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refractory shock

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https://www.readbyqxmd.com/read/28426466/physician-variation-in-time-to-antimicrobial-treatment-for-septic-patients-presenting-to-the-emergency-department
#1
Ithan D Peltan, Kristina H Mitchell, Kristina E Rudd, Blake A Mann, David J Carlbom, Catherine L Hough, Thomas D Rea, Samuel M Brown
OBJECTIVES: Delayed initiation of appropriate antimicrobials is linked to higher sepsis mortality. We investigated interphysician variation in septic patients' door-to-antimicrobial time. DESIGN: Retrospective cohort study. SETTING: Emergency department of an academic medical center. SUBJECTS: Adult patients treated with antimicrobials in the emergency department between 2009 and 2015 for fluid-refractory severe sepsis or septic shock...
April 6, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28425079/outcome-of-patients-with-septic-shock-and-high-dose-vasopressor-therapy
#2
Thomas Auchet, Marie-Alix Regnier, Nicolas Girerd, Bruno Levy
BACKGROUND: Despite the dissemination of international guidelines, mortality from septic shock remains high. Norepinephrine is recommended as first-line vasopressor therapy with a target mean arterial pressure of 65 mmHg. High-dose vasopressor (HDV) may also be required. This study aimed to assess survival in patients with septic shock requiring HDV. We conducted a retrospective study of patients admitted between January 2008 and December 2013 to a 13-bed ICU for septic shock and receiving high-dose vasopressor therapy (defined by a dose >1 µg/kg/min)...
December 2017: Annals of Intensive Care
https://www.readbyqxmd.com/read/28419300/short-term-mechanical-circulatory-support-for-cardiogenic-shock-in-severe-peripartum-cardiomyopathy-la-piti%C3%A3-salp%C3%A3%C2%AAtri%C3%A3-re-experience
#3
Nadia Bouabdallaoui, Pierre Demondion, Pascal Leprince, Guillaume Lebreton
OBJECTIVES: Mechanical circulatory support (MCS) is a valuable option in the setting of cardiogenic shock (CS), although MCS use in severe forms of peripartum cardiomyopathy (PPCM) is underreported. We aimed to investigate maternal outcomes under MCS for refractory CS complicating PPCM. METHODS: We retrospectively reviewed 10 consecutive patients (2010-2015) meeting diagnosis criteria of PPCM that were managed with peripheral veno-arterial extracorporeal membrane oxygenation (pVA-ECMO) for severe CS...
April 16, 2017: Interactive Cardiovascular and Thoracic Surgery
https://www.readbyqxmd.com/read/28416468/cardiac-transplantation-in-children-and-adolescents-with-long-qt-syndrome
#4
Angela M Kelle, J Martijn Bos, Susan P Etheridge, Bryan C Cannon, Randall M Bryant, Jonathan N Johnson, Michael J Ackerman
BACKGROUND: Long QT syndrome (LQTS) is a potentially lethal, yet highly treatable, cardiac channelopathy. Cardiac transplantation has been reported anecdotally for patients with severe LQTS refractory to standard therapies. OBJECTIVE: We evaluated the incidence and risk factors for cardiac transplantation among children evaluated and treated in an LQTS specialty center. METHODS: This was a retrospective review of 349 children with LQTS (mean age at diagnosis, 8...
April 14, 2017: Heart Rhythm: the Official Journal of the Heart Rhythm Society
https://www.readbyqxmd.com/read/28416430/-extracorporeal-membrane-oxygenation-in-critically-ill-neonates-and-children
#5
J Rambaud, J Guilbert, I Guellec, S Jean, A Durandy, M Demoulin, A Amblard, R Carbajal, P-L Leger
Extracorporeal membrane oxygenation is used as a last resort during neonatal and pediatric resuscitation in case of refractory circulatory or respiratory failure under maximum conventional therapies. Different types of ECMO can be used depending on the initial failure. The main indications for ECMO are refractory respiratory failure (acute respiratory distress syndrome, status asthmaticus, severe pneumonia, meconium aspiration syndrome, pulmonary hypertension) and refractory circulatory failure (cardiogenic shock, septic shock, refractory cardiac arrest)...
