available on many labor and delivery units. EXPERIENCE: Lung ultrasonography guided management decisions in a case of shortness of breath after induction of labor for preeclampsia and a case of hemolysis, elevated liver enzymes, and low platelet count syndrome complicated by pulmonary edema...
February 6, 2017: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28176520/-pulmonary-co-infection-due-to-nocardia-cyriacigeorgica-and-aspergillus-fumigatus
#5
R Trastoy, T Manso, X García, G Barbeito, D Navarro, P Rascado, M L Pérez Del Molino
OBJECTIVE: Pulmonary nocardiosis is an uncommon pulmonary infection caused by aerobic gram-positive bacteria of the genus Nocardia. Nocardia sp. are environmental organisms spread worldwide. Approximately 50 Nocardia species have been described to date, about 30 of which are known to cause human disease. Nocardia cyriacigeorgica was first reported in 2001. CASE REPORT: We report a case of infection caused by N. cyriacigeorgica in a patient with B-cells non-Hodgkin lymphoma and diabetes mellitus...
February 8, 2017: Revista Española de Quimioterapia: Publicación Oficial de la Sociedad Española de Quimioterapia
https://www.readbyqxmd.com/read/28151948/model-for-end-stage-liver-disease-excluding-inr-meld-xi-score-in-critically-ill-patients-easily-available-and-of-prognostic-relevance
#6
Bernhard Wernly, Michael Lichtenauer, Marcus Franz, Bjoern Kabisch, Johanna Muessig, Maryna Masyuk, Uta C Hoppe, Malte Kelm, Christian Jung
PURPOSE: MELD-XI, an adapted version of Model for End-stage Liver Disease (MELD) score excluding INR, was reported to predict outcomes e.g. in patients with acute heart failure. We aimed to evaluate MELD-XI in critically ill patients admitted to an intensive care unit (ICU) for prognostic relevance. METHODS: A total of 4381 medical patients (66±14 years, 2862 male) admitted to a German ICU between 2004 and 2009 were included and retrospectively investigated. Admission diagnoses were e...
2017: PloS One
https://www.readbyqxmd.com/read/28149825/correlations-between-pulmonary-artery-pressures-and-inferior-vena-cava-collapsibility-in-critically-ill-surgical-patients-an-exploratory-study
#7
Stanislaw P Stawicki, Thomas J Papadimos, David P Bahner, David C Evans, Christian Jones
INTRODUCTION: As pulmonary artery catheter (PAC) use declines, search continues for reliable and readily accessible minimally invasive hemodynamic monitoring alternatives. Although the correlation between inferior vena cava collapsibility index (IVC-CI) and central venous pressures (CVP) has been described previously, little information exists regarding the relationship between IVC-CI and pulmonary artery pressures (PAPs). The goal of this study is to bridge this important knowledge gap...
October 2016: International Journal of Critical Illness and Injury Science
https://www.readbyqxmd.com/read/28149575/veno-venous-extracorporeal-membrane-oxygenation-cannulation-techniques
#8
REVIEW
Carlo Banfi, Matteo Pozzi, Nils Siegenthaler, Marie-Eve Brunner, Didier Tassaux, Jean-Francois Obadia, Karim Bendjelid, Raphaël Giraud
The development of extracorporeal membrane oxygenation (ECMO) technology allows a new approach for the intensive care management of acute cardiac and/or respiratory failure in adult patients who are not responsive to conventional treatment. Current ECMO therapies provide a variety of options for the multidisciplinary teams who are involved in the management of these critically ill patients. In this regard, veno-venous ECMO (VV-ECMO) can provide quite complete respiratory support, even if this highly complex technique presents substantial risks, such as bleeding, thromboembolic events and infection...
December 2016: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/28149085/complications-in-mechanically-ventilated-patients-of-guillain-barre-syndrome-and-their-prognostic-value
#9
Archana Becket Netto, Arun B Taly, Girish B Kulkarni, G S Uma Maheshwara Rao, Shivaji Rao
INTRODUCTION: The spectrum of various complications in critically ill Guillain-Barre syndrome (GBS) and its effect on the prognosis is lacking in literature. This study aimed at enumerating the complications in such a cohort and their significance in the prognosis and mortality. MATERIALS AND METHODS: Retrospective case record analysis of all consecutive mechanically ventilated patients of GBS in neurology Intensive Care Unit (ICU) of a tertiary care institute for 10 years was done...
