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https://www.readbyqxmd.com/read/29652752/practice-change-from-intermittent-medication-boluses-to-bolusing-from-a-continuous-infusion-in-pediatric-critical-care-a-quality-improvement-project
#1
Jessica L Hochstetler, A Jill Thompson, Natalie M Ball, Melissa C Evans, Shaun C Frame, A Lauren Haney, Amelia K Little, Jaime L O'Donnell, Bryna M Rickett, Elizabeth H Mack
OBJECTIVES: To determine whether implementing a guideline to bolus medications from continuous infusions in PICUs affects nursing satisfaction, patient safety, central line entries, medication utilization, or cost. DESIGN: This is a pre- and postimplementation quality improvement study. SETTING: An 11-bed ICU and 14-bed cardiac ICU in a university-affiliated children's hospital. PATIENTS: Patients less than 18 years old admitted to the PICU or pediatric cardiac ICU receiving a continuous infusion of dexmedetomidine, midazolam, fentanyl, morphine, vecuronium, or cisatracurium from May 2015 to May 2016, excluding November 2015 (washout period), were eligible for inclusion...
April 12, 2018: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/29650397/assessment-of-five-different-probes-for-lung-ultrasound-in-critically-ill-patients-a-pilot-study
#2
Xavier Bobbia, Margaux Chabannon, Thierry Chevallier, Jean Emmanuel de La Coussaye, Jean Yves Lefrant, Sarah Pujol, Pierre-Géraud Claret, Laurent Zieleskiewicz, Claire Roger, Laurent Muller
INTRODUCTION: The present study was aimed at comparing the diagnosis concordance of five echo probes of lung ultrasound (LUS) with CT scans in intensive care and emergency patients with acute respiratory failure. MATERIALS: This prospective, observational, pilot study involved 10 acute patients in whom a thoracic CT scan was performed. An expert performed an LUS reference exam using five different probes: three probes with a high-quality conventional echo machine (cardiac phased-array probe, abdominal convex probe, linear probe) and two probes (cardiac and linear) with a pocket ultrasound device (PUD)...
April 3, 2018: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29644869/pearls-and-pitfalls-in-imaging-of-blunt-traumatic-thoracic-aortic-injury-a-pictorial-review
#3
Neeral R Patel, Elizabeth Dick, Nicola Batrick, Michael Jenkins, Elika Kashef
Blunt thoracic aortic injury (TAI) occurs most frequently as a sequelae of high impact deceleration such as high velocity road traffic accidents and falls from height. The burden of mortality and morbidity is high, however advances in pre-hospital care, diagnostic imaging and endovascular therapies have improved outcomes in this group of patients. Emergent treatment depends on accurate, early diagnosis by the radiologist. It is therefore of paramount importance that radiologists are familiar with both the direct (intimal flap, pseudoaneurysm, aortic contour irregularity and contrast extravasation) and indirect (periaortic haematoma) imaging findings of TAI...
April 12, 2018: British Journal of Radiology
https://www.readbyqxmd.com/read/29629982/end-of-life-care-in-icus-in-east-asia-a-comparison-among-china-korea-and-japan
#4
So Young Park, Jason Phua, Masaji Nishimura, Yiyun Deng, Yan Kang, Keiichi Tada, Younsuck Koh
OBJECTIVES: To compare physicians' perceptions and practice of end-of-life care in the ICU in three East Asian countries cultures similarly rooted in Confucianism. DESIGN: A structured and scenario-based survey of physicians who managed ICU patients from May 2012 to December 2012. SETTING: ICUs in China, Korea, and Japan. SUBJECTS: Specialists who are either intensivists or nonintensivist primary attending physicians in charge of patients (195 in China, 186 in Korea, 224 in Japan)...
April 6, 2018: Critical Care Medicine
https://www.readbyqxmd.com/read/29629925/reducing-maternal-mortality-and-severe-maternal-morbidity-the-role-of-critical-care
#5
Amir A Shamshirsaz, Gary A Dildy
Throughout most of the 20th century, the risk of maternal mortality in high resource countries decreased dramatically; however, this trend recently has stalled in the United States and appears to have reversed. Equally alarming is that for every reported maternal death, there are numerous severe maternal morbidities or near misses. Shifting maternal demographics (eg, obesity, advanced maternal age, multifetal pregnancies), with attendant significant medical comorbidities (eg, hypertension, diabetes, cardiac disease) and the increase in cesarean deliveries significantly contribute to increased maternal morbidity and mortality...
