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https://www.readbyqxmd.com/read/27908333/pitfalls-in-the-treatment-of-sepsis
#1
REVIEW
Lars-Kristofer N Peterson, Karin Chase
Sepsis is a challenging, dynamic, pathophysiology requiring expertise in diagnosis and management. Controversy exists as to the most sensitive early indicators of sepsis and sepsis severity. Patients presenting to the emergency department often lack complete history or clinical data that would point to optimal management. Awareness of these potential knowledge gaps is important for the emergency provider managing the septic patient. Specific areas of management including the initiation and management of mechanical ventilation, the appropriate disposition of the patient, and consideration of transfer to higher levels of care are reviewed...
February 2017: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/27907964/critical-care-neurology-perspective-on-delirium
#2
Matthew B Maas, Andrew M Naidech
The evidence linking delirium to poor outcomes after critical illness is compelling, including higher mortality, prolonged mechanical ventilation, longer length of intensive care unit stay, and long-term cognitive impairments. The attitude toward delirium in the neurologic community is shifting away from viewing it as an unmodifiable, inevitable consequence of severe illness to treating it is as a neurologic emergency, akin to seizures or encephalitis. Delirium, like other manifestations of critical illness encephalopathy, is an organ dysfunction syndrome...
December 2016: Seminars in Neurology
https://www.readbyqxmd.com/read/27895441/a-retrospective-analysis-of-postoperative-patients-admitted-to-the-intensive-care-unit
#3
S Uzman, Y Yilmaz, M Toptas, I Akkoc, Y G Gul, H Daskaya, Y Toptas
BACKGROUND: The aim of this retrospective study was to evaluate postoperative patients admitted to the intensive care unit (ICU) and to describe their characteristics and outcomes. METHODS: We performed a retrospective chart review of 1,756 postoperative patients admitted to the ICU of a tertiary referral hospital from January 2008 to December 2012. For each patient we recorded: demographic data, reason for admission to the ICU, duration of mechanical ventilation, elective versus emergency surgery, type of anaesthesia, American Society of Anesthesiologists (ASA) physical status, Acute Physiology and Chronic Health Evaluation (APACHE) II score, Glasgow Coma Score (GCS), and outcome...
January 2016: Hippokratia
https://www.readbyqxmd.com/read/27879182/-acute-respiratory-failure-caused-by-minocycline
#4
B Kok, M J T van de Ven, H J van Leeuwen
BACKGROUND: In the case of pneumonia an infectious cause is always considered first. However, toxic agents and medicines can also be the cause of pneumonia. CASE DESCRIPTION: A 54-year-old woman was referred to the emergency department because of progressive dyspnoea, a non-productive cough, headache, and fever. She was admitted with the diagnosis community acquired pneumonia. Despite treatment with antibiotics and oxygen she developed hypoxic respiratory failure, which necessitated invasive mechanical ventilation...
2016: Nederlands Tijdschrift Voor Geneeskunde
https://www.readbyqxmd.com/read/27878445/can-non-invasive-ventilation-modify-central-venous-pressure-comparison-between-invasive-measurement-and-ultrasonographic-evaluation
#5
Maurizio Zanobetti, Alessio Prota, Alessandro Coppa, Laura Giordano, Sofia Bigiarini, Peiman Nazerian, Francesca Innocenti, Alberto Conti, Federica Trausi, Simone Vanni, Giuseppe Pepe, Riccardo Pini
Central venous pressure (CVP) is primarily measured to assess intravascular volume status and heart preload. In clinical practice, the measuring device most commonly used in emergency departments and intensive care units, is an electronic transducer that interconnects a central venous catheter (CVC) with a monitoring system. Non-invasive ventilation (NIV) consists in a breathing support that supplies a positive pressure in airways through a mask or a cask though not using an endotracheal prosthesis. In emergency settings, non-invasive ultrasonography evaluation of CVP, and hence of intravascular volume status entail the measurement by a subxiphoid approach of inferior vena cava diameter and its variations in relation to respiratory activity...
