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Cardiac critical care

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https://www.readbyqxmd.com/read/29039621/supporting-emergency-medical-care-teams-with-an-integrated-status-display-providing-real-time-access-to-medical-best-practices-workflow-tracking-and-patient-data
#1
PoLiang Wu, Min-Young Nam, Jeonghwan Choi, Alex Kirlik, Lui Sha, Richard B Berlin
The work of a hospital's medical staff is safety critical and often occurs under severe time constraints. To provide timely and effective cognitive support to medical teams working in such contexts, guidelines in the form of best practice workflows for healthcare have been developed by medical organizations. However, the high cognitive load imposed in such stressful and rapidly changing environments poses significant challenges to the medical staff or team in adhering to these workflows. In collaboration with physicians and nurses from Carle Foundation Hospital, we first studied and modeled medical team's individual responsibilities and interactions in cardiac arrest resuscitation and decomposed their overall task into a set of distinct cognitive tasks that must be specifically supported to achieve successful human-centered system design...
October 17, 2017: Journal of Medical Systems
https://www.readbyqxmd.com/read/29038971/the-implementation-of-targeted-temperature-management-an-evidence-based-guideline-from-the-neurocritical-care-society
#2
Lori Kennedy Madden, Michelle Hill, Teresa L May, Theresa Human, Mary McKenna Guanci, Judith Jacobi, Melissa V Moreda, Neeraj Badjatia
BACKGROUND: Targeted temperature management (TTM) is often used in neurocritical care to minimize secondary neurologic injury and improve outcomes. TTM encompasses therapeutic hypothermia, controlled normothermia, and treatment of fever. TTM is best supported by evidence from neonatal hypoxic-ischemic encephalopathy and out-of-hospital cardiac arrest, although it has also been explored in ischemic stroke, traumatic brain injury, and intracranial hemorrhage patients. Critical care clinicians using TTM must select appropriate cooling techniques, provide a reasonable rate of cooling, manage shivering, and ensure adequate patient monitoring among other challenges...
October 16, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/29033272/graduating-surgical-residents-lack-competence-in-critical-care-ultrasound
#3
Renuka Tripu, Margaret H Lauerman, Daniel Haase, Syeda Fatima, Jacob Glaser, Cassandra Cardarelli, Thomas M Scalea, Sarah Murthi
OBJECTIVE: Ultrasound provides accessible imaging for bedside diagnostics and procedural guidance, but may lead to misdiagnosis in untrained users. The main objective of this study was to determine observed and self-perceived competence with critical care ultrasound in graduated general surgery residents. DESIGN: The design of this study was a retrospective review. Ultrasound training program records were reviewed for number of prior ultrasound examinations performed, self-perceived competence, observed competence on faculty examinations, and intended future use of individual critical care ultrasound examinations...
October 13, 2017: Journal of Surgical Education
https://www.readbyqxmd.com/read/29033047/effect-of-hemodialysis-on-levels-of-high-sensitivity-cardiac-troponin-t
#4
Michael Chen, Howard Gerson, Shaun Eintracht, Sharon J Nessim, Elizabeth MacNamara
Cardiac troponin (cTn) is essential for the diagnosis of an acute coronary syndrome (ACS). However, in end-stage renal disease (ESRD) baseline cTn levels are often elevated, and it is unknown whether the hemodialysis (HD) procedure affects cTn levels. This leaves clinicians unsure of how to interpret cTn in HD patients with cardiac ischemia. We therefore sought to determine if plasma levels of high-sensitivity cardiac troponin T (hs-cTnT) vary during or after HD treatment. We prospectively enrolled 10 chronic HD patients who were admitted to our institution...
September 4, 2017: American Journal of Cardiology
https://www.readbyqxmd.com/read/29033012/timeliness-of-care-and-lung-cancer-tumor-stage-progression-how-long-can-we-wait
#5
Amelia W Maiga, Stephen A Deppen, Rhonda Pinkerman, Carol Callaway-Lane, Pierre P Massion, Robert S Dittus, Eric S Lambright, Jonathan C Nesbitt, David Baker, Eric L Grogan
BACKGROUND: Timely care of lung cancer is presumed critical, yet clear evidence of stage progression with delays in care is lacking. We investigated the reasons for delays in treatment and the impact these delays have on tumor-stage progression. METHODS: We queried our retrospective database of 265 veterans who underwent cancer resection from 2005 to 2015. We extracted time intervals between nodule identification, diagnosis, and surgical resection; changes in nodule radiographic size over time; final pathologic staging; and reasons for delays in care...