January 2017: Journal of Neurosciences in Rural Practice
https://www.readbyqxmd.com/read/28145734/-fellow-of-the-day-a-novel-trainee-role-to-improve-fellows-outpatient-continuity-clinics
#10
Diana J Kelm, Joseph Skalski, Kannan Ramar
RATIONALE: The implementation of team-based care models in residency programs is one method to improve patient and provider outpatient satisfaction. However, to our knowledge, this has not yet been studied in fellowship programs. OBJECTIVES: We instituted a pilot project to test a team-based model of care in our Pulmonary and Critical Care Medicine (PCCM) fellows' clinic by creating a new outpatient role called the "Fellow of the Day" with the goal of reducing clinical disruption for the fellows, provide more educational value for medical students, and improve patient care...
February 1, 2017: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/28144728/-acute-pancreatitis-in-intensive-care-medicine-which-risk-score-is-useful
#11
A J Fischer, F Andreottola, P Lenz, P Lebiedz
INTRODUCTION: Acute pancreatitis is a disease with an increasing incidence in the Western countries associated with a high mortality depending on severity of disease. Etiology is often biliary or due to alcoholism. Incidence of etiology varies between regions depending on risk-factor prevalence. Several risk scores are available to estimate mortality. The aim of the study is to identify the risk factors most relevant for patients being treated for severe acute pancreatitis in an ICU of a tertiary medical center...
January 31, 2017: Medizinische Klinik, Intensivmedizin und Notfallmedizin
https://www.readbyqxmd.com/read/28144686/-new-technical-developments-for-inhaled-sedation
#12
A Meiser, H Bomberg, T Volk, H V Groesdonk
The circle system has been in use for more than 100 years, whereas the first clinical application of an anaesthetic reflector was reported just 15 years ago. In the circle system, all breathing gas is rebreathed after carbon dioxide absorption. A reflector, on the other hand, with the breathing gas flowing to and fro, specifically retains the anaesthetic during expiration and resupplies it during the next inspiration. A high reflection efficiency (number of molecules resupplied/number of molecules exhaled, RE 80-90%) decreases consumption...
January 31, 2017: Der Anaesthesist
https://www.readbyqxmd.com/read/28144059/epidemiological-profile-of-acute-respiratory-distress-syndrome-patients-a-tertiary-care-experience
#13
Rahul Magazine, Shobitha Rao, Bharti Chogtu, Ramkumar Venkateswaran, Hameed Aboobackar Shahul, Umesh Goneppanavar
BACKGROUND: Acute respiratory distress syndrome (ARDS) is seen in critically ill patients. Its etiological spectrum in India is expected to be different from that seen in western countries due to the high prevalence of tropical infections. AIM: To study the epidemiological profile of ARDS patients. SETTING: A tertiary care hospital in Karnataka, India. MATERIALS AND METHODS: Retrospective analysis of 150 out of the 169 ARDS patients diagnosed during 2010-2012...
January 2017: Lung India: Official Organ of Indian Chest Society
https://www.readbyqxmd.com/read/28132853/research-opportunities-and-challenges-in-the-era-of-healthy-living-medicine-unlocking-the-potential
#14
REVIEW
Shane A Phillips, Sharon Martino, Ross Arena
Non-communicable diseases, such as cardiovascular disease (CVD), obesity, cancer, pulmonary disease, and diabetes are a very high global health concern. The health costs of risk factors for CVD, such as hypertension (HTN), is mounting and are unrelenting. As an example, it is estimated that direct and indirect costs due to HTN amounted to $46.4 billion in 2011 and projections of six-fold increases by 2030; the importance of low-cost nonpharmacological interventions involving collaborative teams of health care professionals is at a critical junction...
January 26, 2017: Progress in Cardiovascular Diseases
https://www.readbyqxmd.com/read/28126599/complex-self-management-interventions-in-chronic-disease-unravelled-a-review-of-lessons-learnt-from-an-individual-patient-data-meta-analysis
#15
REVIEW
Nini H Jonkman, Rolf H H Groenwold, Jaap C A Trappenburg, Arno W Hoes, Marieke J Schuurmans
OBJECTIVES: Meta-analyses using individual patient data (IPD) rather than aggregated data are increasingly applied to analyse sources of heterogeneity between trials and have only recently been applied to unravel multicomponent, complex interventions. This paper reflects on methodological challenges encountered in two IPD meta-analyses on self-management interventions in patients with heart failure or chronic obstructive pulmonary disease. STUDY DESIGN AND SETTING: Critical reflection on prior IPD meta-analyses and discussion of literature...
