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Pulmonary Critical Care

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https://www.readbyqxmd.com/read/29437083/the-fontan-procedure-for-single-ventricle-physiology
#1
Melissa Beaudet Jones
The Fontan procedure is the final procedure in staged palliation for patients with functional single-ventricle physiology. The goal of the procedure is to separate systemic and pulmonary blood flow by directing systemic venous return through the Fontan connection to the pulmonary arteries and the lungs without ventricular contribution. Following the procedure, pulmonary blood flow is completely passive and dependent on pressure gradients, resulting in complex postoperative cardiopulmonary interactions. Understanding the physiology is essential to effectively manage these patients...
February 2018: Critical Care Nurse
https://www.readbyqxmd.com/read/29431046/intermediate-care-units-a-survey-of-organization-practices-across-the-united-states
#2
Blair Wendlandt, Thomas Bice, Shannon Carson, Lydia Chang
PURPOSE: Intermediate care units (IMCUs) represent an alternative care setting with nurse staffing levels between those of the general ward and the intensive care unit (ICU). Despite rising prevalence, little is known about IMCU practices across US hospitals. The purpose of this study is to characterize utilization patterns and assess for variation. MATERIALS AND METHODS: A 14-item survey was distributed to a random nationwide sample of pulmonary and critical care physicians between January and April 2017...
January 1, 2018: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/29430450/diagnosis-of-acute-respiratory-distress-syndrome-by-exhaled-breath-analysis
#3
REVIEW
Lieuwe D J Bos
The acute respiratory distress syndrome (ARDS) is a complication of critical illness that is characterized by acute onset, protein rich, pulmonary edema. There is no treatment for ARDS, other than the reduction of additional ventilator induced lung injury. Prediction or earlier recognition of ARDS could result in preventive measurements and might decrease mortality and morbidity. Exhaled breath contains volatile organic compounds (VOCs), a collection of hundreds of small molecules linked to several physiological and pathophysiological processes...
January 2018: Annals of Translational Medicine
https://www.readbyqxmd.com/read/29430446/models-of-disuse-muscle-atrophy-therapeutic-implications-in-critically-ill-patients
#4
REVIEW
Esther Barreiro
Skeletal muscle weakness is common in the intensive care units (ICU). Approximately 50% of patients under mechanical ventilation for more than 7 days show signs of ICU-acquired muscle weakness. In these patients, muscle weakness may be the result of axonal polyneuropathy, myopathy or a combination of both. The commonest risk factors in patients with ICU-acquired weakness (AW) are the severity and duration of the systemic inflammatory response, duration of the stay in the ICU and of mechanical ventilation, hyperglycemia, hypoalbuminemia, parenteral nutrition, and administration of corticosteroids and of neuromuscular blocking agents...
January 2018: Annals of Translational Medicine
https://www.readbyqxmd.com/read/29430441/macrolide-therapy-is-associated-with-reduced-mortality-in-acute-respiratory-distress-syndrome-ards-patients
#5
Fabienne D Simonis, Gianfranco de Iudicibus, Olaf L Cremer, David S Y Ong, Tom van der Poll, Lieuwe D Bos, Marcus J Schultz
Background: Macrolides have been associated with favorable immunological effects in various inflammatory disease states. We investigated the association between macrolide therapy and mortality in patients with the acute respiratory distress syndrome (ARDS). Methods: This was an unplanned secondary analysis of patients with ARDS within a large prospective observational study of critically ill patients in the intensive care units (ICUs) of two university-affiliated hospitals in the Netherlands...
January 2018: Annals of Translational Medicine
https://www.readbyqxmd.com/read/29430408/using-bronchoscopy-to-detect-acquired-tracheoesophageal-fistula-in-mechanically-ventilated-patients
#6
Michael S Green, Johann J Mathew, Lia J Michos, Parmis Green, Mansoor M Aman
Introduction: An acquired Tracheoesophageal fistula (TEF) is commonly caused by a malignancy or trauma, with pulmonary infection or aspiration being the presenting symptom. However, in the critical care setting the presentation can be subtle and may present with difficult ventilation. High endotracheal tube cuff pressures can lead to tracheal erosions and thus increasing the chances for developing a TEF. Prolonged intubation in the presence of other risk factors like poor general state of health, episodic hypotension, nasogastric tubes, and repeated intubations can increase the likelihood of developing an acquired TEF...