April 6, 2018: Clinical Obstetrics and Gynecology
https://www.readbyqxmd.com/read/29628170/preoperative-assessment-of-the-risk-of-postoperative-death-in-patients-with-oral-squamous-cell-carcinoma-a-consideration-beyond-age-sex-and-stage-of-cancer
#6
A K Bartella, A-K Sander, M Kamal, J Steegmann, A Kloss-Brandstätter, J Teichmann, F Hölzle, B Lethaus
Despite improvements in the management of patients in critical care, about 3% patients who have an operation with curative intent for oral squamous cell carcinoma (SCC) do not survive their stay in hospital. Our aim was to assess the risk factors for postoperative death that were independent of the stage of the cancer, or the age and sex of the patients. We screened 4760 consecutive inpatients at a maxillofacial tertiary care centre from 2011 to 2016, and 34 of them had died within the first three months after operation...
April 5, 2018: British Journal of Oral & Maxillofacial Surgery
https://www.readbyqxmd.com/read/29627355/contemporary-reviews-in-critical-care-medicine-atrial-fibrillation-in-the-intensive-care-unit
#7
REVIEW
Nicholas A Bosch, Jonathan Cimini, Allan J Walkey
Atrial fibrillation (AF) is the most common arrhythmia encountered in the intensive care unit. Pre-existing AF is highly prevalent among older patients with chronic conditions who are at risk for critical illness, while new-onset AF can be triggered by accelerated atrial remodeling and arrhythmogenic triggers encountered during critical illness. The acute loss of atrial systole and onset of rapid ventricular rates that characterize new-onset AF often lead to decreased cardiac output and hemodynamic compromise...
April 5, 2018: Chest
https://www.readbyqxmd.com/read/29627229/the-use-of-cell-cycle-arrest-biomarkers-in-the-early-detection-of-acute-kidney-injury-is-this-the-new-renal-troponin
#8
Luis M Ortega, Michael Hueng
Acute kidney injury (AKI) has a high prevalence in critical care patients. Early detection might prevent patients from developing chronic kidney disease and requirement for renal replacement therapy. If we compare AKI with acute coronary syndrome, in which an increase in cardiac troponin may trigger early diagnosis and therapeutic intervention, we could extrapolate a similar technique in patients with early AKI without changes in urinary frequency or serum creatinine. The objective is to identify biomarker-positive, creatinine-negative patients that would allow therapeutic interventions to be initiated before finding changes in serum creatinine, preventing kidney damage...
April 4, 2018: Nefrología: Publicación Oficial de la Sociedad Española Nefrologia
https://www.readbyqxmd.com/read/29625787/tropical-diseases-in-the-icu-a-syndromic-approach-to-diagnosis-and-treatment
#9
Dilip R Karnad, Guy A Richards, Gisele Sampaio Silva, Pravin Amin
Tropical infections form 20-30% of ICU admissions in tropical countries. Diarrheal diseases, malaria, dengue, typhoid, rickettsial diseases and leptospirosis are common causes of critical illness. Overlapping clinical features makes initial diagnosis challenging. A systematic approach involving (1) history of specific continent or country of travel, (2) exposure to specific environments (forests or farms, water sports, consumption of exotic foods), (3) incubation period, and (4) pattern of organ involvement and subtle differences in manifestations help in differential diagnosis and choice of initial empiric therapy...
March 27, 2018: Journal of Critical Care
https://www.readbyqxmd.com/read/29623383/-mechanical-circulatory-support-in-terminal-heart-failure
#10
REVIEW
M Derwall, A Moza, A Brücken
BACKGROUND: After exhaustion of all conservative measures in the treatment of acute and chronic heart insufficiency, there is the possibility to temporarily or permanently support or replace the pump performance of the heart by mechanical circulatory support (MCS) systems. OBJECTIVE: Presentation of the most important cardiac support systems for intensive care medicine, their indications and important risk factors. MATERIAL AND METHODS: Critical review of device manufacturer's specifications, current research and expert opinions...
