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Cardiac critical care

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https://www.readbyqxmd.com/read/29916835/the-modern-cardiovascular-care-unit-the-cardiologist-managing-multiorgan-dysfunction
#1
Thomas Bochaton, Eric Bonnefoy-Cudraz, Nadia Aissaoui
PURPOSE OF REVIEW: Despite many advances in the management of critically ill patients, cardiogenic shock remains a challenge because it is associated with high mortality. Even if there is no universally accepted definition of cardiogenic shock, end-perfusion organ dysfunction is an obligatory and major criterion of its definition.Organ dysfunction is an indicator that cardiogenic shock is already at an advanced stage and is undergoing a rapid self-aggravating evolution. The aim of the review is to highlight the importance to diagnose and to manage the organ dysfunction occurring in the cardiogenic shock patients by providing the best literature published this year...
June 16, 2018: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/29914554/prehospital-point-of-care-emergency-ultrasound-a-cohort-study
#2
Maximilian Scharonow, Christian Weilbach
BACKGROUND: In the prehospital situation, the diagnostic armamentarium available to the rescue physician is limited. Emergency ultrasound has proven to be a useful diagnostic tool, providing crucial information for the management of critically ill and injured patients. The proportion of performed ultrasound scans in all patients attended to by the rescue service team, the quality of the findings and the ultrasound-related changes in management approach and patient transport were evaluated...
June 18, 2018: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/29912937/comparison-of-three-non-invasive-hemodynamic-monitoring-methods-in-critically-ill-children
#3
Chanapai Chaiyakulsil, Marut Chantra, Poomiporn Katanyuwong, Anant Khositseth, Nattachai Anantasit
INTRODUCTION: Hemodynamic parameters measurements were widely conducted using pulmonary artery catheter (PAC) with thermodilution as a reference standard. Due to its technical difficulties in children, transthoracic echocardiography (TTE) has been widely employed instead. Nonetheless, TTE requires expertise and is time-consuming. Noninvasive cardiac output monitoring such as ultrasonic cardiac output monitor (USCOM) and electrical velocimetry (EV) can be performed rapidly with less expertise requirement...
2018: PloS One
https://www.readbyqxmd.com/read/29912069/the-impact-of-critical-care-nursing-certification-on-pediatric-patient-outcomes
#4
Patricia A Hickey, Kimberlee Gauvreau, Courtney Porter, Jean A Connor
OBJECTIVES: To examine the relationship of nursing and unit characteristics including Critical Care Registered Nurse certification on patient complications for children undergoing congenital heart surgery in free-standing children's hospitals in the United States. DESIGN: A cross-sectional descriptive survey of nursing and organizational characteristics was sent electronically. SETTING: Free-standing children's hospitals in the United States...
June 14, 2018: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/29907274/a-targeted-management-approach-to-cardiogenic-shock
#5
REVIEW
Mithun Chakravarthy, Masaki Tsukashita, Srinivas Murali
Cardiogenic shock is a clinical syndrome characterized by low cardiac output and sustained tissue hypoperfusion resulting in end-organ dysfunction and death. In-hospital mortality rates range from 50% to 60%. Urgent diagnosis, timely transfer to a tertiary or quaternary medical facility with critical care management capabilities and multidisciplinary shock teams is a must to increase survival. Aggressive, hemodynamically guided medical management with careful monitoring of clinical and hemodynamic parameters with timely use of appropriate mechanical circulatory support devices is often necessary...
July 2018: Critical Care Clinics
https://www.readbyqxmd.com/read/29907211/comparison-of-dexmedetomidine-versus-propofol-on-hemodynamics-in-surgical-critically-ill-patients
#6
Ya-Fei Chang, Anne Chao, Po-Yuan Shih, Yen-Chun Hsu, Chen-Tse Lee, Yu-Wen Tien, Yu-Chang Yeh, Lee-Wei Chen
BACKGROUND: Sedation with dexmedetomidine and propofol may cause hypotension or bradycardia. This study aimed to compare the effects of dexmedetomidine and propofol on hemodynamics and clinical outcomes in surgical intensive care unit (ICU) patients after major abdominal surgery. MATERIALS AND METHODS: Enrolled patients were randomly allocated to the dexmedetomidine or propofol group. Cardiac index was measured using a continuous noninvasive cardiac output monitor on the basis of chest bioreactance...