January 23, 2017: Journal of Clinical Epidemiology
https://www.readbyqxmd.com/read/28125817/participation-of-necroptosis-in-the-host-response-to-acute-bacterial-pneumonia
#16
Danielle Ahn, Alice Prince
Common pulmonary pathogens, such as Streptococcus pneumoniae and Staphylococcus aureus, as well as the host-adapted pathogens responsible for health care-associated pneumonias, such as the carbapenem-resistant Klebsiella pneumoniae and Serratia marcecsens, are able to activate cell death through the RIPK1/RIPK3/MLKL cascade that causes necroptosis. Necroptosis can influence the pathogenesis of pneumonia through several mechanisms. Activation of this pathway can result in the loss of specific types of immune cells, especially macrophages, and, in so doing, contribute to host pathology through the loss of their critical immunoregulatory functions...
January 27, 2017: Journal of Innate Immunity
https://www.readbyqxmd.com/read/28120278/long-term-management-challenges-in-esophageal-atresia
#17
REVIEW
Abby White, Raphael Bueno
Esophageal atresia is a rare congenital anomaly, but improved surgical and critical care has resulted in survival rates exceeding 90%. Long-term survival is associated with numerous management challenges including chronic motility disorders, dysphagia, strictures, reflux, esophagitis and attendant complications, tracheomalacia and chronic restrictive lung disease, and recurrent pulmonary infections. No guidelines for adolescents and younger or older adults exist for the treatment and monitoring of this specialized patient population...
January 24, 2017: Current Treatment Options in Gastroenterology
https://www.readbyqxmd.com/read/28114931/procalcitonin-guided-diagnosis-and-antibiotic-stewardship-revisited
#18
REVIEW
Ramon Sager, Alexander Kutz, Beat Mueller, Philipp Schuetz
Several controlled clinical studies have evaluated the potential of the infection biomarker procalcitonin (PCT) to improve the diagnostic work-up of patients with bacterial infections and its influence on decisions regarding antibiotic therapy. Most research has focused on lower respiratory tract infections and critically ill sepsis patients. A clinical utility for PCT has also been found for patients with urinary tract infections, postoperative infections, meningitis, and patients with acute heart failure with possible superinfection (i...
January 24, 2017: BMC Medicine
https://www.readbyqxmd.com/read/28110934/-posttraumatic-thromboembolic-complications-incidence-risk-factors-pathophysiology-and-prevention
#19
M Bahloul, K Regaieg, K Chtara, O Turki, N Baccouch, A Chaari, M Bouaziz
Venous thromboembolism (VTE) remains a major challenge in critically ill patients. Subjects admitted in intensive care unit (ICU), in particular trauma patients, are at high-risk for both deep vein thrombosis (DVT) and pulmonary embolism (PE). The rate of symptomatic PE in injured patients has been reported previously ranging from 1 to 6%. The high incidence of posttraumatic venous thromboembolic events is well known. In fact, major trauma is a hypercoagulable state. Several factors placing the individual patient at a higher risk for the development of DVT and PE have been suggested: high ISS score, meningeal hemorrhage and spinal cord injuries have frequently been reported as a significant risk factor for VTEs after trauma...
January 19, 2017: Annales de Cardiologie et D'angéiologie
https://www.readbyqxmd.com/read/28096287/prediction-models-for-exacerbations-in-patients-with-copd
#20
REVIEW
Beniamino Guerra, Violeta Gaveikaite, Camilla Bianchi, Milo A Puhan
Personalised medicine aims to tailor medical decisions to the individual patient. A possible approach is to stratify patients according to the risk of adverse outcomes such as exacerbations in chronic obstructive pulmonary disease (COPD). Risk-stratified approaches are particularly attractive for drugs like inhaled corticosteroids or phosphodiesterase-4 inhibitors that reduce exacerbations but are associated with harms. However, it is currently not clear which models are best to predict exacerbations in patients with COPD...
January 2017: European Respiratory Review: An Official Journal of the European Respiratory Society
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