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https://www.readbyqxmd.com/read/28511024/cardiopulmonary-exercise-testing-and-surgery
#1
Paul O Older, Denny Zh Levett
The surgical patient population is increasingly elderly and comorbid and poses challenges to perioperative physicians. Accurate pre-operative risk stratification is important to direct perioperative care. Reduced aerobic fitness is associated with increased post-operative morbidity and mortality. Cardiopulmonary exercise testing is an integrated and dynamic test that gives an objective measure of aerobic fitness or functional capacity and identifies the cause of exercise intolerance. Cardiopulmonary exercise testing provides an individualized estimate of patient risk that can be used to predict post-operative morbidity and mortality...
May 16, 2017: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/28508270/the-impact-of-combined-cardiopulmonary-exercise-testing-and-spect-myocardial-perfusion-imaging-on-downstream-evaluation-and-management
#2
Georgios Christopoulos, John Bois, Thomas G Allison, Martin Rodriguez-Porcel, Panithaya Chareonthaitawee
OBJECTIVE: The diagnostic yield of combined cardiopulmonary exercise testing (CPET) and myocardial perfusion imaging (MPI) in patients referred for stress testing has received limited study. METHODS: We evaluated consecutive patients who underwent combined CPET-MPI at a single tertiary referral center between 2011 and 2015. An abnormal CPET was defined as any of the following: reduced oxygen consumption, cardiac output impairment, or pulmonary impairment. Normal MPI was defined as the absence of resting or stress perfusion defect...
May 15, 2017: Journal of Nuclear Cardiology: Official Publication of the American Society of Nuclear Cardiology
https://www.readbyqxmd.com/read/28504992/trends-in-perioperative-practice-and-resource-utilization-in-patients-with-obstructive-sleep-apnea-undergoing-joint-arthroplasty
#3
Crispiana Cozowicz, Jashvant Poeran, Ashley Olson, Madhu Mazumdar, Eva E Mörwald, Stavros G Memtsoudis
BACKGROUND: Emerging evidence associating obstructive sleep apnea (OSA) with adverse perioperative outcomes has recently heightened the level of awareness among perioperative physicians. In particular, estimates projecting the high prevalence of this condition in the surgical population highlight the necessity of the development and adherence to "best clinical practices." In this context, a number of expert panels have generated recommendations in an effort to provide guidance for perioperative decision-making...
May 11, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28501864/first-line-support-by-intra-aortic-balloon-pump-in-non-ischaemic-cardiogenic-shock-in-the-era-of-modern-ventricular-assist-devices
#4
Corstiaan A den Uil, Giorgia Galli, Lucia S Jewbali, Kadir Caliskan, Olivier C Manintveld, Jasper J Brugts, Nicolas M van Mieghem, Mattie J Lenzen, Eric Boersma, Alina A Constantinescu
OBJECTIVES: Little is known about circulatory support in cardiogenic shock (CS) from other causes than the acute coronary syndrome or after cardiotomy. We evaluated the effects of first-line intra-aortic balloon pump (IABP) support in this subpopulation of CS patients. METHODS: A retrospective study was performed in 27 patients with CS from end-stage cardiomyopathy supported firstly by IABP in the years 2011-2016. RESULTS: At 24 h, lactate decreased from 3...
May 13, 2017: Cardiology
https://www.readbyqxmd.com/read/28459336/an-official-american-thoracic-society-european-society-of-intensive-care-medicine-society-of-critical-care-medicine-clinical-practice-guideline-mechanical-ventilation-in-adult-patients-with-acute-respiratory-distress-syndrome
#5
Eddy Fan, Lorenzo Del Sorbo, Ewan C Goligher, Carol L Hodgson, Laveena Munshi, Allan J Walkey, Neill K J Adhikari, Marcelo B P Amato, Richard Branson, Roy G Brower, Niall D Ferguson, Ognjen Gajic, Luciano Gattinoni, Dean Hess, Jordi Mancebo, Maureen O Meade, Daniel F McAuley, Antonio Pesenti, V Marco Ranieri, Gordon D Rubenfeld, Eileen Rubin, Maureen Seckel, Arthur S Slutsky, Daniel Talmor, B Taylor Thompson, Hannah Wunsch, Elizabeth Uleryk, Jan Brozek, Laurent J Brochard
BACKGROUND: This document provides evidence-based clinical practice guidelines on the use of mechanical ventilation in adult patients with acute respiratory distress syndrome (ARDS). METHODS: A multidisciplinary panel conducted systematic reviews and metaanalyses of the relevant research and applied Grading of Recommendations, Assessment, Development, and Evaluation methodology for clinical recommendations. RESULTS: For all patients with ARDS, the recommendation is strong for mechanical ventilation using lower tidal volumes (4-8 ml/kg predicted body weight) and lower inspiratory pressures (plateau pressure < 30 cm H2O) (moderate confidence in effect estimates)...
