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https://www.readbyqxmd.com/read/28528347/discriminative-accuracy-of-physician-and-nurse-predictions-for-survival-and-functional-outcomes-6-months-after-an-icu-admission
#1
Michael E Detsky, Michael O Harhay, Dominique F Bayard, Aaron M Delman, Anna E Buehler, Saida A Kent, Isabella V Ciuffetelli, Elizabeth Cooney, Nicole B Gabler, Sarah J Ratcliffe, Mark E Mikkelsen, Scott D Halpern
Importance: Predictions of long-term survival and functional outcomes influence decision making for critically ill patients, yet little is known regarding their accuracy. Objective: To determine the discriminative accuracy of intensive care unit (ICU) physicians and nurses in predicting 6-month patient mortality and morbidity, including ambulation, toileting, and cognition. Design, Setting, and Participants: Prospective cohort study conducted in 5 ICUs in 3 hospitals in Philadelphia, Pennsylvania, and enrolling patients who spent at least 3 days in the ICU from October 2013 until May 2014 and required mechanical ventilation, vasopressors, or both...
May 21, 2017: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/28527874/pressor-support-during-a-jarisch-herxheimer-reaction-after-initiation-of-treatment-for-weil-s-disease
#2
Randi Connor-Schuler, Anee Khan, Nikhil Goyal, Erin Zimny
We present a case of Weil's disease complicated by a Jarisch-Herxheimer reaction (JHR) after initiation of antibiotics while in the emergency department requiring invasive monitoring and vasopressor support. The case is followed by a brief review of the JHR which is rarely observed with treatment of leptospirosis. A healthy 28-year-old female who recently returned from the Caribbean presented to the emergency department with flu-like symptoms. The patient appeared jaundiced with conjunctival suffusion and was ultimately treated with the appropriate antibiotics for leptospirosis in the ED...
April 27, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28527249/-sociodemographic-and-clinical-characteristics-of-patients-infected-with-leptospira-spp-treated-at-four-hospitals-in-medell%C3%A3-n-colombia-2008-2013
#3
Lina María Echeverri-Toro, Sara Penagos, Laura Castañeda, Pablo Villa, Santiago Atehortúa, Faiver Ramírez, Carlos Restrepo, Sigifredo Ospina, Yuli Agudelo, Alicia Hidrón, Paola Agudelo, Eliana Valderrama, Carlos Andrés Agudelo
INTRODUCTION: Leptospirosis remains a significant health problem in tropical regions including Latin America, where its presentation is 100 times higher than that observed in other regions of the world. Mortality reaches 10% in severe cases. Its diagnosis is challenging because clinical manifestations during the initial phase are non-specific and because of limited availability of diagnostic tests. OBJECTIVE: To describe the demographic and clinical characteristics and the outcomes in hospitalized patients with leptospirosis...
January 24, 2017: Biomédica: Revista del Instituto Nacional de Salud
https://www.readbyqxmd.com/read/28526233/keratinocyte-growth-factor-for-the-treatment-of-the-acute-respiratory-distress-syndrome-kare-a-randomised-double-blind-placebo-controlled-phase-2-trial
#4
Daniel F McAuley, Lj Mark Cross, Umar Hamid, Evie Gardner, J Stuart Elborn, Kathy M Cullen, Ahilanandan Dushianthan, Michael Pw Grocott, Michael A Matthay, Cecilia M O'Kane
BACKGROUND: Data from in-vitro, animal, and human lung injury models suggest that keratinocyte growth factor (KGF) might be beneficial in acute respiratory distress syndrome (ARDS). The objective of this trial was to investigate the effect of KGF in patients with ARDS. METHODS: We did a double-blind, allocation concealed, randomised, placebo-controlled phase 2 trial in two intensive care units in the UK, involving patients fulfilling the American-European Consensus Conference Definition of ARDS...
May 16, 2017: Lancet Respiratory Medicine
https://www.readbyqxmd.com/read/28525670/hemoadsorption-treatment-of-patients-with-acute-infective-endocarditis-during-surgery-with-cardiopulmonary-bypass-a-case-series
#5
Karl Träger, Christian Skrabal, Guenther Fischer, Thomas Datzmann, Janpeter Schroeder, Daniel Fritzler, Jan Hartmann, Andreas Liebold, Helmut Reinelt
INTRODUCTION: Infective endocarditis is a serious disease condition. Depending on the causative microorganism and clinical symptoms, cardiac surgery and valve replacement may be needed, posing additional risks to patients who may simultaneously suffer from septic shock. The combination of surgery bacterial spreadout and artificial cardiopulmonary bypass (CPB) surfaces results in a release of key inflammatory mediators leading to an overshooting systemic hyperinflammatory state frequently associated with compromised hemodynamic and organ function...