November 22, 2016: Internal and Emergency Medicine
https://www.readbyqxmd.com/read/27867554/tigecycline-combination-for-ventilator-associated-pneumonia-caused-by-extensive-drug-resistant-acinetobacter-baumannii
#6
Hangyong He, Yali Zheng, Bing Sun, Xiao Tang, Rui Wang, Zhaohui Tong
BACKGROUND: Extensive drug-resistant Acinetobacter baumannii (XDR A. baumannii) has emerged as an important pathogen in patients with ventilator-associated pneumonia (VAP) worldwide. This study determined whether or not combination tigecycline (TGC) treatment improved the short-term outcome of patients with XDR A. baumannii-induced VAP. Methods: Fifty-eight patients admitted to our intensive care unit (ICU) with confirmed XDR A. baumannii VAP between January 2011 and June 2013 were retrospectively studied...
October 2016: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/27848998/fatal-community-acquired-pneumonia-in-children-caused-by-re-emergent-human-adenovirus-7d-associated-with-higher-severity-of-illness-and-fatality-rate
#7
Zhiwu Yu, Zhiwei Zeng, Jing Zhang, Yuxian Pan, Manjun Chen, Yonghui Guo, Nan Yu, James Chodosh, Ning Fu, Xiaoyan Che, Qiwei Zhang
Human adenoviruses (HAdVs) are highly contagious pathogens causing acute respiratory disease (ARD), such as community-acquired pneumonia. HAdV-7d, a re-emergent genomic variant, has been recently reported in Asia and the United States after a several-decade absence. However, whether HAdV-7d is associated with higher severity than other types is currently unclear. In this study, the clinical and epidemiological investigation showed that fever, cough, and sore throat were the three most common respiratory symptoms of HAdV infections...
November 16, 2016: Scientific Reports
https://www.readbyqxmd.com/read/27842746/managing-respiratory-failure-in-obstructive-lung-disease
#8
REVIEW
Stephen P Bergin, Craig R Rackley
Exacerbations of obstructive lung disease are common causes of acute respiratory failure. Short-acting bronchodilators and systemic glucocorticoids are the foundation of pharmacologic management. For patients requiring ventilator support, use of noninvasive ventilation reduces the risk of mortality and progression to invasive mechanical ventilation. Challenges associated with invasive ventilation include ventilator dyssynchrony, air trapping, and dynamic hyperinflation. Careful monitoring and adjustment of ventilatory support parameters helps to optimize the patient-ventilator interaction and minimizes the risk of associated morbidity...
December 2016: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/27829093/postoperative-pulmonary-complications-early-mortality-and-hospital-stay-following-noncardiothoracic-surgery-a-multicenter-study-by-the-perioperative-research-network-investigators
#9
Ana Fernandez-Bustamante, Gyorgy Frendl, Juraj Sprung, Daryl J Kor, Bala Subramaniam, Ricardo Martinez Ruiz, Jae-Woo Lee, William G Henderson, Angela Moss, Nitin Mehdiratta, Megan M Colwell, Karsten Bartels, Kerstin Kolodzie, Jadelis Giquel, Marcos Francisco Vidal Melo
Importance: Postoperative pulmonary complications (PPCs), a leading cause of poor surgical outcomes, are heterogeneous in their pathophysiology, severity, and reporting accuracy. Objective: To prospectively study clinical and radiological PPCs and respiratory insufficiency therapies in a high-risk surgical population. Design, Setting, and Participants: We performed a multicenter prospective observational study in 7 US academic institutions...
November 9, 2016: JAMA Surgery
https://www.readbyqxmd.com/read/27824402/-pathways-of-invasive-ventilated-patients-released-into-intensive-home-care-the-perspective-of-home-care-providers
#10
Y Lehmann, M Ewers
Introduction: Over the past years, many home respiratory care services for invasively mechanically ventilated patients have been set up in Germany. However, little is known about the pathways used by these patients in order to access such specialized care. Methods: A qualitative, exploratory study was undertaken. Semi-structured interviews with 15 leading experts or employees responsible for care transition were conducted and subjected to content analysis. Results: Invasively ventilated patients' pathways into intensive home care tend to be highly random, risky and uncertain...
