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Cardiac critical care

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https://www.readbyqxmd.com/read/28094679/a-retrospective-analysis-of-a-pediatric-tele-echocardiography-service-to-treat-triage-and-reduce-trans-pacific-transport
#1
Christopher A Rouse, Brandon T Woods, C Becket Mahnke
Introduction Tele-echocardiography can ensure prompt diagnosis and prevent the unnecessary transport of infants without critical congenital heart disease, particularly at isolated locations lacking access to tertiary care medical centers. Methods We retrospectively reviewed all infants who underwent tele-echocardiography at a remote 16-bed level IIIB NICU from June 2005 to March 2014. Tele-echocardiograms were completed by cardiac sonographers in Okinawa, Japan, and transmitted asynchronously for review by pediatric cardiologists in Hawaii...
January 1, 2017: Journal of Telemedicine and Telecare
https://www.readbyqxmd.com/read/28089599/impact-of-oral-chlorhexidine-on-bloodstream-infection-in-critically-ill-patients-systematic-review-and-meta-analysis-of-randomized-controlled-trials
#2
REVIEW
Luciano Silvestri, William I Weir, Dario Gregori, Nia Taylor, Durk F Zandstra, Joris J M van Saene, Hendrick K F van Saene
OBJECTIVES: Oropharyngeal overgrowth of microorganisms in the critically ill is a risk factor for lower respiratory tract infection and subsequent invasion of the bloodstream. Oral chlorhexidine has been used to prevent pneumonia, but its effect on bloodstream infection never has been assessed in meta-analyses. The authors explored the effect of oral chlorhexidine on the incidence of bloodstream infection, the causative microorganism, and on all-cause mortality in critically ill patients...
November 2, 2016: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/28088349/stroke-biomarkers-in-clinical-practice-a-critical-appraisal
#3
REVIEW
Geelyn J L Ng, Amy M L Quek, Christine Cheung, Thiruma V Arumugam, Raymond C S Seet
Biomarkers provide critical mechanistic insights to key biologic processes that occur during cerebral ischemia which, when carefully applied, can improve clinical decision-making in acute stroke management. The translation of a blood-based biomarker in ischemic stroke to clinical practice is challenging, in part, due to the complexity of ischemic stroke pathogenesis and the presence of a blood-brain barrier that restricts the release of brain-specific markers into the circulation. The pathologic and clinical aspects of ischemic stroke are described in this review, where a non-exhaustive list of biomarkers that interrogate different aspects of ischemic stroke such as oxidative damage, inflammation, thrombus formation, cardiac function and brain injury are described...
January 11, 2017: Neurochemistry International
https://www.readbyqxmd.com/read/28074823/pharmacological-update-new-drugs-in-cardiac-practice-a-critical-appraisal
#4
REVIEW
Rohan Magoon, Arindam Choudhury, Vishwas Malik, Ridhima Sharma, Poonam Malhotra Kapoor
Cardiac practice involves the application of a range of pharmacological therapies. An anesthesiologist needs to keep pace with the rampant drug developments in the field of cardiovascular medicine for appropriate management in both perioperative and intensive care set-up, to strengthen his/her role as a perioperative physician in practice. The article reviews the changing trends and the future perspectives in major classes of cardiovascular medicine.
January 2017: Annals of Cardiac Anaesthesia
https://www.readbyqxmd.com/read/28052047/mechanical-ventilatory-modes-and-cardioventilatory-phase-synchronization-in-acute-respiratory-failure-patients
#5
Claudio Enrico Mazzucco, Andrea Marchi, Vlasta Bari, Beatrice De Maria, Stefano Guzzetti, Ferdinando Raimondi, Emanuele Catena, Davide Ottolina, Carla Amadio, Silvio Cravero, Tommaso Fossali, Riccardo Colombo, Alberto Porta
Cardioventilatory phase synchronization was studied in ten critically ill patients admitted in intensive care unit (ICU) for acute respiratory failure under two mechanical ventilatory modes: i) pressure controlled ventilation (PCV); ii) pressure support ventilation (PSV). The two modalities were administered to the same patient in different times in a random order. Cardioventilatory phase interactions were typified by plotting the relative position of a heartbeat, detected from the electrocardiogram and collected in n groups, within m ventilatory cycles as a function of the progressive cardiac beat number via the synchrogram...
