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https://www.readbyqxmd.com/read/28822398/variability-in-perioperative-fasting-practices-negatively-impacts-nutritional-support-of-critically-ill-intubated-patients
#1
Molly J Douglas, David Ciraulo
The aim of the study was to quantify nutritional losses related to pre- and postoperative fasts in critically ill intubated patients and to explore whether shorter fasts are safe and appropriate in this population. A retrospective review of mechanically ventilated adults undergoing surgery more than 24 hours after admission to a Level I trauma center over 15 months was done, which yielded 132 procedures and 81 unique patients. Ninety per cent of preoperative periods and 43 per cent of postoperative periods were affected by nonmedical barriers to feeding...
August 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/28822384/clinical-characteristics-of-trauma-patients-requiring-hydrocortisone-treatment-for-refractory-hypotension
#2
Gina Kim, Jeffrey Young
Corticosteroids play an important role in responding to physiologic stress in the human body. However, its application in critical care remains heavily debated. The purpose of this study was to identify patient characteristics associated with receiving stress-dose steroids during the intensive care unit stay after traumatic injury and its effect on in-hospital mortality. Patients admitted to the University of Virginia trauma center between January 1, 2011, and December 31, 2015, were identified using our Trauma Registry...
August 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/28821973/bilirubin-in-the-early-course-of-venovenous-extracorporeal-membrane-oxygenation-support-for-refractory-ards
#3
Chiara Lazzeri, Manuela Bonizzoli, Giovanni Cianchi, Stefano Batacchi, Marco Chiostri, Giorgio Enzo Fulceri, Laura Tadini Buoninsegni, Adriano Peris
Bilirubin is known as a marker of hepatic dysfunction and is incorporated in scoring algorithms to assess prognosis in critically ill patients. No data are so far available on the prognostic role of hepatic dysfunction in patients with severe ARDS on venovenous extracorporeal membrane oxygenation (VV-ECMO) support. In 112 consecutive patients with severe ARDS treated with VV-ECMO, we aimed at assessing whether increased bilirubin during the first 72 h could affect early death. Increased serum bilirubin (≥1...
August 18, 2017: Journal of Artificial Organs: the Official Journal of the Japanese Society for Artificial Organs
https://www.readbyqxmd.com/read/28821524/the-association-between-intensive-care-unit-acquired-hypernatraemia-and-mortality-in-critically-ill-patients-with-cerebrovascular-diseases-a-single-centre-cohort-study-in-japan
#4
Takahiro Imaizumi, Masahiro Nakatochi, Yoshiro Fujita, Rie Nomura, Kenshi Watanabe, Michitaka Maekawa, Taishi Yamakawa, Takayuki Katsuno, Shoichi Maruyama
OBJECTIVES: Hypernatraemia is one of the major electrolyte disorders associated with mortality among critically ill patients in intensive care units (ICUs). It is unclear whether this applies to patients with cerebrovascular diseases in whom high sodium concentrations may be allowed in order to prevent cerebral oedema. This study aimed to examine the association between ICU-acquired hypernatraemia and the prognosis of patients with cerebrovascular diseases. DESIGN: A retrospective cohort study...
August 18, 2017: BMJ Open
https://www.readbyqxmd.com/read/28820799/regional-anesthesia-and-analgesia-after-surgery-in-icu
#5
Mathieu Capdevila, Séverin Ramin, Xavier Capdevila
PURPOSE OF REVIEW: The aim is to demonstrate that ICU physicians should play a pivotal role in developing regional anesthesia techniques that are underused in critically ill patients despite the proven facts in perioperative and long-term pain, organ dysfunction, and postsurgery patient health-related quality of life improvement. RECENT FINDINGS: Regional anesthesia and/or analgesia strategies in ICU reduce the surgical and trauma-stress response in surgical patients as well as complications incidence...