October 12, 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/29030027/comparison-of-right-ventricular-measurements-by-perioperative-transesophageal-echocardiography-as-a-predictor-of-hemodynamic-instability-following-cardiac-surgery
#6
Pei-Chi Ting, An-Hsun Chou, Chia-Chih Liao, Victor Chien-Chia Wu, Feng-Chun Tsai, Jaw-Ji Chu, Min-Wen Yang, Shi-Chuan Chang
BACKGROUND: The relationship between perioperative right ventricular (RV) performance and hemodynamic instability after cardiac surgery seemed less portrayed. Therefore, we sought to elucidate this relationship and compare the accuracy of different RV systolic indices in predicting outcome of cardiac surgery. METHODS: This study enrolled consecutive patients referred for cardiac surgeries. Exclusion criteria were non-sinus rhythm or contraindications to transesophageal echocardiography (TEE)...
October 10, 2017: Journal of the Chinese Medical Association: JCMA
https://www.readbyqxmd.com/read/29029712/advanced-cardiopulmonary-support-for-pulmonary-embolism
#7
Oren Friedman, James M Horowitz, Danny Ramzy
Management of high-risk pulmonary embolism (PE) requires an understanding of the pathophysiology of PE, options for rapid clot reduction, critical care interventions, and advanced cardiopulmonary support. PE can lead to rapid respiratory and hemodynamic collapse via a complex sequence of events leading to acute right ventricular failure. Importantly, reduction in pulmonary vascular resistance must be accomplished either by systemic thrombolytics, catheter directed thrombolytics, endovascular clot extraction, or surgical embolectomy...
September 2017: Techniques in Vascular and Interventional Radiology
https://www.readbyqxmd.com/read/29029356/total-hip-arthroplasty-dislocation-after-cardioversion-a-case-report
#8
Ahmed Siddiqi, Carl T Talmo, James V Bono
New onset postoperative atrial fibrillation (AF) is the most common perioperative arrhythmia in the elderly. The incidence after total joint arthroplasty is much lower than other non-cardiac surgeries. Since postoperative atrial fibrillation can cause increased length of hospital stay, mortality, and healthcare costs, it is critical to focus on prevention and prompt management. New onset atrial fibrillation is treated with rhythm control for patients who demonstrate hemodynamic instability or refractory to rate control measures...
October 12, 2017: Surgical Technology International
https://www.readbyqxmd.com/read/29025961/phosphate-replacement-in-the-critically-ill-potential-implications-for-military-patients
#9
A E Coulden, L J Rickard, N Crooks, N Arora
BACKGROUND: Severe hypophosphataemia in the intensive care unit (ICU) setting has been widely associated with adverse clinical outcomes across multiple organ systems, as well as increased mortality. However, the clinical significance of mild or moderate hypophosphataemia remains uncertain. This can lead to heterogeneous phosphate replacement protocols across different institutions. The aim of this study was to assess the significance of mild and moderate hypophosphataemia on clinical outcomes across several organ systems...
October 12, 2017: Journal of the Royal Army Medical Corps
https://www.readbyqxmd.com/read/29023307/interrater-agreement-of-eeg-interpretation-after-pediatric-cardiac-arrest-using-standardized-critical-care-eeg-terminology
#10
Nicholas S Abend, Shavonne L Massey, Mark Fitzgerald, France Fung, Natalie J Atkin, Rui Xiao, Alexis A Topjian
PURPOSE: We evaluated interrater agreement of EEG interpretation in a cohort of critically ill children resuscitated after cardiac arrest using standardized EEG terminology. METHODS: Four pediatric electroencephalographers scored 10-minute EEG segments from 72 consecutive children obtained 24 hours after return of circulation using the American Clinical Neurophysiology Society's (ACNS) Standardized Critical Care EEG terminology. The percent of perfect agreement and the kappa coefficient were calculated for each of the standardized EEG variables and a predetermined composite EEG background category...