August 2018: Journal of Surgical Research
https://www.readbyqxmd.com/read/29907209/using-artificial-intelligence-to-predict-prolonged-mechanical-ventilation-and-tracheostomy-placement
#7
Joshua Parreco, Antonio Hidalgo, Jonathan J Parks, Robert Kozol, Rishi Rattan
BACKGROUND: Early identification of critically ill patients who will require prolonged mechanical ventilation (PMV) has proven to be difficult. The purpose of this study was to use machine learning to identify patients at risk for PMV and tracheostomy placement. MATERIALS AND METHODS: The Multiparameter Intelligent Monitoring in Intensive Care III database was queried for all intensive care unit (ICU) stays with mechanical ventilation. PMV was defined as ventilation >7 d...
August 2018: Journal of Surgical Research
https://www.readbyqxmd.com/read/29903693/mechanical-circulatory-support-in-patients-with-cardiogenic-shock-in-intensive-care-units-a-position-paper-of-the-unit%C3%A3-de-soins-intensifs-de-cardiologie-group-of-the-french-society-of-cardiology-endorsed-by-the-groupe-ath%C3%A3-rome-et-cardiologie-interventionnelle
#8
REVIEW
Laurent Bonello, Clement Delmas, Guillaume Schurtz, Guillaume Leurent, Eric Bonnefoy, Nadia Aissaoui, Patrick Henry
Cardiogenic shock (CS) is a major challenge in contemporary cardiology. Despite a better understanding of the pathophysiology of CS, its management has only improved slightly. The prevalence of CS has remained stable over the past decade, but its outcome has seen few improvements, with the 1-month mortality rate still in the range of 40-60%. Inotropes and vasopressors are the first-line therapies for CS, but they are associated with significant hazards, and have well-known deleterious effects. Furthermore, a significant number of patients develop refractory CS with haemodynamic instability, causing critical organ hypoperfusion and/or pulmonary congestion, despite increasing doses of catecholamines...
June 11, 2018: Archives of Cardiovascular Diseases
https://www.readbyqxmd.com/read/29903639/focused-transthoracic-echocardiography-curriculum-for-advanced-practice-providers-assures-good-concordance-with-intensivists-at-echocardiography
#9
Jose L Diaz-Gomez, Ami A Grek, Carla P Venegas-Borsellino, Andreea C Chirila, Angela M Builes, Robert A Ratzlaff
OBJECTIVE: To describe a focused transthoracic echocardiography (FoTE) curriculum for advanced practice providers (APPs) for echocardiography-driven diagnosis of shock in critically ill patients. METHODS: Twelve APPs in 4 intensive care units at an academic medical center received didactic sessions on FoTE, including 1-on-1 proctorship with a registered cardiac sonographer. For a period of 6 months the trainees performed individual studies, then they performed FoTE examinations on critically ill patients; their diagnoses were compared with those of experienced intensivists for the same patients...
June 11, 2018: Heart & Lung: the Journal of Critical Care
https://www.readbyqxmd.com/read/29900874/dabigatran-in-patients-with-myocardial-injury-after-non-cardiac-surgery-manage-an-international-randomised-placebo-controlled-trial
#10
P J Devereaux, Emmanuelle Duceppe, Gordon Guyatt, Vikas Tandon, Reitze Rodseth, Bruce M Biccard, Denis Xavier, Wojciech Szczeklik, Christian S Meyhoff, Jessica Vincent, Maria Grazia Franzosi, Sadeesh K Srinathan, Jason Erb, Patrick Magloire, John Neary, Mangala Rao, Prashant V Rahate, Navneet K Chaudhry, Bongani Mayosi, Miriam de Nadal, Pilar Paniagua Iglesias, Otavio Berwanger, Juan Carlos Villar, Fernando Botto, John W Eikelboom, Daniel I Sessler, Clive Kearon, Shirley Pettit, Mukul Sharma, Stuart J Connolly, Shrikant I Bangdiwala, Purnima Rao-Melacini, Andreas Hoeft, Salim Yusuf
BACKGROUND: Myocardial injury after non-cardiac surgery (MINS) increases the risk of cardiovascular events and deaths, which anticoagulation therapy could prevent. Dabigatran prevents perioperative venous thromboembolism, but whether this drug can prevent a broader range of vascular complications in patients with MINS is unknown. The MANAGE trial assessed the potential of dabigatran to prevent major vascular complications among such patients. METHODS: In this international, randomised, placebo-controlled trial, we recruited patients from 84 hospitals in 19 countries...