January 4, 2017: Physiological Measurement
https://www.readbyqxmd.com/read/28035993/brain-monitoring-in-critically-neurologically-impaired-patients
#6
REVIEW
Salazar Jones, Gary Schwartzbauer, Xiaofeng Jia
Assessment of neurologic injury and the evolution of severe neurologic injury is limited in comatose or critically ill patients that lack a reliable neurologic examination. For common yet severe pathologies such as the comatose state after cardiac arrest, aneurysmal subarachnoid hemorrhage (aSAH), and severe traumatic brain injury (TBI), critical medical decisions are made on the basis of the neurologic injury. Decisions regarding active intensive care management, need for neurosurgical intervention, and withdrawal of care, depend on a reliable, high-quality assessment of the true state of neurologic injury, and have traditionally relied on limited assessments such as intracranial pressure monitoring and electroencephalogram...
December 27, 2016: International Journal of Molecular Sciences
https://www.readbyqxmd.com/read/28034580/canadian-cardiovascular-society-canadian-heart-rhythm-society-2016-implantable-cardioverter-defibrillator-guidelines
#7
Matthew Bennett, Ratika Parkash, Pablo Nery, Mario Sénéchal, Blandine Mondesert, David Birnie, Laurence D Sterns, Claus Rinne, Derek Exner, François Philippon, Debra Campbell, Jafna Cox, Paul Dorian, Vidal Essebag, Andrew Krahn, Jaimie Manlucu, Franck Molin, Michael Slawnych, Mario Talajic
Sudden cardiac death is a major public health issue in Canada. However, despite the overwhelming evidence to support the use of implantable cardioverter defibrillators (ICDs) in the prevention of cardiac death there remains significant variability in implantation rates across Canada. Since the most recent Canadian Cardiovascular Society position statement on ICD use in Canada in 2005, there has been a plethora of new scientific information to assist physicians in their discussions with patients considered for ICD implantation to prevent sudden cardiac death due to ventricular arrhythmias...
October 6, 2016: Canadian Journal of Cardiology
https://www.readbyqxmd.com/read/28034400/using-simulation-to-implement-an-or-cardiac-arrest-crisis-checklist
#8
Darleen Dagey
Crisis checklists are cognitive aids used to coordinate care during critical events. Simulation training is a method to validate process improvement initiatives such as checklist implementation. In response to concerns staff members expressed regarding their comfort level when responding to infrequent occurrences such as cardiac arrest and other OR emergencies, the OR Comprehensive Unit-based Safety Program team at our facility decided to institute the use of crisis checklists in the OR during critical events...
January 2017: AORN Journal
https://www.readbyqxmd.com/read/28033081/clinical-databases-and-registries-in-congenital-and-pediatric-cardiac-surgery-cardiology-critical-care-and-anesthesiology-worldwide
#9
David F Vener, Michael Gaies, Jeffrey P Jacobs, Sara K Pasquali
The growth in large-scale data management capabilities and the successful care of patients with congenital heart defects have coincidentally paralleled each other for the last three decades, and participation in multicenter congenital heart disease databases and registries is now a fundamental component of cardiac care. This manuscript attempts for the first time to consolidate in one location all of the relevant databases worldwide, including target populations, specialties, Web sites, and participation information...
January 2017: World Journal for Pediatric & Congenital Heart Surgery
https://www.readbyqxmd.com/read/28032050/discrepancies-between-dental-and-medical-records-of-cardiac-patients-in-alhada-armed-forces-hospital-taif-saudi-arabia
#10
Sana M Al Hibshi, Rajaa M Al-Raddadi, Mansour K Assery
AIMS AND OBJECTIVES: This study aims to estimate the prevalence of medical information discrepancies between dental and medical records of cardiac patients at AlHada Armed Forces Hospital in Taif and to identify the factors contributing to these information discrepancies. MATERIALS AND METHODS: The study applied a descriptive retrospective medical and dental records review of a stratified proportional sample of 289 cardiac patients, which was extracted from 1154 cardiac patients who visited both the cardiology and dental clinics at the AlHada Armed Forces Hospital between 2007 and June 2012...
