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Pulmonary Critical Care

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https://www.readbyqxmd.com/read/29030027/comparison-of-right-ventricular-measurements-by-perioperative-transesophageal-echocardiography-as-a-predictor-of-hemodynamic-instability-following-cardiac-surgery
#1
Pei-Chi Ting, An-Hsun Chou, Chia-Chih Liao, Victor Chien-Chia Wu, Feng-Chun Tsai, Jaw-Ji Chu, Min-Wen Yang, Shi-Chuan Chang
BACKGROUND: The relationship between perioperative right ventricular (RV) performance and hemodynamic instability after cardiac surgery seemed less portrayed. Therefore, we sought to elucidate this relationship and compare the accuracy of different RV systolic indices in predicting outcome of cardiac surgery. METHODS: This study enrolled consecutive patients referred for cardiac surgeries. Exclusion criteria were non-sinus rhythm or contraindications to transesophageal echocardiography (TEE)...
October 10, 2017: Journal of the Chinese Medical Association: JCMA
https://www.readbyqxmd.com/read/29029712/advanced-cardiopulmonary-support-for-pulmonary-embolism
#2
Oren Friedman, James M Horowitz, Danny Ramzy
Management of high-risk pulmonary embolism (PE) requires an understanding of the pathophysiology of PE, options for rapid clot reduction, critical care interventions, and advanced cardiopulmonary support. PE can lead to rapid respiratory and hemodynamic collapse via a complex sequence of events leading to acute right ventricular failure. Importantly, reduction in pulmonary vascular resistance must be accomplished either by systemic thrombolytics, catheter directed thrombolytics, endovascular clot extraction, or surgical embolectomy...
September 2017: Techniques in Vascular and Interventional Radiology
https://www.readbyqxmd.com/read/29029709/medical-management-of-pulmonary-embolism-beyond-anticoagulation
#3
Nancy Hsu, Tisha Wang, Oren Friedman, Igor Barjaktarevic
Pulmonary embolism (PE) is a common medical condition that carries significant morbidity and mortality. Although diagnosis, anticoagulation, and interventional clot-burden reduction strategies represent the focus of clinical research and care in PE, appropriate risk stratification and supportive care are crucial to ensure good outcomes. In this chapter, we will discuss the medical management of PE from the time of presentation to discharge, focusing on the critical care of acute right ventricular failure, anticoagulation of special patient populations, and appropriate follow-up testing after acute PE...
September 2017: Techniques in Vascular and Interventional Radiology
https://www.readbyqxmd.com/read/29028375/health-disparities-in-patients-with-pulmonary-arterial-hypertension-a-blueprint-for-action-an-official-american-thoracic-society-statement
#4
Arunabh Talwar, Joe G N Garcia, Halley Tsai, Matthew Moreno, Tim Lahm, Roham T Zamanian, Roberto Machado, Steven M Kawut, Mona Selej, Stephen Mathai, Laura Hoyt D'Anna, Sonu Sahni, Erik J Rodriquez, Richard Channick, Karen Fagan, Michael Gray, Jessica Armstrong, Josanna Rodriguez Lopez, Vinicio de Jesus Perez
BACKGROUND: Health disparities have a major impact in the quality of life and clinical care received by minorities in the United States. Pulmonary arterial hypertension (PAH) is a rare cardiopulmonary disorder that affects children and adults and that, if untreated, results in premature death. The impact of health disparities in the diagnosis, treatment, and clinical outcome of patients with PAH has not been systematically investigated. OBJECTIVES: The specific goals of this research statement were to conduct a critical review of the literature concerning health disparities in PAH, identify major research gaps and prioritize direction for future research...
October 15, 2017: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/28993038/capnography-in-the-emergency-department-a-review-of-uses-waveforms-and-limitations
#5
Brit Long, Alex Koyfman, Michael A Vivirito
BACKGROUND: Capnography has many uses in the emergency department (ED) and critical care setting, most commonly cardiac arrest and procedural sedation. OBJECTIVE OF THE REVIEW: This review evaluates several indications concerning capnography beyond cardiac arrest and procedural sedation in the ED, as well as limitations and specific waveforms. DISCUSSION: Capnography includes the noninvasive measurement of CO2, providing information on ventilation, perfusion, and metabolism in intubated and spontaneously breathing patients...