May 1, 2017: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/28449851/acute-compartment-syndrome
#6
Andrew H Schmidt
Acute compartment syndrome is a well-known complication of tibial fractures, yet it remains difficult to diagnose and the only effective treatment is surgical fasciotomy. Delayed fasciotomy is the most important factor contributing to poor outcomes, and as a result, treatment is biased towards performing early fasciotomy. Current diagnosis of ACS is based on clinical findings and intramuscular pressure (IMP) measurement, and is targeted at identifying safe thresholds for when fasciotomy can be avoided. Since clinical findings are variable and difficult to quantify, measurement of IMP - ideally continuously - is the cornerstone of surgical decision - making...
April 24, 2017: Injury
https://www.readbyqxmd.com/read/28432006/stepwise-use-of-circulatory-support-devices-in-a-patient-refractory-to-cardiopulmonary-resuscitation
#7
Marco Spartera, Richard J Jabbour, Mauro Chiarito, Michele De Bonis, Federico Pappalardo
This case describes the management of a patient admitted to an emergency department with general malaise, who deteriorated into cardiac arrest and refractory to advanced life support measures. After extracorporeal cardiopulmonary resuscitation (eCPR) with veno-arterial extracorporeal membrane oxygenation in association with an Impella 2.5 device, the patient underwent cardiac surgery (tissue aortic valve replacement, coronary artery bypass grafting and implantation of short-term paracorporeal left ventricular assist device)...
April 8, 2017: Cardiovascular Revascularization Medicine: Including Molecular Interventions
https://www.readbyqxmd.com/read/28430808/quantification-of-hypoxia-related-gene-expression-as-a-potential-approach-for-clinical-outcome-prediction-in-breast-cancer
#8
Abderrahim El Guerrab, Anne Cayre, Fabrice Kwiatkowski, Maud Privat, Jean-Marc Rossignol, Fabrice Rossignol, Frédérique Penault-Llorca, Yves-Jean Bignon
Breast cancers are solid tumors frequently characterized by regions with low oxygen concentrations. Cellular adaptations to hypoxia are mainly determined by "hypoxia inducible factors" that mediate transcriptional modifications involved in drug resistance and tumor progression leading to metastasis and relapse occurrence. In this study, we investigated the prognostic value of hypoxia-related gene expression in breast cancer. A systematic review was conducted to select a set of 45 genes involved in hypoxia signaling pathways and breast tumor progression...
2017: PloS One
https://www.readbyqxmd.com/read/28387975/insular-and-cingulate-attenuation-during-decision-making-is-associated-with-future-transition-to-stimulant-use-disorder
#9
Jennifer L Stewart, Mamona Butt, April C May, Susan F Tapert, Martin P Paulus
AIMS: To understand processes placing individuals at risk for stimulant (amphetamine and cocaine) use disorder. DESIGN: Longitudinal study. SETTING: University of California, San Diego Department of Psychiatry, USA. PARTICIPANTS: Occasional stimulant users (OSU; n = 184) underwent a baseline clinical interview and a functional magnetic resonance imaging (fMRI) session. On the basis of a follow-up clinical interview completed three years later, OSU (n = 147) were then categorized as problem stimulant users (PSU: n = 36; those who developed stimulant use disorders in the interim) or desisted stimulant users (DSU: n = 74; those who stopped using)...
April 7, 2017: Addiction
https://www.readbyqxmd.com/read/28333829/acute-traumatic-coagulopathy-the-elephant-in-a-room-of-blind-scientists
#10
Michael A Meledeo, Maryanne C Herzig, James A Bynum, Xiaowu Wu, Anand K Ramasubramanian, Daniel N Darlington, Kristin M Reddoch, Andrew P Cap
Acute traumatic coagulopathy (ATC) is the failure of coagulation homeostasis that can rapidly arise following traumatic injury, hemorrhage, and shock; it is associated with higher injury severity, coagulation abnormalities, and increased blood transfusions. Acute traumatic coagulopathy has historically been defined by a prolonged prothrombin time, although newer, more informative measurements of hemostatic function have been used to improve diagnosis and support clinical decision making. The underlying biochemical mechanisms of and best practice therapeutics for ATC remain under active investigation because of its significant correlation to poor outcomes...