November 2016: Journal of International Society of Preventive & Community Dentistry
https://www.readbyqxmd.com/read/28024558/detection-prevention-and-management-of-delirium-in-the-critically-ill-cardiac-patient-and-patients-who-undergo-cardiac-procedures
#11
REVIEW
Rakesh C Arora, George Djaiani, James L Rudolph
Delirium is an acute change in cognitive functioning, characterized by inattention and associated with alterations in awareness and fluctuation in arousal, disorganized thinking, or altered level that preferentially affects older adult patients. In the acutely ill cardiac patient, the incidence of delirium has been reported as high as 73%, depending on the type and sensitivity of delirium assessment. Cardiac patients with delirium experience higher rates of in-hospital and longer-term mortality and are at risk for progressive cognitive impairment, loss of functional independence, and increased hospitalization costs...
January 2017: Canadian Journal of Cardiology
https://www.readbyqxmd.com/read/28024552/the-swan-ganz-catheter-remains-a-critically-important-component-of-monitoring-in-cardiovascular-critical-care
#12
Matthew Lee, Gerard F Curley, Mary Mustard, C David Mazer
Few inventions in modern medicine have generated as passionate and extended debate as the pulmonary artery catheter (PAC). Since its introduction in 1970, the PAC remains an indispensable monitor in cardiovascular critical care. Despite attempts to develop less invasive alternatives, the PAC remains unequaled as a single monitoring device capable of measuring physiological derangement in most components of the circulation, in the awake or sedated patient, with real-time feedback on the efficacy of an intervention...
January 2017: Canadian Journal of Cardiology
https://www.readbyqxmd.com/read/28024551/end-of-life-issues-in-cardiac-critical-care-the-option-of-organ-donation
#13
REVIEW
Karim Serri, Pierre Marsolais
Despite important advances in the care of postcardiac arrest patients, severe brain injury remains one of the major causes of death in the cardiac intensive care unit. Neurological prognostication after cardiac arrest has evolved significantly since the introduction of therapeutic hypothermia. It now relies on a multimodal approach and a minimal observation period of 72 hours is usually advocated. However, when brain injury is severe and the prognosis considered dismal, patients become eligible for organ donation...
January 2017: Canadian Journal of Cardiology
https://www.readbyqxmd.com/read/28024550/simulation-as-a-tool-to-ensure-competency-and-quality-of-care-in-the-cardiac-critical-care-unit
#14
REVIEW
Véronique Brunette, Nicolas Thibodeau-Jarry
Cardiac critical care units are high-risk clinical environments. Medical emergencies are frequent and require the intervention of a cohesive, efficient, and well trained interprofessional team. In modern clinical practice there is increased emphasis on safety but also increased lack of acceptance of medical errors and as a consequence, increased litigation. In the past decade, simulation-based learning has arisen as an effective and safe means to learn and practice acute care setting skills. It has been used and studied in different contexts including procedural skills training, crisis resource management and team training, patient and family member communication skills, and health care system quality improvement...
January 2017: Canadian Journal of Cardiology
https://www.readbyqxmd.com/read/28024549/temporary-mechanical-circulatory-support-in-cardiac-critical-care-a-state-of-the-art-review-and-algorithm-for-device-selection
#15
REVIEW
A Dave Nagpal, Rohit K Singal, Rakesh C Arora, Yoan Lamarche
With more than 60 years of continuous development and improvement, a variety of temporary mechanical circulatory support (MCS) devices and implantation strategies exist, each with unique advantages and disadvantages. A thorough understanding of each available device is essential for optimizing patient outcomes in a fiscally responsible manner. In this state of the art review we examine the entire range of commonly available peripheral and centrally cannulated temporary MCS devices, including intra-aortic balloon pumps, the Impella (Abiomed, Danvers, MA) family of microaxial pumps, the TandemHeart (CardiacAssist Inc, Pittsburg, PA) pump and percutaneous cannulas, centrally cannulated centrifugal pumps such as the CentriMag (Thoratec Corp, Pleasanton, CA/St Jude Medical, St Paul, MN/Abbott Laboratories, Abbott Park, IL) and Rotaflow (Maquet Holding BV & Co KG, Rastatt Germany), and extracorporeal membrane oxygenation...