October 10, 2017: Journal of Clinical Neurophysiology: Official Publication of the American Electroencephalographic Society
https://www.readbyqxmd.com/read/29023259/personal-and-professional-characteristics-of-u-s-dual-boarded-critical-care-cardiologists-in-2015
#11
Daniel M Blumenthal, Bassem Mikhael, Patrick R Lawler, Robert W Yeh, Joshua P Metlay, David M Dudzinski
OBJECTIVES: Evaluate the characteristics of U.S. physicians who are board certified in cardiology and critical care medicine ("dual-boarded cardiologists"). DESIGN: Retrospective cross-sectional study using a comprehensive database of licensed U.S. physicians linked to Medicare claims. SETTING: The United States. SUBJECTS: Dual-boarded cardiologists. MEASUREMENTS AND MAIN RESULTS: We used a comprehensive physician database to identify all physicians who were board certified in cardiology and critical care medicine before July 2015...
October 11, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/29017649/-usefulness-of-procalcitonin-for-the-diagnosis-of-infection-in-cardiac-surgical-patients
#12
Hao Wang, Na Cui, Fang Niu, Hongying Xu, Yun Long, Dawei Liu
OBJECTIVE: To determine the value of procalcitonin (PCT) as an early marker of postoperative infection after cardiac surgery with cardiopulmonary bypass (CPB). METHODS: A retrospective study was conducted. Patients with systemic inflammatory response syndrome (SIRS) after cardiac surgery with CPB admitted to intensive care unit (ICU) of Peking Union Medical College Hospital from November 2014 to January 2017 were enrolled. The cardiac surgery types and intraoperative conditions, the treatments in ICU, postoperative 28-day mortality and hospital mortality of the patients; the levels of plasma PCT measured at ICU admission, postoperative 1, 3, and 5 days were collected...
October 2017: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
https://www.readbyqxmd.com/read/28993038/capnography-in-the-emergency-department-a-review-of-uses-waveforms-and-limitations
#13
Brit Long, Alex Koyfman, Michael A Vivirito
BACKGROUND: Capnography has many uses in the emergency department (ED) and critical care setting, most commonly cardiac arrest and procedural sedation. OBJECTIVE OF THE REVIEW: This review evaluates several indications concerning capnography beyond cardiac arrest and procedural sedation in the ED, as well as limitations and specific waveforms. DISCUSSION: Capnography includes the noninvasive measurement of CO2, providing information on ventilation, perfusion, and metabolism in intubated and spontaneously breathing patients...
October 6, 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28991109/patient-blood-management-in-pediatric-cardiac-surgery-a-review
#14
Jill M Cholette, David Faraoni, Susan M Goobie, Victor Ferraris, Nabil Hassan
Efforts to reduce blood product transfusions and adopt blood conservation strategies for infants and children undergoing cardiac surgical procedures are ongoing. Children typically receive red blood cell and coagulant blood products perioperatively for many reasons, including developmental alterations of their hemostatic system, and hemodilution and hypothermia with cardiopulmonary bypass that incites inflammation and coagulopathy and requires systemic anticoagulation. The complexity of their surgical procedures, complex cardiopulmonary interactions, and risk for inadequate oxygen delivery and postoperative bleeding further contribute to blood product utilization in this vulnerable population...
October 5, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28988172/haemodynamic-response-to-crystalloids-or-colloids-in-shock-an-exploratory-subgroup-analysis-of-a-randomised-controlled-trial
#15
Nicholas Heming, Souheil Elatrous, Samir Jaber, Anne Sylvie Dumenil, Joël Cousson, Xavier Forceville, Antoine Kimmoun, Jean Louis Trouillet, Jérôme Fichet, Nadia Anguel, Michael Darmon, Claude Martin, Sylvie Chevret, Djillali Annane
OBJECTIVE: To compare the haemodynamic effect of crystalloids and colloids during acute severe hypovolaemic shock. DESIGN: Exploratory subgroup analysis of a multicentre randomised controlled trial (Colloids Versus Crystalloids for the Resuscitation of the Critically Ill, CRISTAL, ClinicalTrials.gov NCT00318942). SETTING: CRISTAL was conducted in intensive care units in Europe, North Africa and Canada. PARTICIPANTS: Current analysis included all patients who had a pulmonary artery catheter in place at randomisation...