April 14, 2017: Archives de Pédiatrie: Organe Officiel de la Sociéte Française de Pédiatrie
https://www.readbyqxmd.com/read/28409501/successful-treatment-of-fulminant-lyme-myocarditis-with-mechanical-circulatory-support-in-a-young-male-adult-a-case-report
#6
Željko Župan, Dino Mijatović, Igor Medved, Snježana Kraljić, Jurica Juranić, Berislav Barbalić, Marin Oštrić
We describe the case of fulminant myocarditis due to Lyme disease and use of mechanical circulatory support (MCS) for the treatment of the Lyme carditis associated with refractory cardiogenic shock. Fulminant Lyme myocarditis in young adult male patient led to a sudden onset of acute, severe biventricular heart failure with progressive cardiogenic shock, and multiorgan failure immediately after admission.
April 14, 2017: Croatian Medical Journal
https://www.readbyqxmd.com/read/28404157/nab-paclitaxel-versus-solvent-based-paclitaxel-in-patients-with-previously-treated-advanced-gastric-cancer-absolute-an-open-label-randomised-non-inferiority-phase-3-trial
#7
Kohei Shitara, Atsuo Takashima, Kazumasa Fujitani, Keisuke Koeda, Hiroki Hara, Norisuke Nakayama, Shuichi Hironaka, Kazuhiro Nishikawa, Yoichi Makari, Kenji Amagai, Shinya Ueda, Kazuhiro Yoshida, Hideki Shimodaira, Tomohiro Nishina, Masahiro Tsuda, Yukinori Kurokawa, Takao Tamura, Yasutsuna Sasaki, Satoshi Morita, Wasaburo Koizumi
BACKGROUND: Weekly administration of solvent-based paclitaxel is one of the standard second-line chemotherapy regimens for advanced gastric cancer. Nanoparticle albumin-bound paclitaxel (nab-paclitaxel) was developed to improve the solubility of paclitaxel and does not need premedication to avoid infusion-related reactions associated with solvent-based paclitaxel. Additionally, higher doses of nab-paclitaxel can be administered over a shorter infusion time and at higher drug concentrations compared with solvent-based paclitaxel...
April 2017: Lancet. Gastroenterology & Hepatology
https://www.readbyqxmd.com/read/28402404/long-term-outcome-of-surgical-cryoablation-for-refractory-ventricular-tachycardia-in-patients-with-non-ischemic-cardiomyopathy
#8
Jackson J Liang, Brian P Betensky, Daniele Muser, Erica S Zado, Elad Anter, Nimesh D Desai, David J Callans, Rajat Deo, David S Frankel, Mathew D Hutchinson, David Lin, Michael P Riley, Robert D Schaller, Gregory E Supple, Pasquale Santangeli, Michael A Acker, Joseph E Bavaria, Wilson Y Szeto, Prashanth Vallabhajosyula, Francis E Marchlinski, Sanjay Dixit
Aims: Limited data exist on the long-term outcome of patients (pts) with non-ischemic cardiomyopathy (NICM) and ventricular tachycardia (VT) refractory to conventional therapies undergoing surgical ablation (SA). We aimed to investigate the long-term survival and VT recurrence in NICM pts with VT refractory to radiofrequency catheter ablation (RFCA) who underwent SA. Methods and results: Consecutive pts with NICM and VT refractory to RFCA who underwent SA were included...
April 10, 2017: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
https://www.readbyqxmd.com/read/28400684/early-prediction-of-3-month-survival-of-patients-in-refractory-cardiogenic-shock-and-cardiac-arrest-on-extracorporeal-life-support
#9
Clément Delmas, Jean-Marie Conil, Simon Sztajnic, Bernard Georges, Caroline Biendel, Camille Dambrin, Michel Galinier, Vincent Minville, Olivier Fourcade, Stein Silva, Bertrand Marcheix
BACKGROUND: Extracorporeal life support (ECLS) holds the promise of significant improvement of the survival of patient in refractory cardiogenic shock (CS) or cardiac arrest (CA). Nevertheless, it remains to be shown to which extent these highly invasive supportive techniques could improve long-term patient's outcome. METHODS: The outcomes of 82 adult ECLS patients at our institution between January 2012 and December 2013 were retrospectively analyzed. RESULTS: Patients were essentially men (64...
March 2017: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/28396856/bidomain-predictions-of-virtual-electrode-induced-make-and-break-excitations-around-blood-vessels
#10
Adam J Connolly, Edward Vigmond, Martin J Bishop
INTRODUCTION AND BACKGROUND: Virtual electrodes formed by field stimulation during defibrillation of cardiac tissue play an important role in eliciting activations. It has been suggested that the coronary vasculature is an important source of virtual electrodes, especially during low-energy defibrillation. This work aims to further the understanding of how virtual electrodes from the coronary vasculature influence defibrillation outcomes. METHODS: Using the bidomain model, we investigated how field stimulation elicited activations from virtual electrodes around idealized intramural blood vessels...