January 2017: Canadian Journal of Cardiology
https://www.readbyqxmd.com/read/28024548/canadian-cardiovascular-society-canadian-cardiovascular-critical-care-society-canadian-association-of-interventional-cardiology-position-statement-on-the-optimal-care-of-the-postarrest-patient
#16
Graham C Wong, Sean van Diepen, Craig Ainsworth, Rakesh C Arora, Jean G Diodati, Mark Liszkowski, Michael Love, Chris Overgaard, Greg Schnell, Jean-Francois Tanguay, George Wells, Michel Le May
Out of hospital cardiac arrest (OHCA) is associated with a low rate of survival to hospital discharge and high rates of neurological morbidity among survivors. Programmatic efforts to institute and integrate OHCA best care practices from the bystander response through to the in-hospital phase have been associated with improved patient outcomes. This Canadian Cardiovascular Society position statement was developed to provide comprehensive yet practical recommendations to guide the in-hospital care of OHCA patients...
January 2017: Canadian Journal of Cardiology
https://www.readbyqxmd.com/read/28024459/post-acute-hospital-healthcare-services-for-people-with-mild-stroke-a-scoping-review
#17
Tenelle Hodson, Louise Gustafsson, Petrea Cornwell, Amanda Love
BACKGROUND: People with mild stroke comprise a significant proportion of the overall stroke population. Previously this population has been viewed as having limited impairments, receiving minimal services following hospital discharge. Recent findings demonstrate that the implications of mild stroke are more significant than originally comprehended, warranting further services. OBJECTIVES: To identify the evidence-base regarding services for people with mild stroke, post-acute hospital discharge, that target secondary prevention and/or changes following stroke...
December 26, 2016: Topics in Stroke Rehabilitation
https://www.readbyqxmd.com/read/28019045/autonomic-modulation-for-the-treatment-of-ventricular-arrhythmias-therapeutic-use-of-percutaneous-stellate-ganglion-blocks
#18
Marat Fudim, Richard Boortz-Marx, Chetan B Patel, Albert Y Sun, Jonathan P Piccini
Ventricular tachycardia (VT), ventricular fibrillation (VF) and electrical storm are commonly encountered emergency conditions in cardiac and surgical intensive care units. In most cases, recurrent ventricular arrhythmias or electrical storm are associated with a heightened sympathetic tone. These arrhythmias can be difficult to treat and may be refractory to beta-blockade, antiarrhythmic therapy, sedation, and mechanical hemodynamic support. While monomorphic ventricular tachycardia and PVC-triggered polymorphic ventricular tachycardia may sometimes be amenable to successful ablation, some patients may be too critically ill to make such an approach feasible...
December 26, 2016: Journal of Cardiovascular Electrophysiology
https://www.readbyqxmd.com/read/28017278/three-dimensional-transoesophageal-echocardiography-for-cardiac-output-in-critically-ill-patients-a-pilot-study-of-ultrasound-versus-the-thermodilution-method
#19
Nadjib Hammoudi, Guillaume Hékimian, Florent Laveau, Marc Achkar, Richard Isnard, Alain Combes
BACKGROUND: Three-dimensional transoesophageal echocardiography (3D-TOE) is a new noninvasive tool for quantitative assessment of left ventricular (LV) volumes and ejection fraction. AIM: The objective of this pilot study was to evaluate the feasibility and accuracy of 3D-TOE for the estimation of cardiac output (CO), using transpulmonary thermodilution with the Pulse index Contour Continuous Cardiac Output (PiCCO) system as the reference method, in intensive care unit (ICU) patients...
December 21, 2016: Archives of Cardiovascular Diseases
https://www.readbyqxmd.com/read/28011279/association-of-prophylactic-endotracheal-intubation-in-critically-ill-patients-with-upper-gi-bleeding-and-cardiopulmonary-unplanned-events
#20
Umar Hayat, Peter J Lee, Hamid Ullah, Shashank Sarvepalli, Rocio Lopez, John J Vargo
BACKGROUND: Prophylactic endotracheal intubation (PEI) is often advocated to mitigate the risk of cardiopulmonary adverse events in patients presenting with brisk upper gastrointestinal bleed (UGIB). However, the benefit of such a measure remains controversial. Our study aimed to compare the incidence of cardiopulmonary unplanned events (CUE) between patients who underwent endotracheal intubation versus those who didn't, in critically ill patients with brisk UGIB. METHODS: Patients aged 18 years or older who had presented at Cleveland Clinic between 2011 and 2014 with hematemesis and/or patients with melena with consequential hypovolemic shock were included...
December 20, 2016: Gastrointestinal Endoscopy
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