June 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28331972/safe-sleeping-positions-practice-and-policy-for-babies-with-cleft-palate
#11
Karen Davies, Iain A Bruce, Patricia Bannister, Peter Callery
Guidance recommends 'back to sleep' positioning for infants from birth in order to reduce the risk of sudden infant death. Exceptions have been made for babies with severe respiratory difficulties where lateral positioning may be recommended, although uncertainty exists for other conditions affecting the upper airway structures, such as cleft palate. This paper presents research of (i) current advice on sleep positioning provided to parents of infants with cleft palate in the UK; and (ii) decision making by clinical nurse specialists when advising parents of infants with cleft palate...
May 2017: European Journal of Pediatrics
https://www.readbyqxmd.com/read/28273332/comparison-between-model-predicted-tumor-oxygenation-dynamics-and-vascular-flow-related-doppler-indices
#12
Antonella Belfatto, Ailyn M Vidal Urbinati, Delia Ciardo, Dorella Franchi, Federica Cattani, Roberta Lazzari, Barbara A Jereczek-Fossa, Roberto Orecchia, Guido Baroni, Pietro Cerveri
PURPOSE: Mathematical modeling is a powerful and flexible method to investigate complex phenomena. It discloses the possibility of reproducing expensive as well as invasive experiments in a safe environment with limited costs. This makes it suitable to mimic tumor evolution and response to radiotherapy although the reliability of the results remains an issue. Complexity reduction is therefore a critical aspect in order to be able to compare model outcomes to clinical data. Among the factors affecting treatment efficacy, tumor oxygenation is known to play a key role in radiotherapy response...
March 8, 2017: Medical Physics
https://www.readbyqxmd.com/read/28157275/continuous-cardiotocography-ctg-as-a-form-of-electronic-fetal-monitoring-efm-for-fetal-assessment-during-labour
#13
REVIEW
Zarko Alfirevic, Declan Devane, Gillian Ml Gyte, Anna Cuthbert
BACKGROUND: Cardiotocography (CTG) records changes in the fetal heart rate and their temporal relationship to uterine contractions. The aim is to identify babies who may be short of oxygen (hypoxic) to guide additional assessments of fetal wellbeing, or determine if the baby needs to be delivered by caesarean section or instrumental vaginal birth. This is an update of a review previously published in 2013, 2006 and 2001. OBJECTIVES: To evaluate the effectiveness and safety of continuous cardiotocography when used as a method to monitor fetal wellbeing during labour...
February 3, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28114683/physician-decision-making-and-clinical-outcomes-with-laboratory-polysomnography-or-limited-channel-sleep-studies-for-obstructive-sleep-apnea-a-randomized-trial
#14
RANDOMIZED CONTROLLED TRIAL
Ching Li Chai-Coetzer, Nick A Antic, Garun S Hamilton, Nigel McArdle, Keith Wong, Brendon J Yee, Aeneas Yeo, Rajeev Ratnavadivel, Matthew T Naughton, Teanau Roebuck, Richard Woodman, R Doug McEvoy
Background: The clinical utility of limited-channel sleep studies (which are increasingly conducted at home) versus laboratory polysomnography (PSG) for diagnosing obstructive sleep apnea (OSA) is unclear. Objective: To compare patient outcomes after PSG versus limited-channel studies. Design: Multicenter, randomized, noninferiority study. (Australian New Zealand Clinical Trials Registry: ACTRN12611000926932). Setting: 7 academic sleep centers...
March 7, 2017: Annals of Internal Medicine
https://www.readbyqxmd.com/read/28074789/extracorporeal-membrane-oxygenation-in-severe-influenza-infection-with-respiratory-failure-a-systematic-review-and-meta-analysis
#15
REVIEW
Shashvat Sukhal, Jaskaran Sethi, Malini Ganesh, Pedro A Villablanca, Anita K Malhotra, Harish Ramakrishna
INTRODUCTION: Extracorporeal membrane oxygenation (ECMO) has been extensively used for potentially reversible acute respiratory failure associated with severe influenza A (H1N1) pneumonia; however, it remains an expensive, resource-intensive therapy, with a high associated mortality. This systematic review and meta-analysis aims to summarize and pool outcomes data available in the published literature to guide clinical decision-making and further research. METHODS: We conducted a systematic search of MEDLINE (1966 to April 15, 2015), EMBASE (1980 to April 15, 2015), CENTRAL, and Google Scholar for patients with severe H1N1 pneumonia and respiratory failure who received ECMO...