2017: Frontiers in Bioengineering and Biotechnology
https://www.readbyqxmd.com/read/28394814/percutaneous-mechanical-circulatory-support-using-impella%C3%A2-devices-for-decompensated-cardiogenic-shock-a-pediatric-heart-center-experience
#11
Dhaval Parekh, Aamir Jeewa, Sebastian C Tume, William J Dreyer, Ricardo Pignatelli, David Horne, Henri Justino, Athar M Qureshi
Cardiogenic shock remains a significant cause of mortality and morbidity in children with heart failure. Percutaneous mechanical circulatory support may be an additional tool to augment left heart support and decompression in addition to conventional therapies. This report aims to review the clinical and hemodynamic outcomes of the Impella® device at a pediatric center. A retrospective review of all implants between October 2014 and November 2016 was conducted. Clinical outcomes, device implant techniques, complications, and hemodynamic data were collected...
April 6, 2017: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
https://www.readbyqxmd.com/read/28376015/comparing-dopamine-and-epinephrine-in-pediatric-fluid-refractory-hypotensive-septic-shock
#12
Julie Leviter, Dale W Steele, Mark R Zonfrillo
No abstract text is available yet for this article.
April 2017: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/28368882/ranolazine-therapy-in-drug-refractory-ventricular-arrhythmias
#13
Antonio Curnis, Francesca Salghetti, Manuel Cerini, Enrico Vizzardi, Edoardo Sciatti, Francesca Vassanelli, Clara Villa, Lorenza Inama, Abdallah Raweh, Daniele Giacopelli, Luca Bontempi
AIMS: Ranolazine is an antiischemic and antianginal agent, but experimental and preclinical data provided evidence of additional antiarrhythmic properties. The aim of this study was to evaluate the safety and efficacy of ranolazine in reducing episodes of ventricular arrhythmias in patients with recurrent antiarrhythmic drug-refractory ventricular arrhythmias or with chronic angina. METHODS: Seventeen implantable cardioverter defibrillator (ICD) recipients, who had experienced a worsening of their ventricular arrhythmia burden, and 12 ICD recipients with angina were enrolled...
March 31, 2017: Journal of Cardiovascular Medicine
https://www.readbyqxmd.com/read/28363618/extracorporeal-cpr-and-intra-aortic-balloon-pumping-in-tachycardia-induced-cardiomyopathy-complicating-cardiac-arrest
#14
Jun Wan Lee, Hong Joon Ahn, Youn Ho Yoo, Jin Woong Lee, Seung Whan Kim, Si Wan Choi
Although tachycardia-induced cardiomyopathy (TIC) due to atrial fibrillation occurs frequently, it is under-recognized in clinical settings. TIC has a wide range of clinical manifestations, from asymptomatic tachycardia to cardiomyopathy leading to end stage heart failure. We present a case of a 48year-old-woman who presented as cardiogenic shock, and rapidly progressed to cardiac arrest from recently diagnosed but undertreated atrial fibrillation, resulting TIC in the emergency department (ED). She was rescued by extracorporeal cardiopulmonary resuscitation (E-CPR) for refractory cardiac arrest in the ED, and received concomitant intra-aortic balloon counterpulsation (IABP) support for severe left ventricular failure...
March 22, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28355687/-clinical-analysis-of-pelvic-abscess-with-endometriosis
#15
Y T Liu, H H Shi, X Yu, S Wang, Q B Fan, H Y Liu
Objective: To investigate the clinical features, diagnosis and treatments of pelvic abscess with endometriosis. Methods: A retrospective analysis was performed on 129 cases of pelvic abscess in Peking Union Medical College Hospital from January 2000 to January 2016. Among them, 34 women with endometriosis were divided into the study group and the others were in the control group. The clinical characteristics, therapeutic regimens and outcomes were compared. Results: (1) General conditions: there were no statistic differences between the two groups in age, WBC, serum CA(125), intrauterine device in use, pelvic inflammatory disease history; while incidence rates of dysmenorrhea (65%, 22/34) and infertility (21%, 7/34) in the study group were higher than those in the control group (all P<0...