August 2017: Anesthesiology and Pain Medicine
https://www.readbyqxmd.com/read/29428185/lack-of-correlation-between-left-ventricular-outflow-tract-velocity-time-integral-and-stroke-volume-index-in-mechanically-ventilated-patients
#7
R Blancas, Ó Martínez-González, D Ballesteros, A Núñez, J Luján, D Rodríguez-Serrano, A Hernández, C Martínez-Díaz, C M Parra, B L Matamala, M A Alonso, M Chana
OBJECTIVE: To assess the correlation between left ventricular outflow tract velocity time integral (LVOT VTI) and stroke volume index (SVI) calculated by thermodilution methods in ventilated critically ill patients. DESIGN: A prospective, descriptive, multicenter study was performed. SETTING: Five intensive care units from university hospitals. PATIENTS: Patients older than 17 years needing mechanical ventilation and invasive hemodynamic monitoring were included...
February 7, 2018: Medicina Intensiva
https://www.readbyqxmd.com/read/29425462/challenges-in-pulmonary-hypertension-controversies-in-treating-the-tip-of-the-iceberg
#8
Jason M Elinoff, Richa Agarwal, Christopher F Barnett, Raymond L Benza, Michael J Cuttica, Ahmed M Gharib, Michael P Gray, Paul M Hassoun, Anna R Hemnes, Marc Humbert, Todd M Kolb, Tim Lahm, Jane A Leopold, Stephen C Mathai, Vallerie V McLaughlin, Ioana R Preston, Erika B Rosenzweig, Oksana A Shlobin, Virginia D Steen, Roham T Zamanian, Michael A Solomon
The Critical Care Medicine Department of the National Institutes of Health Clinical Center and the Pulmonary Hypertension Association held a joint symposium to discuss "Challenges in Pulmonary Hypertension: Beating, Breathing, and Beyond." Communities of interest including patient advocates, clinicians, and academic investigators gathered together to raise awareness and highlight the challenges in diagnosing and treating pulmonary hypertension (PH). The current symposium focused on whether or not pulmonary arterial hypertension specific treatments are warranted as therapies for PH due to heart failure with preserved ejection fraction, interstitial lung disease, and pulmonary veno-occlusive disease/pulmonary capillary hemangiomatosis...
February 9, 2018: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/29424188/revolving-door-respiratory-patients-a-rehabilitative-perspective
#9
Massimiliano Polastri, Lara Pisani, Andrea Dell'Amore, Stefano Nava
Rehabilitation is an integral component of care for patients affected by either acute or chronic pulmonary diseases. The key elements of rehabilitation treatment for critical respiratory patients are as follows: weaning from mechanical ventilation, respiratory therapy, physical reconditioning, and occupational therapy. It should be noted that patients affected by pulmonary diseases are prone to hospital re-admission due to frequent exacerbations, especially in cases with more severe stages of chronic obstructive pulmonary disease...
September 22, 2017: Monaldi Archives for Chest Disease, Archivio Monaldi Per le Malattie del Torace
https://www.readbyqxmd.com/read/29423554/performance-of-a-second-generation-pulmonary-capnotracking-system-for-continuous-monitoring-of-cardiac-output
#10
Philip J Peyton, Monique Kozub
Technologies for minimally-invasive cardiac output measurement in patients during surgery remain little used in routine practice. We tested a redeveloped system based on CO 2 elimination (VCO 2 ) by the lungs for use in ventilated patients, which can be seamlessly integrated into a modern anesthesia/monitoring platform, and provides automated, continuous breath-by-breath cardiac output monitoring. A prototype measurement system was constructed to measure VCO 2 and end-tidal CO 2 concentration with each breath...
