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Respiratory,critical care,

Chiara Robba, Andrea Ortu, Federico Bilotta, Alessandra Lombardo, Mypinder S Sekhon, Fabio Gallo, Basil F Matta
BACKGROUND: Veno-venous extra-corporeal membrane oxygenation (vv-ECMO) is an established salvage therapy for severe respiratory failure, and may provide an alternative form of treatment for trauma-induced acute respiratory distress syndrome (ARDS) when conventional treatments have failed. The need for systemic anticoagulation is a relative contraindication in patients with bleeding risks, especially in multi traumatic injury. METHODS: We describe a case series of four trauma patients with ARDS who were managed with ECMO admitted to the Neuro Critical Care Unit (NCCU) at Addenbrooke's Hospital, Cambridge (UK), from January 2000 to January 2016...
October 25, 2016: Journal of Trauma and Acute Care Surgery
Ryan M J Ivie, Emily A Vail, Hannah Wunsch, Monica P Goldklang, Robert Fowler, Vivek K Moitra
OBJECTIVE: We conducted this study to determine the generalizability of information gained from randomized controlled trials in critically ill patients by assessing the incidence of eligibility for each trial. DESIGN: Prospective, observational cohort study. We identified the 15 most highly cited randomized controlled trials in critical care medicine published between 1998 and 2008. We examined the inclusion and exclusion criteria for each randomized controlled trial and then assessed the eligibility of each patient admitted to a study ICU for each randomized controlled trial and calculated rates of potential trial eligibility in the cohort...
October 24, 2016: Critical Care Medicine
Hasan M Al-Dorzi, Abdulaziz S Aldawood, Raymond Khan, Salim Baharoon, John D Alchin, Amal A Matroud, Sameera M Al Johany, Hanan H Balkhy, Yaseen M Arabi
BACKGROUND: Middle East respiratory syndrome coronavirus (MERS-CoV) has caused several hospital outbreaks, including a major outbreak at King Abdulaziz Medical City, a 940-bed tertiary-care hospital in Riyadh, Saudi Arabia (August-September 2015). To learn from our experience, we described the critical care response to the outbreak. METHODS: This observational study was conducted at the Intensive Care Department which covered 5 ICUs with 60 single-bedded rooms. We described qualitatively and, as applicable, quantitatively the response of intensive care services to the outbreak...
December 2016: Annals of Intensive Care
Shannon Doocy, Emily Lyles, Baptiste Hanquart, Michael Woodman
BACKGROUND: Given the large burden of non-communicable diseases (NCDs) among both Syrian refugees and the host communities within which they are settled, humanitarian actors and the government of Lebanon face immense challenges in addressing health needs. This study assessed health status, unmet needs, and utilization of health services among Syrian refugees and host communities in Lebanon. METHODS: A cross-sectional survey of Syrian refugees and host communities in Lebanon was conducted using a two-stage cluster survey design with probability proportional to size sampling...
2016: Conflict and Health
Ankana Daga, Fredrick Dapaah-Siakwan, Sharina Rajbhandari, Cassandra Arevalo, Agnes Salvador
BACKGROUND: Acute kidney injury (AKI) is common in critically ill premature infants. There is a lack of consensus on the diagnostic definition of AKI in very low birth weight (VLBW) infants. The primary aim of this study was to determine the incidence and risk factors for AKI in VLBW infants using the AKI network (AKIN) and pRIFLE (pediatric Risk, Injury, Failure, Loss, End-Stage) criteria and to evaluate whether Clinical Risk Index for Babies (CRIB II) score is a predictor of AKI. The secondary objective was to determine the extent of agreement between the AKIN and pRIFLE criteria in the diagnosis of AKI in VLBW infants...
September 28, 2016: Pediatrics and Neonatology
Pauline K Park, Jeremy W Cannon, Wen Ye, Lorne H Blackbourne, John B Holcomb, William Beninati, Lena M Napolitano
BACKGROUND: The overall incidence and mortality of acute respiratory distress syndrome (ARDS) in civilian trauma settings have decreased over the past four decades; however, the epidemiology and impact of ARDS on modern combat casualty care are unknown. We sought to determine the incidence, risk factors, resource utilization, and mortality associated with ARDS in current combat casualty care. METHODS: This was a retrospective review of mechanically ventilated US combat casualties within the Department of Defense Trauma Registry (formerly the Joint Theater Trauma Registry) during Operation Iraqi Freedom/Enduring Freedom (October 2001 to August 2008) for ARDS development, resource utilization, and mortality...
November 2016: Journal of Trauma and Acute Care Surgery
Joseph M Blankush, Robbie Freeman, Joy McIlvaine, Trung Tran, Stephen Nassani, I Michael Leitman
Modified Early Warning Scores (MEWS) provide real-time vital sign (VS) trending and reduce ICU admissions in post-operative patients. These early warning calculations classically incorporate oxygen saturation, heart rate, respiratory rate, systolic blood pressure, and temperature but have not previously included end-tidal CO2 (EtCO2), more recently identified as an independent predictor of critical illness. These systems may be subject to failure when physiologic data is incorrectly measured, leading to false alarms and increased workload...