April 5, 2018: Der Anaesthesist
https://www.readbyqxmd.com/read/29622180/roles-of-transesophageal-echocardiography-and-cardiac-computed-tomography-for-evaluation-of-left-atrial-thrombus-and-associated-pathology-a-review-and-critical-analysis
#11
REVIEW
Faraz Pathan, Harvey Hecht, Jagat Narula, Thomas H Marwick
Evaluation of the left atrium and left atrial appendage for the presence of thrombus prior to cardioversion and pulmonary vein isolation, and of the entire heart for embolic sources in the setting of cryptogenic stroke, has long been standard medical care. Guidelines have uniformly recommended transesophageal echocardiography (TEE) to accomplish these goals. In recent years, computed tomographic angiography has demonstrated diagnostic accuracy similar to that of TEE for the detection of thrombus. Analysis of the pertinent data and relative merits of the 2 technologies leads to the conclusions that: 1) both modalities have some unique, nonoverlapping capabilities that may dictate their use in specific situations; 2) computed tomographic angiography is a reasonable alternative to TEE when the primary aim is to exclude left atrial and left atrial appendage thrombus and in patients in whom the risks associated with TEE outweigh the benefits; and 3) both options should be discussed with the patient in the setting of shared decision making...
April 2018: JACC. Cardiovascular Imaging
https://www.readbyqxmd.com/read/29621027/cardiac-output-monitoring-how-to-choose-the-optimal-method-for-the-individual-patient
#12
Bernd Saugel, Jean-Louis Vincent
PURPOSE OF REVIEW: To review the different methods available for the assessment of cardiac output (CO) and describe their specific indications in intensive care and perioperative medicine. RECENT FINDINGS: In critically ill patients, persistent circulatory shock after initial resuscitation is an indication for the assessment of CO to monitor the response to fluids and vasoactive agents. In patients with circulatory shock associated with right ventricular dysfunction, pulmonary artery hypertension, or acute respiratory distress syndrome, invasive CO monitoring using indicator dilution methods is indicated...
April 4, 2018: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/29619866/enteral-guanfacine-to-treat-severe-anxiety-and-agitation-complicating-critical-care-after-cardiac-surgery
#13
Habib Srour, Komal Pandya, Alex Flannery, Kevin Hatton
This article is the first reported case describing the off-label use of enteral immediate-release guanfacine, a long-acting α-2 adrenergic agonist most commonly used in the treatment of attention-deficit hyperactivity disorder, for sedation in a patient with severe anxiety and agitation limiting mechanical ventilation weaning several days after cardiac surgery. In this case, after several days of unsuccessful attempts to control his agitation and anxiety with conventional therapies, guanfacine therapy was initiated, and the patient was rapidly weaned from all other sedatives and mechanical ventilation shortly thereafter...
April 1, 2018: Seminars in Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/29618079/effects-of-massage-in-reducing-the-pain-and-anxiety-of-the-cardiac-surgery-critically-ill-a-randomized-controlled-trial
#14
Madalina Boitor, Géraldine Martorella, Christine Maheu, Andréa Maria Laizner, Céline Gélinas
Objective: To evaluate the effectiveness of hand massage on the pain and anxiety of the cardiac surgery critically ill. Design: A three-arm randomized controlled trial. Setting: This study was conducted in a medical-surgical intensive care unit in Canada. Subjects: Adult patients who underwent elective cardiac surgery, who were able to speak French/English and to self-report symptoms, without a high risk of postoperative complications were eligible...
March 30, 2018: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
https://www.readbyqxmd.com/read/29617154/n-terminal-pro-brain-natriuretic-peptide-and-high-sensitivity-troponin-t-exhibit-additive-prognostic-value-for-the-outcome-of-critically-ill-patients
#15
Max Lenz, Konstantin A Krychtiuk, Georg Goliasch, Klaus Distelmaier, Johann Wojta, Gottfried Heinz, Walter S Speidl
BACKGROUND: Patients treated at medical intensive care units suffer from various pathologies and often present with elevated troponin T (TnT) and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels. Both markers may reflect different forms of cardiac involvement in critical illness. Therefore, the aim of our study was to examine the synergistic prognostic potential of NT-proBNP and high-sensitivity TnT (hs)TnT in unselected critically ill patients. METHODS: We included all consecutive patients admitted to our intensive care unit within one year, excluding those suffering from acute myocardial infarction or undergoing cardiac surgery and measured NT-proBNP and TnT plasma levels on the day of admission and 72 hours thereafter...