February 8, 2018: Journal of Clinical Monitoring and Computing
https://www.readbyqxmd.com/read/29423196/renal-recovery-after-severe-acute-kidney-injury-in-critically-ill-myeloma-patients-a-retrospective-study
#11
Adrien Joseph, Stephanie Harel, Marion Venot, Sandrine Valade, Eric Mariotte, Claire Pichereau, Akli Chermak, Lara Zafrani, Elie Azoulay, Emmanuel Canet
Background: Despite substantial improvements in the management of multiple myeloma, renal failure remains an important burden that tremendously impairs prognosis. The purpose of this study was to describe the characteristics and to establish prognostic factors of renal recovery in myeloma patients admitted to the intensive care unit (ICU) for acute kidney injury (AKI) Stage 3 treated with renal replacement therapy (RRT). Methods: A retrospective single-centre cohort study was performed, including consecutive myeloma patients admitted to one medical ICU between 1 January 2007 and 1 September 2015 and treated with RRT...
February 2018: Clinical Kidney Journal
https://www.readbyqxmd.com/read/29406840/prostacyclin-use-among-patients-with-pulmonary-arterial-hypertension-in-the-united-states-a-retrospective-analysis-of-a-large-health-care-claims-database
#12
Charles D Burger, Janis A Pruett, Cassandra A Lickert, Ariel Berger, Brian Murphy, William Drake
BACKGROUND: Prostacyclins play an important role in the management of pulmonary arterial hypertension (PAH). Intravenous prostacyclin was the first disease-specific treatment for patients with PAH. Subcutaneous and nonparenteral (oral or inhaled) formulations have subsequently become available. However, data are lacking on how these different prostacyclin formulations are being used in clinical practice. OBJECTIVES: To (a) conduct retrospective analyses of a large U...
December 18, 2017: Journal of Managed Care & Specialty Pharmacy
https://www.readbyqxmd.com/read/29406771/recommended-reading-from-cedars-sinai-medical-center-pulmonary-and-critical-care-medicine-fellows
#13
Zhou Zhang, Joseph Gordon, Kasra Sedarati, Jennifer Hwang
No abstract text is available yet for this article.
February 6, 2018: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/29402713/chronic-obstructive-pulmonary-disease-is-associated-with-short-term-complications-following-total-hip-arthroplasty
#14
George A Yakubek, Gannon L Curtis, Nipun Sodhi, Mhamad Faour, Alison K Klika, Michael A Mont, Wael K Barsoum, Carlos A Higuera
BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality. Furthermore, COPD patients are at increased risk of complications following surgery. The purpose of this study was to evaluate the postoperative total hip arthroplasty (THA) outcomes of COPD patients. Specifically, we asked the following questions: (1) Is COPD associated with adverse perioperative outcomes and (2) Does COPD increase the risk of short-term complications following THA? METHODS: The American College of Surgeons National Surgical Quality Improvement Program database was used to identify 64,796 patients who underwent THA between 2008 and 2014...
January 9, 2018: Journal of Arthroplasty
https://www.readbyqxmd.com/read/29389828/current-management-of-sarcoidosis-i-pulmonary-cardiac-and-neurologic-manifestations
#15
Sterling G West
PURPOSE OF REVIEW: Sarcoidosis is a systemic disease characterized by noncaseating granulomatous inflammation of multiple organ systems. Pulmonary, cardiac, and neurologic involvements have the worst prognosis. Current recommendations for the therapeutic management and follow-up of sarcoidosis involving these critical organs will be reviewed. RECENT FINDINGS: In those sarcoidosis patients requiring immunosuppressive therapy, corticosteroids are used first at varying doses depending on the presenting manifestation...