October 20, 2016: Journal of Clinical Monitoring and Computing
Viviane B L Torres, Juliana Vassalo, Ulysses V A Silva, Pedro Caruso, André P Torelly, Eliezer Silva, José M M Teles, Marcos Knibel, Ederlon Rezende, José J S Netto, Claudio Piras, Luciano C P Azevedo, Fernando A Bozza, Nelson Spector, Jorge I F Salluh, Marcio Soares
INTRODUCTION: Cancer patients are at risk for severe complications related to the underlying malignancy or its treatment and, therefore, usually require admission to intensive care units (ICU). Here, we evaluated the clinical characteristics and outcomes in this subgroup of patients. MATERIALS AND METHODS: Secondary analysis of two prospective cohorts of cancer patients admitted to ICUs. We used multivariable logistic regression to identify variables associated with hospital mortality...
2016: PloS One
Gregory A Schmidt, Timothy D Girard, John P Kress, Peter E Morris, Daniel R Ouellette, Waleed Alhazzani, Suzanne M Burns, Scott K Epstein, Andres Esteban, Eddy Fan, Miquel Ferrer, Gilles L Fraser, Michelle Gong, Catherine Hough, Sangeeta Mehta, Rahul Nanchal, Sheena Patel, Amy J Pawlik, Curtis N Sessler, Thomas Strøm, William Schweickert, Kevin C Wilson, Jonathon D Truwit
BACKGROUND: This clinical practice guideline addresses six questions related to liberation from mechanical ventilation in critically ill adults. It is the result of a collaborative effort between the American Thoracic Society (ATS) and American College of Chest Physicians (CHEST). METHODS: A multi-disciplinary panel posed six clinical questions in a Population, Intervention, Comparator and Outcomes (PICO) format. A comprehensive literature search and evidence synthesis was performed for each question, which included appraising the certainty in the evidence (i...
October 20, 2016: American Journal of Respiratory and Critical Care Medicine
O Karam, F Gebistorf, J Wetterslev, A Afshari
Acute respiratory distress syndrome is associated with high mortality and morbidity. Inhaled nitric oxide has been used to improve oxygenation but its role remains controversial. Our primary objective in this systematic review was to examine the effects of inhaled nitric oxide administration on mortality in adults and children with acute respiratory distress syndrome. We included all randomised, controlled trials, irrespective of date of publication, blinding status, outcomes reported or language. Our primary outcome measure was all-cause mortality...
October 20, 2016: Anaesthesia
N C Knox, K A Weedmark, J Conly, A W Ensminger, F S Hosein, S J Drews
An outbreak of Legionnaires' disease occurred in an inner city district in Calgary, Canada. This outbreak spanned a 3-week period in November-December 2012, and a total of eight cases were identified. Four of these cases were critically ill requiring intensive care admission but there was no associated mortality. All cases tested positive for Legionella pneumophila serogroup 1 (LP1) by urinary antigen testing. Five of the eight patients were culture positive for LP1 from respiratory specimens. These isolates were further identified as Knoxville monoclonal subtype and sequence subtype ST222...
October 20, 2016: Epidemiology and Infection
Deng-Wei Chou, Shu-Ling Wu, Kuo-Mou Chung, Shu-Chen Han, Bruno Man-Hon Cheung
OBJECTIVES: Septic pulmonary embolism is an uncommon but life-threatening disorder. However, data on patients with septic pulmonary embolism who require critical care have not been well reported. This study elucidated the clinicoradiological spectrum, causative pathogens and outcomes of septic pulmonary embolism in patients requiring critical care. METHODS: The electronic medical records of 20 patients with septic pulmonary embolism who required intensive care unit admission between January 2005 and December 2013 were reviewed...
October 1, 2016: Clinics
Flavia Petrini, Ida Di Giacinto, Rita Cataldo, Clelia Esposito, Vittorio Pavoni, Paolo Donato, Antonella Trolio, Guido Merli, Massimiliano Sorbello, Paolo Pelosi
Proper management of obese patients requires a team vision and appropriate behaviors by all health care providers in hospital. Specialist competencies are fundamental, as are specific clinical pathways and good clinical practices designed to deal with patients whose body mass index is ≥30 kg/m2. Standards of care for bariatric and non-bariatric surgery and for the critical care management of this population exist but are not well defined nor clearly followed in every hospital. Thus every anesthesiologist is likely to deal with this challenging population...