April 1, 2018: European Heart Journal. Acute Cardiovascular Care
https://www.readbyqxmd.com/read/29615134/improving-outcomes-after-pediatric-cardiac-arrest-the-icu-resuscitation-project-study-protocol-for-a-randomized-controlled-trial
#16
Ron W Reeder, Alan Girling, Heather Wolfe, Richard Holubkov, Robert A Berg, Maryam Y Naim, Kathleen L Meert, Bradley Tilford, Joseph A Carcillo, Melinda Hamilton, Matthew Bochkoris, Mark Hall, Tensing Maa, Andrew R Yates, Anil Sapru, Robert Kelly, Myke Federman, J Michael Dean, Patrick S McQuillen, Deborah Franzon, Murray M Pollack, Ashley Siems, John Diddle, David L Wessel, Peter M Mourani, Carleen Zebuhr, Robert Bishop, Stuart Friess, Candice Burns, Shirley Viteri, David A Hehir, R Whitney Coleman, Tammara L Jenkins, Daniel A Notterman, Robert F Tamburro, Robert M Sutton
BACKGROUND: Quality of cardiopulmonary resuscitation (CPR) is associated with survival, but recommended guidelines are often not met, and less than half the children with an in-hospital arrest will survive to discharge. A single-center before-and-after study demonstrated that outcomes may be improved with a novel training program in which all pediatric intensive care unit staff are encouraged to participate in frequent CPR refresher training and regular, structured resuscitation debriefings focused on patient-centric physiology...
April 3, 2018: Trials
https://www.readbyqxmd.com/read/29608503/risk-adjusted-overall-mortality-as-a-quality-measure-in-the-cardiovascular-intensive-care-unit
#17
Michael Goldfarb
Risk-adjusted mortality has been proposed as a quality of care indicator to gauge Cardiovascular Intensive Care Unit (CICU) performance. Mortality is easily measured, readily understandable, and a meaningful outcome for the patient, provider, administrative agencies, and other key stakeholders. Disease-specific risk-adjusted mortality is commonly used in cardiovascular medicine as an indicator of care quality, for external accreditation, and to determine payer reimbursement. However, the evidence base for overall risk-adjusted mortality in the CICU is limited, with most available data coming from the general critical care literature...
March 30, 2018: Cardiology in Review
https://www.readbyqxmd.com/read/29596291/interprofessional-simulations-promote-knowledge-retention-and-enhance-perceptions-of-teamwork-skills-in-a-surgical-trauma-burn-intensive-care-unit-setting
#18
Katie L George, Beth Quatrara
BACKGROUND: The current state of health care encompasses highly acute, complex patients, managed with ever-changing technology. The ability to function proficiently in critical care relies on knowledge, technical skills, and interprofessional teamwork. Integration of these factors can improve patient outcomes. Simulation provides "hands-on" practice and allows for the integration of teamwork into knowledge/skill training. However, simulation can require a significant investment of time, effort, and financial resources...
May 2018: Dimensions of Critical Care Nursing: DCCN
https://www.readbyqxmd.com/read/29596267/a-stewardship-program-to-optimize-the-use-of-inhaled-nitric-oxide-in-pediatric-critical-care
#19
Tanya Di Genova, Christina Sperling, Ashley Gionfriddo, Zelia Da Silva, Leanne Davidson, Jason Macartney, Michael Finelli, Robert P Jankov, Peter C Laussen
PURPOSE: Inhaled nitric oxide (iNO) is a pulmonary vasodilator that is approved for use in term and near-term neonates with hypoxic respiratory failure associated with evidence of pulmonary hypertension. However, it is commonly used in infants and children to treat a variety of other cardiopulmonary diseases associated with pulmonary hypertension and hypoxic respiratory failure. In critically ill children, iNO therapy may be continued for a prolonged period, and this increases the risk for adverse consequences including toxicity and unnecessary costs...
April 2018: Quality Management in Health Care
https://www.readbyqxmd.com/read/29595699/severe-bilateral-isolated-coronary-ostial-lesions-as-a-rare-manifestation-of-radiation-induced-cardiac-disease-a-case-report
#20
Metesh Nalin Acharya, Mohammad El-Diasty, Bastian Schmack, Alexander Weymann, Ashham Mansur, Aron-Frederik Popov
RATIONALE: With advances in contemporary radiotherapy techniques, and as cancer survival improves, severe isolated coronary ostial disease may develop many years following mediastinal radiotherapy, even in the absence of classical cardiovascular risk factors. PATIENT CONCERNS: We describe the case of a 73-year-old woman with previous chest radiotherapy for breast cancer who underwent coronary artery bypass graft surgery for severe bilateral coronary ostial lesions...
March 2018: Medicine (Baltimore)
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