January 31, 2018: Current Opinion in Rheumatology
https://www.readbyqxmd.com/read/29383510/epidemiology-causes-evolution-and-outcome-in-a-single-center-cohort-of-1116-critically-ill-patients-with-hypoxic-hepatitis
#16
Astrid Van den Broecke, Laura Van Coile, Alexander Decruyenaere, Kirsten Colpaert, Dominique Benoit, Hans Van Vlierberghe, Johan Decruyenaere
BACKGROUND: Hypoxic hepatitis (HH) is a type of acute hepatic injury that is histologically characterized by centrilobular liver cell necrosis and that is caused by insufficient oxygen delivery to the hepatocytes. Typical for HH is the sudden and significant increase of aspartate aminotransferase (AST) in response to cardiac, circulatory or respiratory failure. The aim of this study is to investigate its epidemiology, causes, evolution and outcome. METHODS: The screened population consisted of all adults admitted to the intensive care unit (ICU) at the Ghent University Hospital between January 1, 2007 and September 21, 2015...
January 30, 2018: Annals of Intensive Care
https://www.readbyqxmd.com/read/29376545/idiopathic-pulmonary-fibrosis-in-a-swiss-interstitial-lung-disease-reference-centre
#17
Sabina Guler, Pascal Zumstein, Sabina Berezowska, Alexander Pöllinger, Thomas Geiser, Manuela Funke-Chambour
BACKGROUND: Idiopathic pulmonary fibrosis (IPF) differs substantially from other idiopathic interstitial pneumonias regarding disease trajectory and the appropriate management strategies, making meticulous diagnosis essential. However, patient characteristics and clinical practice vary between clinical trials, and real life and registries provide the opportunity to critically analyse current clinical practices in order to ultimately improve patient care. METHODS: We aimed to identify characteristics of our baseline IPF cohort at initiation of a web-based registry for patients with idiopathic interstitial pneumonia...
January 29, 2018: Swiss Medical Weekly
https://www.readbyqxmd.com/read/29373189/patient-blood-management-in-cardiac-surgery-results
#18
A Pajares, L Larrea, I Zarragoikoetexea, A Tur, R Vicente, P Argente
OBJECTIVE: The main objective of the study was to evaluate the effect of implementing a blood-saving programme in patients undergoing elective cardiac surgery with an analysis of the transfusion rate and complications. MATERIALS AND METHODS: A single-centre, observational, retrospective, comparative study which included 604 consecutive patients older than 15 years old undergoing elective cardiac surgery. Two groups of patients were created according to whether or not they were included in a blood-saving protocol, and analysed between December 2012 and July 2013 (293 patients, prep group) and April 2015 to May 2016 (311 patients, posp group)...
January 17, 2018: Revista Española de Anestesiología y Reanimación
https://www.readbyqxmd.com/read/29360422/management-of-acute-respiratory-failure-in-the-patient-with-sepsis-or-septic-shock
#19
Sarah Moore, Brian Weiss, Jose L Pascual, Lewis J Kaplan
Sepsis and septic shock are each commonly accompanied by acute respiratory failure and the need for invasive as well as non-invasive ventilation throughout a patient's intensive care unit course. We explore the underpinnings of acute respiratory failure of pulmonary as well as non-pulmonary origin in the context of invasive and non-invasive management approaches. Both pharmacologic and non-pharmacologic adjuncts to ventilatory and oxygenation support are highlighted as well. Finally, rescue modalities are positioned within the intensivist's armamentarium for global care of support of the critically ill or injured patient with sepsis or septic shock...
January 23, 2018: Surgical Infections
https://www.readbyqxmd.com/read/29353024/outcomes-and-mortality-prediction-model-of-critically-ill-adults-with-acute-respiratory-failure-and-interstitial-lung-disease
#20
Whitney Gannon, David J Lederer, Mauer Biscotti, Azka Javaid, Nina Patel, Daniel Brodie, Matthew Bacchetta, Matthew Baldwin
BACKGROUND: We aimed to examine short- and long-term mortality in a mixed population of interstitial lung disease (ILD) patients with acute respiratory failure, and to identify those at lower versus higher risk of in-hospital death. METHODS: We conducted a single-center retrospective cohort study of 126 consecutive adults with ILD admitted to an intensive care unit (ICU) for respiratory failure at a tertiary care hospital between 2010 and 2014 who did not undergo lung transplantation during their hospitalization...
January 15, 2018: Chest
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