October 6, 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28988172/haemodynamic-response-to-crystalloids-or-colloids-in-shock-an-exploratory-subgroup-analysis-of-a-randomised-controlled-trial
#6
Nicholas Heming, Souheil Elatrous, Samir Jaber, Anne Sylvie Dumenil, Joël Cousson, Xavier Forceville, Antoine Kimmoun, Jean Louis Trouillet, Jérôme Fichet, Nadia Anguel, Michael Darmon, Claude Martin, Sylvie Chevret, Djillali Annane
OBJECTIVE: To compare the haemodynamic effect of crystalloids and colloids during acute severe hypovolaemic shock. DESIGN: Exploratory subgroup analysis of a multicentre randomised controlled trial (Colloids Versus Crystalloids for the Resuscitation of the Critically Ill, CRISTAL, ClinicalTrials.gov NCT00318942). SETTING: CRISTAL was conducted in intensive care units in Europe, North Africa and Canada. PARTICIPANTS: Current analysis included all patients who had a pulmonary artery catheter in place at randomisation...
October 6, 2017: BMJ Open
https://www.readbyqxmd.com/read/28985025/multidisciplinary-approach-to-cardiac-and-pulmonary-vascular-disease-risk-assessment-in-liver-transplantation-an-evaluation-of-the-evidence-and-consensus-recommendations
#7
Lisa B VanWagner, Matthew E Harinstein, James R Runo, Christopher Darling, Marina Serper, Shelley Hall, Jon A Kobashigawa, Laura L Hammel
Liver transplant (LT) candidates today are older, have greater medical severity of illness, and have more cardiovascular comorbidities than ever before. In addition, there are specific cardiovascular responses in cirrhosis that can be detrimental to the LT candidate. Cirrhotic cardiomyopathy, a condition characterized by increased cardiac output and a reduced ventricular response to stress, is present in up to 30% of patients with cirrhosis thus challenging perioperative management. Current noninvasive tests that assess for subclinical coronary and myocardial disease have low sensitivity, and altered hemodynamics during the LT surgery can unmask latent cardiovascular disease either intraoperatively or in the immediate postoperative period...
October 6, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28984373/pulmonary-ultrasound-scoring-system-for-intubated-critically-ill-patients-and-its-association-with-clinical-metrics-and-mortality-a-prospective-cohort-study
#8
David M Tierney, Lori L Boland, Josh D Overgaard, Joshua S Huelster, Ann Jorgenson, James P Normington, Roman R Melamed
PURPOSE: Pulmonary ultrasound (PU) examination at the point-of-care can rapidly identify the etiology of acute respiratory failure (ARF) and assess treatment response. The often-subjective classification of PU abnormalities makes it difficult to document change over time and communicate findings across providers. The study goal was to develop a simple, PU scoring system that would allow for standardized documentation, have high interprovider agreement, and correlate with clinical metrics...
October 6, 2017: Journal of Clinical Ultrasound: JCU
https://www.readbyqxmd.com/read/28971652/-the-morbidity-and-mortality-of-influenza-patients-treated-at-rambam-medical-center-intensive-care-unit-in-the-years-2009-2014
#9
Yaron Bar-Lavie, Khetam Hussein, Ami Mayo, Daniel King, Zipi Kra-Oz, Michal Paul
INTRODUCTION: Data regarding the characteristics and results of the treatment of patients hospitalized in intensive care units (ICUs) with influenza in Israel are limited. AIMS: We evaluated the characteristics and outcomes of patients treated at Rambam Medical Center at the adult department of critical care medicine for influenza between the years 2009-2014. METHODS: A retrospective cohort study was conducted. Patients were detected by laboratory reports and data were extracted from electronic medical records...