May 19, 2017: International Journal of Artificial Organs
https://www.readbyqxmd.com/read/28523028/peripheral-arterial-blood-pressure-versus-central-crterial-blood-pressure-monitoring-in-critically-ill-patients-after-cardio-pulmonary-bypass
#6
Rana Altaf Ahmad, Suhail Ahmad, Anjum Naveed, Mirza Ahmad Raza Baig
OBJECTIVE: To determine the accuracy of peripheral (radial) arterial access as compared to central (femoral) arterial access for measurement of invasive blood pressure (IBP) in critically ill patients after cardiopulmonary bypass. METHODS: Sixty patients (60) who required high inotropic/vasopressor support on weaning from cardio-pulmonary bypass and weaned off in 2(nd) attempt were included in this study. The duration of this study was from June 2015 to August 2016...
March 2017: Pakistan Journal of Medical Sciences Quarterly
https://www.readbyqxmd.com/read/28520696/an-ovine-model-of-hyperdynamic-endotoxemia-and-vital-organ-metabolism
#7
Liam Byrne, Nchafatso G Obonyo, Sara Diab, Kimble Dunster, Margaret Passmore, Ai Ching Boon, Louise See Hoe, Karen Hay, Frank Van Haren, John-Paul Tung, Louise Cullen, Kiran Shekar, Kathryn Maitland, John F Fraser
BACKGROUND: Animal models of endotoxemia are frequently used to understand the pathophysiology of sepsis and test new therapies. However, important differences exist between commonly used experimental models of endotoxemia and clinical sepsis. Animal models of endotoxemia frequently produce hypodynamic shock in contrast to clinical hyperdynamic shock. This difference may exaggerate the importance of hypoperfusion as a causative factor in organ dysfunction. This study sought to develop an ovine model of hyperdynamic endotoxemia and assess if there is evidence of impaired oxidative metabolism in the vital organs...
May 17, 2017: Shock
https://www.readbyqxmd.com/read/28520567/persistent-hypotension-and-cerebral-swelling-resulting-from-mesenteric-traction-syndrome-after-omental-to-pial-pedicle-flap-transfer-in-a-young-woman-with-refractory-moyamoya-disease-a-case-report
#8
Harvey J Woehlck, Suneeta Gollapudy, Christopher J Roberts, Akinwunmi Oni-Orisan, Raphael H Sacho, Paul S Pagel
Superficial temporal arterial to middle cerebral arterial anastomosis is often the initial surgical treatment of Moyamoya disease. In refractory cases, placing a pedicle flap of omentum over the ischemic brain has resulted in clinical improvement or stabilization of symptoms. We present a case of persistent mesenteric traction syndrome manifested by hypotension unresponsive to conventional doses of vasopressors during and after pulling the omentum to the brain. As prostacyclin is a major mediator of hypotension from mesenteric traction syndrome and also a cerebral vasodilator, we discuss the possibility that brain swelling may be a manifestation of mesenteric traction syndrome...
May 17, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28514322/relationship-between-a-sepsis-intervention-bundle-and-in-hospital-mortality-among-hospitalized-patients-a-retrospective-analysis-of-real-world-data
#9
Priya A Prasad, Erica R Shea, Stephen Shiboski, Mary C Sullivan, Ralph Gonzales, David Shimabukuro
BACKGROUND: Sepsis is a systemic response to infection that can lead to tissue damage, organ failure, and death. Efforts have been made to develop evidence-based intervention bundles to identify and manage sepsis early in the course of the disease to decrease sepsis-related morbidity and mortality. We evaluated the relationship between a minimally invasive sepsis intervention bundle and in-hospital mortality using robust methods for observational data. METHODS: We performed a retrospective cohort study at the University of California, San Francisco, Medical Center among adult patients discharged between January 1, 2012, and December 31, 2014, and who received a diagnosis of severe sepsis/septic shock (SS/SS)...