August 17, 2017: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/28820753/prevention-of-exposure-keratopathy-in-critically-ill-patients-a-single-center-randomized-pilot-trial-comparing-ocular-lubrication-with-bandage-contact-lenses-and-punctal-plugs
#6
Itai Bendavid, Inbal Avisar, Irena Serov Volach, Amir Sternfeld, Idit Dan Brazis, Lewaa Umar, Yiftach Yassur, Pierre Singer, Jonathan David Cohen
OBJECTIVES: To compare the effectiveness of bandage contact lenses and punctal plugs with ocular lubricants in preventing corneal damage in mechanically ventilated and sedated critically ill patients. DESIGN: Single-center, prospective, randomized, pilot study. SETTING: Sixteen-bed, general ICU at a tertiary academic medical center. PATIENTS: Adults admitted to the ICU and anticipated to require mechanical ventilation and continuous sedation for greater than or equal to 4 days...
August 17, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28820609/cardio-pulmonary-interactions-physiologic-basis-and-clinical-applications
#7
Michael R Pinsky
The hemodynamic effects of ventilation can be grouped into three concepts: 1) spontaneous ventilation is exercise; 2) changes in lung volume alter autonomic tone, pulmonary vascular resistance, and can compress the heart in the cardiac fossa; 3) spontaneous inspiratory efforts decrease intrathoracic pressure (ITP) increasing venous return and impeding left ventricular (LV) ejection; whereas positive pressure ventilation decreases venous return and unloads LV ejection. Spontaneous inspiratory efforts may induce acute LV failure and cardiogenic pulmonary edema...
August 18, 2017: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/28820608/skeletal-muscle-ultrasound-in-critical-care-a-tool-in-need-of-translation
#8
Marina Mourtzakis, Selina Parry, Bronwen Connolly, Zudin Puthucheary
With the emerging interest in documenting and understanding muscle atrophy and function in critically ill patients and survivors, ultrasonography has transformational potential in measuring muscle quantity and quality. Here, we discuss the importance of quantifying skeletal muscle in the ICU setting. We also identify the merits and limitations of various modalities that are capable of accurately and precisely measuring muscularity. Ultrasound is emerging as a potentially powerful tool for skeletal muscle quantification; however, there are key challenges that need to be addressed in future work to ensure useful interpretation and comparability of results across diverse observational and interventional studies...
August 18, 2017: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/28820454/personal-hygiene-practices-among-urban-homeless-persons-in-boston-ma
#9
Jessica H Leibler, Daniel D Nguyen, Casey León, Jessie M Gaeta, Debora Perez
Persons experiencing homelessness in the United States experience significant barriers to self-care and personal hygiene, including limited access to clean showers, laundry and hand washing facilities. While the obstacles to personal hygiene associated with homelessness may increase risk of infectious disease, hygiene-related behaviors among people experiencing homelessness has received limited attention. We conducted a cross-sectional study of individuals experiencing homelessness in Boston, MA (n = 194) to identify hygiene-related self-care practices and risk factors for reduced hygiene in this population...
August 18, 2017: International Journal of Environmental Research and Public Health
https://www.readbyqxmd.com/read/28820232/recognizing-and-managing-adrenal-disorders-in-the-emergency-department
#10
Amy Cutright, Stephen Ducey, Claudia L. Barthold
Primary and secondary adrenal insufficiency are underrecognized conditions among emergency department patients, affecting an estimated 10% to 20% of critically ill patients. The signs and symptoms of cortisol deficit can be nonspecific and wide-ranging, and identification and swift treatment with stress-dosing of hydrocortisone is vital to avoid life-threatening adrenal crisis. Laboratory evaluation focuses on identification of electrolyte abnormalities typical of adrenal insufficiency, and while additional testing may depend on the type and severity of symptoms, it should not delay corticosteroid replacement...