September 2017: Harefuah
https://www.readbyqxmd.com/read/28966921/echocardiographic-evaluation-of-hemodynamics-in-neonates-and-children
#10
REVIEW
Yogen Singh
Hemodynamic instability and inadequate cardiac performance are common in critically ill children. The clinical assessment of hemodynamic status is reliant upon physical examination supported by the clinical signs such as heart rate, blood pressure, capillary refill time, and measurement of the urine output and serum lactate. Unfortunately, all of these parameters are surrogate markers of cardiovascular well-being and they provide limited direct information regarding the adequacy of blood flow and tissue perfusion...
2017: Frontiers in Pediatrics
https://www.readbyqxmd.com/read/28961222/pro-inflammatory-versus-immunomodulatory-effects-of-silver-nanoparticles-in-the-lung-the-critical-role-of-dose-size-and-surface-modification
#11
Francesca Alessandrini, Antje Vennemann, Silvia Gschwendtner, Avidan U Neumann, Michael Rothballer, Tanja Seher, Maria Wimmer, Susanne Kublik, Claudia Traidl-Hoffmann, Michael Schloter, Martin Wiemann, Carsten B Schmidt-Weber
The growing use of silver nanoparticles (Ag-NPs) in consumer products raises concerns about their toxicological potential. The purpose of the study was to investigate the size- and coating-dependent pulmonary toxicity of Ag-NPs in vitro and in vivo, using an ovalbumin (OVA)-mouse allergy model. Supernatants from (5.6-45 µg/mL) Ag50-PVP, Ag200-PVP or Ag50-citrate-treated NR8383 alveolar macrophages were tested for lactate dehydrogenase and glucuronidase activity, tumor necrosis factor (TNF)-α release and reactive oxygen species (ROS) production...
September 29, 2017: Nanomaterials
https://www.readbyqxmd.com/read/28955410/pulmonary-and-critical-care-training-in-the-usa
#12
Christopher Merrick, Fabien Maldonado
No abstract text is available yet for this article.
September 2017: Breathe
https://www.readbyqxmd.com/read/28953498/diagnostic-accuracy-of-point-of-care-ultrasound-performed-by-pulmonary-critical-care-physicians-for-right-ventricle-assessment-in-patients-with-acute-pulmonary-embolism
#13
Jason Filopei, Samuel O Acquah, Eric E Bondarsky, David J Steiger, Navitha Ramesh, Madeline Ehrlich, Paru Patrawalla
OBJECTIVES: Risk stratification for acute pulmonary embolism using imaging presence of right ventricular dysfunction is essential for triage; however, comprehensive transthoracic echocardiography has limited availability. We assessed the accuracy and timeliness of Pulmonary Critical Care Medicine Fellow's performance of goal-directed echocardiograms and intensivists' interpretations for evaluating right ventricular dysfunction in acute pulmonary embolism. DESIGN: Prospective observational study and retrospective chart review...
September 26, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28938306/different-clinical-course-and-complications-in-interagency-registry-for-mechanically-assisted-circulatory-support-1-patients-managed-with-or-without-extracorporeal-membrane-oxygenation
#14
Jason J Han, Jennifer Chung, Carol W Chen, Ann C Gaffey, Alex Sotolongo, Christyna Justice, Alyse E Ameer, J Eduardo Rame, Christian Bermudez, Michael A Acker, Pavan Atluri
Extracorporeal membrane oxygenation (ECMO) as a bridge to left ventricular assist device (LVAD) implantation has shown promise in improving end-organ function and optimizing outcomes in some critically ill patients, but the practice remains controversial. Retrospective review of patients who received LVADs from May 2008 to September 2016 at a high-volume, tertiary care cardiovascular center was performed. Subjects were Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) class 1 patients divided into ECMO bridge and non-ECMO bridge cohorts...
September 21, 2017: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
https://www.readbyqxmd.com/read/28936967/-effect-of-sedation-on-respiratory-function-of-patients-undergoing-mechanical-ventilation
#15
Jie Yang, Yan Kang
Sedation and analgesia for ventilated patients is an important treatment in intensive care unit (ICU). Patients receiving mechanical ventilation therapy comfortably and safely can improve patient-ventilator synchrony, reduce ventilation-related lung injury (VILI), improve compliance, decrease oxygen consumption and stress, prevent accidents, and reduce the incidence of complications and mortality in critical patients. Although sedation may protect lung function, it also has a greater impact on respiratory function...