November 7, 2016: Das Gesundheitswesen
https://www.readbyqxmd.com/read/27814848/respiratory-dysfunction-in-patients-with-chronic-neck-pain-what-is-the-current-evidence
#11
Zacharias Dimitriadis, Eleni Kapreli, Nikolaos Strimpakos, Jacqueline Oldham
Respiratory function of patients with neck pain has not been given much consideration in usual clinical practice. The problem has however been highlighted occasionally by renown clinical scientists and recently there is a growing interest in the investigation of respiratory function in this clinical population. The aim of this review is to critically present the emerging evidence and discuss the similarities and differences observed. Although the evidence for some respiratory parameters is conflicting, it seems to be generally agreed that others such as maximal voluntary ventilation, strength of respiratory muscles, chest mechanics and partial pressure of arterial carbon dioxide are affected in patients with chronic neck pain...
October 2016: Journal of Bodywork and Movement Therapies
https://www.readbyqxmd.com/read/27811559/rib-fractures-in-trauma-patients-does-operative-fixation-improve-outcome
#12
Peter Majak, Pål A Næss
PURPOSE OF REVIEW: Renewed interest in surgical fixation of rib fractures has emerged. However, conservative treatment is still preferred at most surgical departments. We wanted to evaluate whether operative treatment of rib fractures may benefit severely injured patients. RECENT FINDINGS: Several studies report a reduction in mechanical ventilation time, ICU length of stay (LOS), hospital LOS, pneumonia, need for tracheostomy, pain and costs in operatively treated patients with multiple rib fractures compared with patients treated nonoperatively...
December 2016: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/27809826/hospitalizations-due-to-respiratory-failure-in-patients-with-amyotrophic-lateral-sclerosis-and-their-impact-on-survival-a-population-based-cohort-study
#13
Federica Edith Pisa, Giancarlo Logroscino, Paolo Giacomelli Battiston, Fabio Barbone
BACKGROUND: Respiratory failure, infections and aspiration pneumonia, are the main causes of morbidity and mortality in Amyotrophic Lateral Sclerosis (ALS). In a population-based cohort, we assessed (a) hospital utilization and (b) impact of hospitalization for respiratory failure on survival. METHODS: All patients with incident ALS in Friuli Venezia Giulia region, Italy, from 2002 to 2009, were identified through multiple sources. Diagnosis was validated through clinical documentation review...
November 3, 2016: BMC Pulmonary Medicine
https://www.readbyqxmd.com/read/27801369/risk-factors-for-hospital-infections-caused-by-carbapanem-resistant-acinetobacter-baumannii
#14
Zorana M Djordjevic, Marko M Folic, Nevena D Folic, Nevena Gajovic, Olgica Gajovic, Slobodan M Jankovic
INTRODUCTION: Acinetobacter baumannii is one of major causative agents of severe, life-threatening hospital infections (HIs), especially in intensive care units (ICUs). Our aim was to discover the risk factors associated with the emergence of HIs caused by carbapenem-resistant Acinetobacter baumannii (CRAB), as well as those associated with death in patients who suffer from such infections. METHODOLOGY: A prospective cohort study was conducted over a five-year period in the medical-surgical ICU of the Clinical Centre in Kragujevac, Serbia...
October 31, 2016: Journal of Infection in Developing Countries
https://www.readbyqxmd.com/read/27798539/pediatric-minor-traumatic-brain-injury-with-intracranial-hemorrhage-identifying-low-risk-patients-who-may-not-benefit-from-icu-admission
#15
Erin Comer Burns, Beech Burns, Craig D Newgard, Amber Laurie, Rongwei Fu, Theresa Graif, Casey S Ward, Abbie Bauer, David Steinhardt, Laura M Ibsen, David M Spiro
BACKGROUND: Pediatric patients with any severity of traumatic intracranial hemorrhage (tICH) are often admitted to intensive care units (ICUs) for early detection of secondary injury. We hypothesize that there is a subset of these patients with mild injury and tICH for whom ICU care is unnecessary. OBJECTIVES: To quantify tICH frequency and describe disposition and to identify patients at low risk of inpatient critical care intervention (CCI). METHODS: We retrospectively reviewed patients aged 0 to 17 years with tICH at a single level I trauma center from 2008 to 2013...