September 2017: Emergency Medicine Practice
https://www.readbyqxmd.com/read/28820041/a-report-of-7-year-experience-on-pediatric-continuous-renal-replacement-therapy
#11
Ayse Filiz Yetimakman, Selman Kesici, Murat Tanyildiz, Umut Selda Bayrakci, Benan Bayrakci
BACKGROUND: Continuous renal replacement therapies (CRRTs) either as continuous venovenous hemofiltration (CVVH) or hemodiafiltration (CVVHD) are used frequently in critically ill children. Many clinical variables and technical issues are known to affect the result. The factors that could be modified to increase the survival of renal replacement are sought. As a contribution, we present the data on 104 patients who underwent CRRT within a 7-year period. MATERIALS AND METHOD: A total of 104 patients admitted between 2009 and 2016 were included in the study...
January 1, 2017: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/28820040/effect-of-interhospital-icu-relocation-on-patient-physiology-and-clinical-outcomes
#12
David R Janz, Yasin A Khan, Jennifer L Mooney, Matthew W Semler, Todd W Rice, Jessica L Johnson, Bennett P deBoisblanc
Relocation of large numbers of critically ill patients between hospitals is sometimes necessary and the risks associated with relocation may be high. In the setting of adherence to an interhospital intensive care unit (ICU) relocation protocol, we aimed to determine whether the interhospital relocation of all ICU patients in a single day is associated with changes in vital signs, device removal, and worse clinical outcomes. We conducted a prospective, observational, cohort study of all critically ill adults admitted to a tertiary medical center's ICUs on the day of a planned hospital relocation and exposed to interhospital ICU relocation compared with unexposed critically ill adults...
January 1, 2017: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/28820036/efficacy-and-safety-of-the-early-addition-of-vasopressin-to-norepinephrine-in-septic-shock
#13
Drayton A Hammond, Julia Cullen, Jacob T Painter, Kelsey McCain, Oktawia A Clem, Amy L Brotherton, Divyan Chopra, Nikhil Meena
BACKGROUND: Delays in achievement of target mean arterial pressure (MAP) have been associated with increased mortality in patients with septic shock. Vasopressin may be added to norepinephrine to raise MAP or decrease norepinephrine dosage. The purpose of this study was to determine whether early initiation of vasopressin to norepinephrine resulted in a reduced time to target MAP compared to norepinephrine monotherapy. METHODS: This retrospective cohort study compared early addition of vasopressin within 4 hours of septic shock onset to norepinephrine versus initial norepinephrine monotherapy in medically, critically ill patients with septic shock admitted from May 2014 to October 2015...
January 1, 2017: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/28819399/outcomes-of-cancer-therapy-administered-to-treatment-na%C3%A3-ve-lung-cancer-patients-in-the-intensive-care-unit
#14
Yen-Fu Chen, Jou-Wei Lin, Chao-Chi Ho, Ching-Yao Yang, Chia-Hao Chang, Tao-Min Huang, Chung-Yu Chen, Kuan-Yu Chen, Jin-Yuan Shih, Chong-Jen Yu
Objectives: Therapy outcomes for newly diagnosed, critically ill lung cancer patients have seldom been evaluated. This study evaluated therapy outcomes for treatment-naïve lung cancer patients in the intensive care unit (ICU). Materials and Methods: Patients were excluded if they had previously received lung cancer treatment, such as systemic chemotherapy, targeted therapy, radiotherapy, or surgical lung resection before ICU admission. The therapeutic strategies for the treatment-naïve patients were determined while they were in the ICU...
2017: Journal of Cancer
https://www.readbyqxmd.com/read/28818344/the-2016-espen-arvid-wretlind-lecture-the-gut-in-stress
#15
REVIEW
Stephen A McClave, Cynthia C Lowen, Robert G Martindale
The gut has a major influence on the course of the human stress response in critical illness for several reasons; the quantity of its immune tissue, the extent of interface with the external environment, the expanse of the microbiome, and its access to the systemic circulation. In critical illness, it is not uncommon to lose mucosal barrier function, which exposes the host to the downside effects of luminal contents and epithelial cell regulation. In that setting, the microbiome is converted to a pathobiome, upregulation of metabolic and immune responses occurs, and homeostatic defense systems are compromised...