September 2017: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
https://www.readbyqxmd.com/read/28936695/early-application-of-airway-pressure-release-ventilation-may-reduce-the-duration-of-mechanical-ventilation-in-acute-respiratory-distress-syndrome
#16
Yongfang Zhou, Xiaodong Jin, Yinxia Lv, Peng Wang, Yunqing Yang, Guopeng Liang, Bo Wang, Yan Kang
PURPOSE: Experimental animal models of acute respiratory distress syndrome (ARDS) have shown that the updated airway pressure release ventilation (APRV) methodologies may significantly improve oxygenation, maximize lung recruitment, and attenuate lung injury, without circulatory depression. This led us to hypothesize that early application of APRV in patients with ARDS would allow pulmonary function to recover faster and would reduce the duration of mechanical ventilation as compared with low tidal volume lung protective ventilation (LTV)...
September 22, 2017: Intensive Care Medicine
https://www.readbyqxmd.com/read/28934249/variability-in-objective-and-subjective-measures-affects-baseline-values-in-studies-of-patients-with-copd
#17
MULTICENTER STUDY
Wayne H Anderson, Jae Wook Ha, David J Couper, Wanda K O'Neal, R Graham Barr, Eugene R Bleecker, Elizabeth E Carretta, Christopher B Cooper, Claire M Doerschuk, M Bradley Drummond, MeiLan K Han, Nadia N Hansel, Victor Kim, Eric C Kleerup, Fernando J Martinez, Stephen I Rennard, Donald Tashkin, Prescott G Woodruff, Robert Paine, Jeffrey L Curtis, Richard E Kanner
RATIONALE: Understanding the reliability and repeatability of clinical measurements used in the diagnosis, treatment and monitoring of disease progression is of critical importance across all disciplines of clinical practice and in clinical trials to assess therapeutic efficacy and safety. OBJECTIVES: Our goal is to understand normal variability for assessing true changes in health status and to more accurately utilize this data to differentiate disease characteristics and outcomes...
2017: PloS One
https://www.readbyqxmd.com/read/28932559/pupillary-abnormalities-in-non-selected-critically-ill-patients-an-observational-study
#18
Philippe Portran, Martin Cour, Romain Hernu, Sylvie de la Salle, Laurent Argaud
BACKGROUND: Repeated pupillary examination is a key element of neurologic surveillance in intensive care units (ICU). However, in non-selected critically ill patients, the clinical interest of monitoring pupillary diameter and light reflex is poorly documented. We aimed to determine the prevalence and the etiologies of pupillary abnormalities (PAs) in this ICU patient population. METHODS: We performed a prospective, observational study in a medical university affiliated ICU over a 6-month period...
August 2017: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/28929090/echocardiographic-assessment-of-pulmonary-arterial-hypertension-for-pediatricians-and-neonatologists
#19
REVIEW
Gregory James Skinner
There is a growing awareness of the role that increased pulmonary vascular resistance (PVR) plays in many pathologies; therefore, assessment of pulmonary artery pressure (PAP) is an increasingly requested investigation in the critical care environment. This article will go through the basic concepts regarding PAP and PVR, then will go on to outline the various echocardiographic parameters which are used to assess them. Finally, an outline of how to undertake this assessment will be presented.
2017: Frontiers in Pediatrics
https://www.readbyqxmd.com/read/28925861/perioperative-pulmonary-medication-management
#20
Johnathan Ross Renew, Stephen Aniskevich
BACKGROUND: Pulmonary conditions such as asthma and chronic obstructive pulmonary disease (COPD) are common conditions that warrant special consideration in the perioperative period. When these patients undergo surgical interventions, they have risk of complications such as bronchospasm, hypoxia, and even postoperative respiratory failure that warrants unplanned intensive care unit admission. Thus, clinicians must be familiar with pulmonary medication regimens that are critical for maintaining stable homeostasis of these chronic conditions...
September 18, 2017: Current Clinical Pharmacology
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