January 2017: Annals of Cardiac Anaesthesia
https://www.readbyqxmd.com/read/28071865/the-impact-of-evidence-based-sepsis-guidelines-on-emergency-department-clinical-practice-a-pre-post-medical-record-audit
#16
Bernadine Romero, Margaret Fry, Michael Roche
AIMS AND OBJECTIVES: The aim of this study was to explore the number of patients presenting with sepsis before and after guideline implementation; the impact of sepsis guidelines on triage assessment, Emergency Department management and time to antibiotics. BACKGROUND: Sepsis remains one of the leading causes of mortality and morbidity within hospitals. Globally, strategies have been implemented to reduce morbidity and mortality rates, which rely on the early recognition and management of sepsis...
January 10, 2017: Journal of Clinical Nursing
https://www.readbyqxmd.com/read/28070916/non-invasive-assessment-of-muscle-oxygenation-may-aid-in-optimising-transfusion-threshold-decisions-in-ambulatory-paediatric-patients
#17
K A Schenkman, D S Hawkins, W A Ciesielski, M Delaney, L S L Arakaki
OBJECTIVE: To assess the potential utility of a novel non-invasive muscle oxygen measurement to determine the presence of muscle hypoxia in patients with anaemia. BACKGROUND: Recent assessment of the risk/benefit ratio of blood transfusion has led to clinical strategies optimising transfusion decisions. These decisions are primarily based on haematocrit (Hct) but not oxygen delivery, the primary function of red blood cells (RBCs). We hypothesised that muscle oxygenation (MOx) would correlate with Hct in patients with anaemia and may be a physiologically relevant determinant of the transfusion threshold...
February 2017: Transfusion Medicine
https://www.readbyqxmd.com/read/28001135/a-survey-of-physicians-attitudes-toward-decision-making-authority-for-initiating-and-withdrawing-va-ecmo-results-and-ethical-implications-for-shared-decision-making
#18
Ellen C Meltzer, Natalia S Ivascu, Meredith Stark, Alexander V Orfanos, Cathleen A Acres, Paul J Christos, Thomas Mangione, Joseph J Fins
OBJECTIVE: Although patients exercise greater autonomy than in the past, and shared decision making is promoted as the preferred model for doctor-patient engagement, tensions still exist in clinical practice about the primary locus of decision-making authority for complex, scarce, and resource-intensive medical therapies: patients and their surrogates, or physicians. We assessed physicians' attitudes toward decisional authority for adult venoarterial extracorporeal membrane oxygenation (VA-ECMO), hypothesizing they would favor a medical locus...
2016: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/27999120/the-effect-of-mandible-advancement-splints-in-mild-moderate-and-severe-obstructive-sleep-apnea-the-need-for-sleep-registrations-during-follow-up
#19
Tuula Palotie, Siru Riekki, Antti Mäkitie, Adel Bachour, Sirpa Arte, Leif Bäck
OBJECTIVE AND DESIGN: Our aim was to evaluate the effect of mandible advancement splint (MAS) in mild, moderate, and severe obstructive sleep apnea (OSA). We also determined, if and in which OSA-groups the adequate forward movement in MAS could be quantified without sleep registration for different OSA levels. A retrospective study. SETTINGS: The effect of MAS was measured with clinical methods and by sleep registration. PARTICIPANTS: The series consisted of 103 patients, 75 males and 28 females (mean age 52 years) suffering from mild (32 per cent), moderate (32 per cent), or severe (36 per cent) OSA, who were treated with MAS at Helsinki University Hospital, Finland during the years 2011-2012...
December 20, 2016: European Journal of Orthodontics
https://www.readbyqxmd.com/read/27925054/prone-position-in-patients-with-acute-respiratory-distress-syndrome
#20
Mariano Setten, Gustavo Adrián Plotnikow, Matías Accoce
Acute respiratory distress syndrome occupies a great deal of attention in intensive care units. Despite ample knowledge of the physiopathology of this syndrome, the focus in intensive care units consists mostly of life-supporting treatment and avoidance of the side effects of invasive treatments. Although great advances in mechanical ventilation have occurred in the past 20 years, with a significant impact on mortality, the incidence continues to be high. Patients with acute respiratory distress syndrome, especially the most severe cases, often present with refractory hypoxemia due to shunt, which can require additional treatments beyond mechanical ventilation, among which is mechanical ventilation in the prone position...
October 2016: Revista Brasileira de Terapia Intensiva
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