October 19, 2016: Minerva Anestesiologica
James E Archer, Adrian C Gardner, Helen P Roper, Ashish A Chikermane, Andrew J Tatman
This study summaries the current management of scoliosis in patients with Duchenne Muscular Dystrophy. A literature review of Medline was performed and the collected articles critically appraised. This literature is discussed to give an overview of the current management of scoliosis within Duchenne Muscular Dystrophy. Importantly, improvements in respiratory care, the use of steroids and improving surgical techniques have allowed patients to maintain quality of life and improved life expectancy in this patient group...
September 2016: J Spine Surg
Yarelis Alvarado Reyes, Alexandra Perez, Gloria Rodriguez-Vega
OBJECTIVE: Vitamin D deficiency has been associated with increased risk and adverse outcomes in many clinical settings including cardiovascular disease, stroke, and critically ill patients. Therefore we aimed to determine whether vitamin D deficiency had any effect in aneurysmal subarachnoid hemorrhage (aSAH) clinical outcomes. METHODS: A retrospective record review was conducted in a tertiary community hospital in Puerto Rico. Adult patients admitted to the neurosurgical intensive care unit (NICU) with a diagnosis of aSAH from January 2013 to July 2014, who had a 25-hydroxyvitamin-D level drawn, were included...
October 15, 2016: World Neurosurgery
Michael J Murray, Heidi DeBlock, Brian Erstad, Anthony Gray, Judi Jacobi, Che Jordan, William McGee, Claire McManus, Maureen Meade, Sean Nix, Andrew Patterson, M Karen Sands, Richard Pino, Ann Tescher, Richard Arbour, Bram Rochwerg, Catherine Friederich Murray, Sangeeta Mehta
OBJECTIVE: To update the 2002 version of "Clinical practice guidelines for sustained neuromuscular blockade in the adult critically ill patient." DESIGN: A Task Force comprising 17 members of the Society of Critical Medicine with particular expertise in the use of neuromuscular-blocking agents; a Grading of Recommendations Assessment, Development, and Evaluation expert; and a medical writer met via teleconference and three face-to-face meetings and communicated via e-mail to examine the evidence and develop these practice guidelines...
November 2016: Critical Care Medicine
Angel Paternina-Caicedo, Jezid Miranda, Ghada Bourjeily, Andrew Levinson, Carmelo Dueñas, Camilo Bello Muñoz, José A Rojas-Suarez
BACKGROUND: Every day, about 830 women die worldwide from preventable causes related to pregnancy and childbirth. Obstetric early-warning scores have been proposed as a potential tool to reduce maternal morbidity and mortality, based upon the identification of predetermined abnormal values in the vital signs or laboratory parameters, to generate a rapid and effective medical response. Several early-warning scores have been developed for obstetrical patients, but the majority are the result of a clinical consensus rather than statistical analyses of clinical outcome measures (i...
October 14, 2016: American Journal of Obstetrics and Gynecology
Folafoluwa O Odetola, Renee R Anspach, Yong Y Han, Sarah J Clark
PURPOSE: To investigate the decision making underlying transfer of children with respiratory failure from level II to level I pediatric intensive care unit care. METHODS: Interviews with 19 eligible level II pediatric intensive care unit physicians about a hypothetical scenario of a 2-year-old girl in respiratory failure: RESULTS: At baseline, indices critical to management were as follows: OI (53%), partial pressure of oxygen in arterial blood (Pao2)/Fio2 (32%), and inflation pressure (16%)...
October 4, 2016: Journal of Critical Care
Alladi Mohan, G Sivaram Naik, J Harikrishna, D Prabath Kumar, M H Rao, Kvs Sarma, K K Guntupalli
BACKGROUND & OBJECTIVES: Ingestion of Cleistanthus collinus causes hypokalemia and cardiac arrhythmias leading to mortality in most cases. We undertook this retrospective study to evaluate the clinical presentation and predictors of outcome in critically ill patients admitted with C. collinus poisoning. METHODS: The case records of 56 patients admitted to the medical intensive care unit (MICU) of a tertiary care teaching hospital in south India (2000-2014) with C...
June 2016: Indian Journal of Medical Research
Surendra K Sharma, Anunay Gupta, Ashutosh Biswas, Abhishek Sharma, Atul Malhotra, K T Prasad, Sreenivas Vishnubhatla, Sajal Ajmani, Hridesh Mishra, Manish Soneja, Shobha Broor
BACKGROUND & OBJECTIVES: Acute respiratory distress syndrome (ARDS) is a common disorder in critically ill patients and is associated with high mortality. There is a paucity of literature on this condition from developing countries. This prospective observational study was designed to find out the aetiology, outcomes and predictors of mortality in ARDS. METHODS: Sixty four consecutive patients who satisfied American-European Consensus Conference (AECC) definition of ARDS from medical Intensive Care Unit (ICU) of a tertiary care centre in New Delhi, India, were enrolled in the study...
June 2016: Indian Journal of Medical Research
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