May 12, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28509399/association-of-renin-angiotensin-antagonists-with-adverse-perioperative-events-in-patients-undergoing-elective-orthopaedic-surgery-a-case-control-study
#10
Amith Zainudheen, Ian A Scott, Xenia Caney
BACKGROUND: Renin angiotensin antagonists (RAAs) may block protective vasopressor responses during surgery. Evidence linking RAAs with intraoperative hypotension and perioperative adverse events is conflicting. METHODS: Retrospective case-control study of 258 consecutive patients who underwent elective total knee or hip replacement between January 1(st) 2013 and August 31(st) 2016, and who were chronically prescribed a single blood pressure lowering agent up to the time of surgery...
May 16, 2017: Internal Medicine Journal
https://www.readbyqxmd.com/read/28508370/a-proteomic-evaluation-of-sympathetic-activity-biomarkers-of-the-hypothalamus-pituitary-adrenal-axis-by-western-blotting-technique-following-experimental-traumatic-brain-injury
#11
Hale Zerrin Toklu, Yasemin Sakarya, Nihal Tümer
Endocrine disorders and autonomic dysfunction are common paradigms following traumatic brain injury (TBI). Alterations in the hypothalamus-pituitary-adrenal (HPA) axis following TBI may result in impaired vasopressor response, energy imbalance, fatigue, depression, or neurological disorders. Autonomic dysfunction is a common disorder following TBI. The sympathetic activity markers on HPA axis can be measured by Western blot protein analysis. Tyrosine hydroxylase, dopamine beta hydroxylase are the key enzymes for the synthesis of norepinephrine; and neuropeptide Y (NPY) is the peptide that is co-stored and co-released with norepinephrine...
2017: Methods in Molecular Biology
https://www.readbyqxmd.com/read/28507756/predictive-factors-of-short-term-mortality-in-ischaemic-colitis-and-development-of-a-new-prognostic-scoring-model-of-in-hospital-mortality
#12
Armando Peixoto, Marco Silva, Rui Gaspar, Rui Morais, Pedro Pereira, Guilherme Macedo
BACKGROUND: Ischaemic colitis (IC) is the most common form of intestinal ischaemia with a wide spectrum of severity, with possible risk of death. OBJECTIVE: The purpose of this study was to evaluate predictive factors of in-hospital and short-term mortality, in a cohort of patients with IC. METHODS: Retrospective analysis of IC cases diagnosed between 2008-2013 in a single tertiary centre, with assessment of factors at the time of diagnosis associated with in-hospital and 90-day mortality...
April 2017: United European Gastroenterology Journal
https://www.readbyqxmd.com/read/28506218/investigation-of-the-pathophysiology-of-cardiopulmonary-bypass-using-rodent-extracorporeal-life-support-model
#13
Ru-Wen Chang, Chien-Ming Luo, Hsi-Yu Yu, Yih-Sharng Chen, Chih-Hsien Wang
BACKGROUND: Extracorporeal life support (ECLS) systems are life-saving devices used for treating patients with severe cardiopulmonary failure. In this study, we implemented a rat model of ECLS without the administration of inotropes or vasopressors. METHODS: The rats underwent 5 min of untreated asphyxial cardiac arrest and were resuscitated by ECLS for 30 min. The right external jugular vein and right femoral artery were separately cannulated to the ECLS outflow and inflow, respectively...
May 15, 2017: BMC Cardiovascular Disorders
https://www.readbyqxmd.com/read/28506137/elevation-of-serum-park7-and-il-8-levels-is-associated-with-acute-lung-injury-in-patients-with-severe-sepsis-septic-shock
#14
Xiao-Wei Liu, Tao Ma, Quan Cai, Li Wang, Hong-Wei Song, Zhi Liu
OBJECTIVE: Methods containing only clinical information fail to meet the needs of prediction of acute lung injury (ALI) because of the relatively low positive predictive value. This study aimed to investigate the feasibility of using biomarkers as predictors of ALI in populations with severe sepsis/septic shock and to explore difference among biomarkers after adjustment for potential confounders. METHODS: Serum specimens were collected from patients with severe sepsis/septic shock (n = 172) presented to the emergency department...