June 9, 2018: Lancet
https://www.readbyqxmd.com/read/29892007/familial-hypercholesterolemia-in-very-young-myocardial-infarction
#11
Sha Li, Hui-Wen Zhang, Yuan-Lin Guo, Na-Qiong Wu, Cheng-Gang Zhu, Xi Zhao, Di Sun, Xiong-Yi Gao, Ying Gao, Yan Zhang, Ping Qing, Xiao-Lin Li, Jing Sun, Geng Liu, Qian Dong, Rui-Xia Xu, Chuan-Jue Cui, Jian-Jun Li
Familial hypercholesterolemia (FH) is one of the most common causes of premature myocardial infarction (MI). However, The patterns of FH remained unrecognized in clinical care, especially in very young patients (VYPs, ≤35 years) with MI. The present study enrolled a total of 1,093 VYPs (≤35 years) presenting a first MI. Clinical diagnosis of FH was made using Dutch Lipid Clinic Network criteria. Coronary severity was assessed by Gensini score (GS). Patients were followed for a median of 40-months with cardiac death, stroke, MI, post-discharge revascularization or unstable angina as primary endpoints...
June 11, 2018: Scientific Reports
https://www.readbyqxmd.com/read/29889132/less-or-more-hemodynamic-monitoring-in-critically-ill-patients
#12
Mathieu Jozwiak, Xavier Monnet, Jean-Louis Teboul
PURPOSE OF REVIEW: Hemodynamic investigations are required in patients with shock to identify the type of shock, to select the most appropriate treatments and to assess the patient's response to the selected therapy. We discuss how to select the most appropriate hemodynamic monitoring techniques in patients with shock as well as the future of hemodynamic monitoring. RECENT FINDINGS: Over the last decades, the hemodynamic monitoring techniques have evolved from intermittent toward continuous and real-time measurements and from invasive toward less-invasive approaches...
June 7, 2018: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/29879852/predictors-of-extubation-failure-after-open-chest-cardiac-surgery-based-on-routinely-collected-data-the-importance-of-a-shared-interprofessional-clinical-assessment
#13
Gianfranco Sanson, Massimiliano Sartori, Lorella Dreas, Roberta Ciraolo, Adam Fabiani
BACKGROUND: Extubation failure (ExtF) is associated with prolonged hospital length of stay and mortality in adult cardiac surgery patients postoperatively. In this population, ExtF-related variables such as the arterial partial pressure of oxygen to fraction of inspired oxygen ratio (PaO2 /FiO2 ), rapid shallow breathing index, cough strength, endotracheal secretions and neurological function have been sparsely researched. AIM: To identify variables that are predictive of ExtF and related outcomes...
June 1, 2018: European Journal of Cardiovascular Nursing
https://www.readbyqxmd.com/read/29877876/critical-care-echocardiography-and-outcomes-in-the-critically-ill
#14
Karan Singh, Paul Mayo
PURPOSE OF REVIEW: Critical care echocardiography offers a comprehensive assessment of cardiac anatomy and function performed by the intensivist at point of care. This has resulted in widespread use of critical care echocardiography in ICUs leading to the question if this increased usage has resulted in improved patient outcomes. RECENT FINDINGS: Recent studies have evaluated the role of critical care echocardiography in the ICU with an emphasis on establishing accurate diagnosis and measurement of haemodynamic variables...
June 4, 2018: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/29872632/catheter-directed-thrombolysis-combined-with-ecmo-for-massive-pulmonary-emboli
#15
J Lauren Lindsey, Rajay Jain, Vidula Vachharajani
This case report discusses a previously healthy young male who suffered an in hospital cardiac arrest, found to be secondary to massive pulmonary emboli (PE). This patient was not a candidate for PE dosing of tPA, but continued to have worsening cardiogenic shock and acute hypoxic respiratory failure. The decision was made to initiate venoarterial extracorporeal membrane oxygenation (VA ECMO) in combination with catheter assisted thrombolysis. With time, the sequelae of his disease process changed. Although his cardiogenic shock improved, the hypoxemia worsened, and the patient was transitioned from VA to venovenous (VV) ECMO, while managing further complications due to multiple episodes of cardiac arrest and severe coagulopathy with multiple, acute, life-threatening bleeding events...