October 28, 2016: Pediatric Emergency Care
https://www.readbyqxmd.com/read/27798538/compartment-syndrome-secondary-to-group-a-streptococcus-infection-in-the-presence-of-a-congenital-hemangioma
#16
Sharon L Kracoff
OBJECTIVES: Nontraumatic compartment syndrome is frequently difficult to diagnose but this is especially troublesome in infants. Pain is the most sensitive sign and is characteristically severe and refractory to routine analgesia. Failure to diagnose and treat can lead to disability, multiorgan failure, and death. Surgical intervention is crucial and includes emergent fasciotomy, debridement, nerve decompression, and later skin grafting. Streptococcal myositis causing compartment syndrome is more likely in the immunocompromised patient...
October 28, 2016: Pediatric Emergency Care
https://www.readbyqxmd.com/read/27792804/trismus-as-a-clinical-manifestation-of-tetanus-a-case-report
#17
Ioannis Papadiochos, Sofia Papadiochou, Vassilis Petsinis, Lampros Goutzanis, Charikleia Atsali, Nikolaos Papadogeorgaki
Although the incidence of tetanus disease has radically declined in developed countries, both dental practitioners and oral and maxillofacial surgeons should be knowledgeable about its diagnosis since initial manifestations of the disease, such as trismus and dysphagia, are observed in the orofacial region. This study reports on a case of generalized tetanus diagnosed in a middle-aged man. Before the tetanus diagnosis, the patient had sought medical advice from seven different health care professionals, including a dentist and an oral and maxillofacial surgeon...
October 2016: Journal of Oral & Facial Pain and Headache
https://www.readbyqxmd.com/read/27790606/nutrition-a-primary-therapy-in-pediatric-acute-respiratory-distress-syndrome
#18
REVIEW
Bryan Wilson, Katri Typpo
Appropriate nutrition is an essential component of intensive care management of children with acute respiratory distress syndrome (ARDS) and is linked to patient outcomes. One out of every two children in the pediatric intensive care unit (PICU) will develop malnutrition or have worsening of baseline malnutrition and present with specific micronutrient deficiencies. Early and adequate enteral nutrition (EN) is associated with improved 60-day survival after pediatric critical illness, and, yet, despite early EN guidelines, critically ill children receive on average only 55% of goal calories by PICU day 10...
2016: Frontiers in Pediatrics
https://www.readbyqxmd.com/read/27780589/risk-factors-for-pressure-ulcer-development-in-intensive-care-units-systematic-review
#19
M Lima Serrano, M I González Méndez, F M Carrasco Cebollero, J S Lima Rodríguez
INTRODUCTION: Pressure ulcers represent a significant problem for patients, professionals and health systems. Their reported incidence and prevalence are significant worldwide. Their character iatrogenic states that its appearance is preventable and its incidence is an indicator of scientific and technical quality both in primary care and specialized care. The aim of this review was to identify risk factors associated with the occurrence of pressure ulcers in critically ill patients. METHODOLOGY: The PRISMA Declaration recommendations have been followed and adapted to studies identifying risk factors...
October 22, 2016: Medicina Intensiva
https://www.readbyqxmd.com/read/27780558/clinical-predictors-of-early-acute-respiratory-distress-syndrome-in-trauma-patients
#20
Michael P O'Leary, Jessica A Keeley, Arthur Yule, Caitlyn Suruki, David S Plurad, Ashkan Moazzez, Angela L Neville, Brant A Putnam, Dennis Y Kim
BACKGROUND: The objectives of this study were to examine the incidence and severity of early acute respiratory distress syndrome (ARDS) according to the Berlin Definition and to identify risk factors associated with the development of early post-traumatic ARDS. METHODS: A 2.5-year retrospective database of adult trauma patients who required mechanical ventilation for greater than 48 hours at a level 1 trauma center was analyzed for variables predictive of early (<48 hours after injury), mild, moderate, and severe ARDS and in-hospital mortality...
September 30, 2016: American Journal of Surgery
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