March 25, 2017: Zhonghua Fu Chan Ke za Zhi
https://www.readbyqxmd.com/read/28348102/acute-peritoneal-dialysis-in-patients-with-acute-kidney-injury
#16
Seong Cho, Sung-Rok Kim, Yu-Ji Lee
♦ Background: The purpose of this study was to evaluate the efficacy, complications, and mortality rate associated with acute peritoneal dialysis (PD) in patients with acute kidney injury (AKI). ♦ Methods: A total of 75 patients who were treated at Samsung Changwon Hospital between February 2005 and March 2016 were included in the study sample. The outcomes included in-hospital survival, renal recovery, metabolic and fluid control rates, and technical success rates. ♦ Results: Refractory heart failure was the most frequent cause of acute PD (49...
March 27, 2017: Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis
https://www.readbyqxmd.com/read/28343448/hemoadsorption-by-cytosorb-in-septic-patients-a-case-series
#17
Klaus Kogelmann, Dominik Jarczak, Morten Scheller, Matthias Drüner
BACKGROUND: Septic shock, defined as life-threatening organ dysfunction caused by a dysregulated host response to infection, is a highly lethal condition that causes substantial morbidity and mortality among critically ill patients. One of the hallmarks of sepsis is the excessive release of cytokines and other inflammatory mediators causing refractory hypotension, tissue damage, metabolic acidosis and ultimately multiple organ failure. In this context, cytokine reduction by hemoadsorption represents a new concept for blood purification, developed to attenuate the overwhelming systemic levels of pro-inflammatory and anti-inflammatory mediators released in the early phase of sepsis...
March 27, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/28332876/evaluation-and-management-of-adrenal-insufficiency-in-critically-ill-patientsdisease-state-review
#18
Amir H Hamrahian, Maria Fleseriu
Definition of normal adrenal function in critically ill patients remains controversial, despite a large body of literature. Furthermore, evaluation of adrenal function in these patients is complex. A decrease in cortisol breakdown rather than an increase in cortisol production has been suggested as the main contributor to elevated cortisol levels in critically ill patients. The concept of relative adrenal insufficiency has multiple pathophysiological flaws and is not supported by current evidence. Patients with septic shock who are pressor-dependent or refractory to fluid resuscitation should receive a short course of hydrocortisone regardless of their serum cortisol levels or their response to a Cosyntropin stimulation test (CST)...
March 23, 2017: Endocrine Practice
https://www.readbyqxmd.com/read/28320996/feasibility-of-extracorporeal-shock-wave-myocardial-revascularization-therapy-for-post-acute-myocardial-infarction-patients-and-refractory-angina-pectoris-patients
#19
Masahiro Myojo, Jiro Ando, Masae Uehara, Masao Daimon, Masafumi Watanabe, Issei Komuro
Extracorporeal shockwave myocardial revascularization (ESMR) is one of the new treatment options for refractory angina pectoris (RAP), and some studies have indicated its effectiveness. A single-arm prospective trial to assess the feasibility of ESMR using Cardiospec for patients with post-acute myocardial infarction (AMI) and RAP was designed and performed. The patients were treated with 9 sessions of ESMR to the ischemic areas for 9 weeks. The feasibility measures included echocardiography; cardiac magnetic resonance imaging; troponin T, creatine kinase-MB (CK-MB), and brain natriuretic peptide testing; and a Seattle Angina Questionnaire (SAQ) survey...
April 6, 2017: International Heart Journal
https://www.readbyqxmd.com/read/28319524/combined-therapy-of-ventricular-assist-device-and-extracorporeal-membrane-oxygenation-for-profound-acute-cardiopulmonary-failure
#20
Kevin Fujita, Koji Takeda, Boyganzi Li, Christine Mauro, Paul Kurlansky, Sowmyashree Sreekanth, Jiho Han, Lauren K Truby, Reshad Garan, Veli Topkara, Melana Yuzefpolskaya, Paolo Colombo, Yoshifumi Naka, Hiroo Takayama
Short-term ventricular assist devices (ST-VAD) have been effective in treating patients with refractory cardiogenic shock. Membrane oxygenators (MO) can be added to the circuit for concomitant profound refractory hypoxia. This study reports outcomes of combined therapy in this portion of patients. This is a retrospective review of 166 patients who received an ST-biventricular assist device (BiVAD) or right ventricular assist device (RVAD) for cardiogenic shock between November 2007 and November 2014. An MO was added to the RVAD for profound hypoxia refractory to maximized ventilation...
March 17, 2017: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
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