2018: Respiratory Medicine Case Reports
https://www.readbyqxmd.com/read/29868973/conservative-versus-liberal-oxygenation-targets-in-critically-ill-children-the-randomised-multiple-centre-pilot-oxy-picu-trial
#16
Mark J Peters, Gareth A L Jones, Daisy Wiley, Jerome Wulff, Padmanabhan Ramnarayan, Samiran Ray, David Inwald, Michael Grocott, Michael Griksaitis, John Pappachan, Lauran O'Neill, Simon Eaton, Paul R Mouncey, David A Harrison, Kathryn M Rowan
BACKGROUND: Oxygen saturation monitoring for children receiving respiratory support is standard worldwide. No randomised clinical trials have compared peripheral oxygen saturation (SpO2 ) targets for critically ill children. The harm of interventions to raise SpO2 to > 94% may exceed their benefits. METHODS: We undertook an open, parallel-group randomised trial of children > 38 weeks completed gestation and < 16 years of age receiving invasive or non-invasive respiratory support and supplemental oxygen who were admitted urgently to one of three paediatric intensive care units...
June 4, 2018: Intensive Care Medicine
https://www.readbyqxmd.com/read/29863644/education-and-training-in-pediatric-cardiac-critical-care
#17
Mary E McBride, Lillian Su, Catherine K Allan
No abstract text is available yet for this article.
June 2018: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/29863638/characteristics-risk-factors-and-outcomes-of-extracorporeal-membrane-oxygenation-use-in-pediatric-cardiac-icus-a-report-from-the-pediatric-cardiac-critical-care-consortium-registry
#18
Marissa A Brunetti, J William Gaynor, Lauren B Retzloff, Jessica L Lehrich, Mousumi Banerjee, Venugopal Amula, David Bailly, Darren Klugman, Josh Koch, Javier Lasa, Sara K Pasquali, Michael Gaies
OBJECTIVES: Cardiopulmonary failure in children with cardiac disease differs from the general pediatric critical care population, yet the epidemiology of extracorporeal membrane oxygenation support in cardiac ICUs has not been described. We aimed to characterize extracorporeal membrane oxygenation utilization and outcomes across surgical and medical patients in pediatric cardiac ICUs. DESIGN: Retrospective analysis of the Pediatric Cardiac Critical Care Consortium registry to describe extracorporeal membrane oxygenation frequency and outcomes...
June 2018: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/29860705/the-present-and-future-of-cardiac-arrest-care-international-experts-reach-out-to-caregivers-and-healthcare-authorities
#19
REVIEW
Jerry P Nolan, Robert A Berg, Clifton W Callaway, Laurie J Morrison, Vinay Nadkarni, Gavin D Perkins, Claudio Sandroni, Markus B Skrifvars, Jasmeet Soar, Kjetil Sunde, Alain Cariou
PURPOSE: The purpose of this review is to describe the epidemiology of out-of-hospital cardiac arrest (OHCA), disparities in organisation and outcome, recent advances in treatment and ongoing controversies. We also outline the standard of care that should be provided by the critical care specialist and propose future directions for cardiac arrest research. METHODS: Narrative review with contributions from international resuscitation experts. RESULTS: Although it is recognised that survival rates from OHCA are increasing there is considerable scope for improvement and many countries have implemented national strategies in an attempt to achieve this goal...
June 2, 2018: Intensive Care Medicine
https://www.readbyqxmd.com/read/29858989/long-term-survival-and-resource-use-in-critically-ill-cardiac-surgery-patients-a-population-based-study
#20
Daniel I McIsaac, Bernard McDonald, Coralie A Wong, Carl van Walraven
PURPOSE: Most cardiac surgery patients recover well; a substantial minority become critically ill after surgery. The epidemiology of critical illness after cardiac surgery is poorly described. We measured the association of prolonged critical illness with long-term survival and resource use after cardiac surgery. METHODS: This was a historical population-based cohort study in Ontario, Canada (2002-2013), of adult cardiac surgery patients. Validated methods were used to measure postoperative intensive care unit (ICU) length of stay (LOS)...
June 1, 2018: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
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