January 1, 2017: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/28505627/endothelial-damage-signals-refractory-acute-kidney-injury-in-critically-ill-patients
#15
Theis S Itenov, Jens-Ulrik Jensen, Sisse R Ostrowski, Pär I Johansson, Katrin M Thormar, Jens D Lundgren, Morten H Bestle
Critically ill patients with acute kidney injury (AKI) are heterogeneous on pathophysiology and prognosis. The role of endothelial damage in the pathogenesis of refractory AKI has not been clarified. The aim was to determine if biomarkers of endothelial damage, independently of the inflammatory insult on the kidney, can predict recovery of acute kidney injury. METHODS: From the "Procalcitonin And Survival Study" multicenter intensive care unit cohort, followed for 28 days after admission, we included patients without chronic kidney disease, who survived >24 h after admission and with plasma samples at admission available for biomarker analysis...
June 2017: Shock
https://www.readbyqxmd.com/read/28503840/a-critical-note-on-treatment-of-a-severe-diltiazem-intoxication-high-dose-calcium-and-glucagon-infusions
#16
N M Van Veggel, G J Van der Veen, T C Jansen, E M Westerman
The morbidity and mortality of a severe calcium channel blocker intoxication is high due to serious toxic cardiac effects. Its treatment is supported by low-quality evidence from heterogeneous literature. We describe a case of a severe diltiazem intoxication and critically appraise the efficacy and role of high-dose calcium and glucagon infusions. A 53-year-old woman was admitted to the emergency department with a cardiogenic shock with complete AV block, not responding to atropine, isoprenaline and an external pacemaker...
May 15, 2017: Basic & Clinical Pharmacology & Toxicology
https://www.readbyqxmd.com/read/28497428/cccs-ssai-wikirecs-clinical-practice-guideline-vasopressors-in-early-traumatic-shock
#17
Bram Rochwerg, Mathieu Hylands, Morten Møller, Pierre Asfar, Dian Cohen, Rachel G Khadaroo, John H Laake, Anders Perner, Teddie Tanguay, Sandy Widder, Per Vandvik, Annette Kristiansen, François Lamontagne
No abstract text is available yet for this article.
May 11, 2017: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
https://www.readbyqxmd.com/read/28497427/cccs-ssai-wikirecs-clinical-practice-guideline-vasopressor-blood-pressure-targets-in-critically-ill-adults-with-hypotension
#18
Bram Rochwerg, Mathieu Hylands, Morten Møller, Pierre Asfar, Dian Cohen, Rachel G Khadaroo, John H Laake, Anders Perner, Teddie Tanguay, Sandy Widder, Per Vandvik, Annette Kristiansen, François Lamontagne
No abstract text is available yet for this article.
May 11, 2017: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
https://www.readbyqxmd.com/read/28497426/a-systematic-review-of-vasopressor-blood-pressure-targets-in-critically-ill-adults-with-hypotension
#19
Mathieu Hylands, Morten Hylander Moller, Pierre Asfar, Augustin Toma, Anne Julie Frenette, Nicolas Beaudoin, Émilie Belley-Côté, Frédérick D'Aragon, Jon Henrik Laake, Reed Alexander Siemieniuk, Emmanuel Charbonney, François Lauzier, Joey Kwong, Bram Rochwerg, Per Olav Vandvik, Gordon Guyatt, François Lamontagne
PURPOSE: Clinicians must balance the risks from hypotension with the potential adverse effects of vasopressors. Experts have recommended a mean arterial pressure (MAP) target of at least 65 mmHg, and higher in older patients and in patients with chronic hypertension or atherosclerosis. We conducted a systematic review of randomized-controlled trials comparing higher vs lower blood pressure targets for vasopressor therapy administered to hypotensive critically ill patients. METHODS: We searched MEDLINE®, EMBASE™, and the Cochrane Central Register of Controlled Trials for studies of higher vs lower blood pressure targets for vasopressor therapy in critically ill hypotensive adult patients...
May 11, 2017: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
https://www.readbyqxmd.com/read/28495690/intensive-care-in-thoracic-oncology
#20
Anne-Pascale Meert, Bogdan Grigoriu, Marc Licker, Paul E Van Schil, Thierry Berghmans
The admission of lung cancer patients to intensive care is related to postprocedural/postoperative care and medical complications due to cancer or its treatment, but is also related to acute organ failure not directly related to cancer.Despite careful preoperative risk management and the use of modern surgical and anaesthetic techniques, thoracic surgery remains associated with high morbidity, related to the extent of resection and specific comorbidities. Fast-tracking processes with timely recognition and treatment of complications favourably influence patient outcome...
May 2017: European Respiratory Journal: Official Journal of the European Society for Clinical Respiratory Physiology
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