July 29, 2017: Clinical Nutrition: Official Journal of the European Society of Parenteral and Enteral Nutrition
https://www.readbyqxmd.com/read/28818213/the-natural-history-and-outcomes-of-line-associated-upper-extremity-deep-venous-thromboses-in-critically-ill-patients
#16
Joshua Underhill, Matthew A Sherman, Ryan Howard, Anthony Hage, Andrea Obi, Lena Napolitano, Dawn M Coleman
OBJECTIVE: Anticoagulation remains the standard of care for line-associated upper extremity deep venous thrombosis (UEDVT). This treatment carries the risk of hemorrhagic complications, possibly more so in surgical patients. Considering the low-risk profile of UEDVT-which is associated with fewer, less severe pulmonary emboli than lower extremity deep venous thrombosis-current UEDVT treatment guidelines may be overly aggressive. The goal of this study was to review outcomes of line-associated UEDVT in critically ill patients and to define the efficacy of current treatment protocols in pulmonary embolism (PE) prevention while avoiding hemorrhagic complications...
September 2017: Journal of Vascular Surgery. Venous and Lymphatic Disorders
https://www.readbyqxmd.com/read/28818075/perspectives-of-basic-wheelchair-users-on-improving-their-access-to-wheelchair-services-in-kenya-and-philippines-a-qualitative-study
#17
Emma Williams, Elizabeth Hurwitz, Immaculate Obaga, Brenda Onguti, Adovich Rivera, Tyrone Reden L Sy, R Lee Kirby, Jamie Noon, Deepti Tanuku, Anthony Gichangi, Eva Bazant
BACKGROUND: The United Nations has called for countries to improve access to mobility devices when needed. The World Health Organization has published guidelines on the provision of manual wheelchairs in less-resourced settings. Yet little is known about the extent to which appropriate wheelchairs are available and provided according to international guidelines. This study's purpose was to describe wheelchair users' experiences receiving services and acquiring wheelchair skills in urban and peri-urban areas of Kenya and the Philippines...
August 17, 2017: BMC International Health and Human Rights
https://www.readbyqxmd.com/read/28817693/clinical-signs-profound-acidemia-hypoglycemia-and-hypernatremia-are-predictive-of-mortality-in-1-400-critically-ill-neonatal-calves-with-diarrhea
#18
Florian M Trefz, Ingrid Lorenz, Annette Lorch, Peter D Constable
Profound acidemia impairs cellular and organ function and consequently should be associated with an increased risk of mortality in critically ill humans and animals. Neonatal diarrhea in calves can result in potentially serious metabolic derangements including profound acidemia due to strong ion (metabolic) acidosis, hyper-D-lactatemia, hyper-L-lactatemia, azotemia, hypoglycemia, hyperkalemia and hyponatremia. The aim of this retrospective study was to assess the prognostic relevance of clinical and laboratory findings in 1,400 critically ill neonatal calves with diarrhea admitted to a veterinary teaching hospital...
2017: PloS One
https://www.readbyqxmd.com/read/28817422/lung-ultrasound-in-the-critically-ill-the-blue-protocol
#19
Davinder Ramsingh
No abstract text is available yet for this article.
August 11, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28816919/enteral-nutrition-practices-in-critically-ill-children-requiring-noninvasive-positive-pressure-ventilation
#20
Matthew K Leroue, Ryan J Good, Heather E Skillman, Angela S Czaja
OBJECTIVES: Evaluate the practice of providing enteral nutrition in critically ill children requiring noninvasive positive pressure ventilation. DESIGN: Retrospective cohort study. SETTING: PICU within a quaternary care children's hospital. PATIENTS: PICU patients older than 30 days requiring noninvasive positive pressure ventilation for greater than or equal to 24 hours from August 2014 to June 2015. Invasive mechanical ventilation prior to noninvasive positive pressure ventilation and inability to receive enteral nutrition at baseline were additional exclusionary criteria...
August 12, 2017: Pediatric Critical Care Medicine
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