October 6, 2017: BMJ Open
https://www.readbyqxmd.com/read/28987857/intracranial-hemorrhage-in-patients-with-durable-mechanical-circulatory-support-devices-institutional-review-and-proposed-treatment-algorithm
#16
Wyatt L Ramey, Robyn L Basken, Christina M Walter, Zain Khalpey, G Michael Lemole, Travis M Dumont
OBJECTIVE: Spontaneous intracranial hemorrhage (ICH) is frequently managed in neurosurgery. Patients with durable mechanical circulatory support devices, including total artificial hearts (TAHs) and left ventricular assist devices (LVADs) are often encountered in the setting of ICH. While durable mechanical circulatory support devices have improved survival and quality of life for patients with advanced heart failure, ICH is one of the most feared complications following LVAD and TAH implantation...
October 4, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28987397/duration-of-postoperative-mechanical-ventilation-as-a-quality-metric-for-pediatric-cardiac-surgical-programs
#17
Michael Gaies, David K Werho, Wenying Zhang, Janet E Donohue, Sarah Tabbutt, Nancy S Ghanayem, Mark A Scheurer, John M Costello, J William Gaynor, Sara K Pasquali, Justin B Dimick, Mousumi Banerjee, Steven M Schwartz
BACKGROUND: Few metrics exist to assess quality of care at pediatric cardiac surgical programs, limiting opportunities for benchmarking and quality improvement. Postoperative duration of mechanical ventilation (POMV) may be an important quality metric because of its association with complications and resource utilization. In this study we modelled case-mix-adjusted POMV duration and explored hospital performance across POMV metrics. METHODS: This study used the Pediatric Cardiac Critical Care Consortium clinical registry to analyze 4,739 hospitalizations from 15 hospitals (October 2013 to August 2015)...
October 4, 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/28985025/multidisciplinary-approach-to-cardiac-and-pulmonary-vascular-disease-risk-assessment-in-liver-transplantation-an-evaluation-of-the-evidence-and-consensus-recommendations
#18
Lisa B VanWagner, Matthew E Harinstein, James R Runo, Christopher Darling, Marina Serper, Shelley Hall, Jon A Kobashigawa, Laura L Hammel
Liver transplant (LT) candidates today are older, have greater medical severity of illness, and have more cardiovascular comorbidities than ever before. In addition, there are specific cardiovascular responses in cirrhosis that can be detrimental to the LT candidate. Cirrhotic cardiomyopathy, a condition characterized by increased cardiac output and a reduced ventricular response to stress, is present in up to 30% of patients with cirrhosis thus challenging perioperative management. Current noninvasive tests that assess for subclinical coronary and myocardial disease have low sensitivity, and altered hemodynamics during the LT surgery can unmask latent cardiovascular disease either intraoperatively or in the immediate postoperative period...
October 6, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28984797/validation-of-radial-artery-based-uncalibrated-pulse-contour-method-pulsioflex-in-critically-ill-patients-a-observational-study
#19
Jörn Grensemann, Jerome M Defosse, Meike Willms, Uwe Schiller, Frank Wappler, Samir G Sakka
BACKGROUND: Because of their simplicity, uncalibrated pulse contour (UPC) methods have been introduced into clinical practice in critical care but are often validated with a femoral arterial waveform. OBJECTIVE: We aimed to test the accuracy of cardiac index (CI) measurements and trending ability from a radial artery with one UPC. DESIGN: An observational study. SETTING: Tertiary care mixed-surgical ICU. Data were obtained from April 2015 to July 2016...
November 2017: European Journal of Anaesthesiology
https://www.readbyqxmd.com/read/28979515/comparing-cardiac-output-monitors-and-defining-agreement-a-systematic-review-and-meta-analysis
#20
Iain R Crossingham, Daniel R Nethercott, Malachy O Columb
BACKGROUND: Measuring cardiac output is common in critical care and perioperative medicine. Different monitoring systems are often judged against others in comparative studies. There is no agreed standard or definition on which to base the conclusions of such studies. OBJECTIVES: To review comparative studies of cardiac output monitors using an agreement:tolerability index (ATI) as a measure of monitor precision. To compare the ATI of a monitor with the conclusions of authors regarding agreement and clinical utility...
November 2016: J Intensive Care Soc
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