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balance disturbances in patients with critical illness

Karin Becke, Christoph Eich, Claudia Höhne, Martin Jöhr, Andreas Machotta, Markus Schreiber, Robert Sümpelmann
Inspired by the Choosing Wisely initiative, a group of pediatric anesthesiologists representing the German Working Group on Paediatric Anaesthesia (WAKKA) coined and agreed upon 10 concise positive ("dos") or negative ("don'ts") evidence-based recommendations. (i) In infants and children with robust indications for surgical, interventional, or diagnostic procedures, anesthesia or sedation should not be avoided or delayed due to the potential neurotoxicity associated with the exposure to anesthetics...
May 30, 2018: Paediatric Anaesthesia
Tessa van Middelaar, Sophie D Ivens, Petra G van Peet, Rosalinde K E Poortvliet, Edo Richard, A Jeannette Pols, Eric P Moll van Charante
OBJECTIVES: To explore general practitioners' (GPs) routines and considerations on (de)prescribing antihypertensive medication (AHM) in older patients, their judgement on usability of the current guideline and needs for future support. DESIGN: Semistructured interviews. SETTING: Dutch general practice. PARTICIPANTS: Fifteen GPs were purposively sampled based on level of experience and practice characteristics until saturation was reached...
April 20, 2018: BMJ Open
A Tranberg, H R Thorarinsdottir, A Holmberg, U Schött, B Klarin
BACKGROUND: The normal body exists in mutualistic balance with a large range of microbiota. The primary goal of this study was to establish whether there is an imbalance in the oropharyngeal flora early after hospital or ICU admittance, and whether flora differs between control, ward and critically ill patients. The secondary goal was to explore whether there are patient characteristics that can be associated with a disturbed oropharyngeal flora. METHODS: Oropharyngeal cultures were obtained from three different study groups: (1) controls from the community, (2) ward patients and (3) critically ill patients, the two latter within 24 h after admittance...
March 8, 2018: Acta Anaesthesiologica Scandinavica
Jia Li
The concept of oxygen transport, defined as the relation between oxygen consumption (VO2) and delivery (DO2), is of fundamental importance in critically ill patients. The past 200 years have witnessed a stepwise progressive improvement in the understanding of pathophysiological disturbances in the balance of DO2 and VO2 in critically ill patients including those after cardiopulmonary bypass surgery. Intermittent spectacular technological achievements have accelerated the rate of progress. Therapeutic advances have been particularly impressive during the recent decades...
February 2018: Cardiology in the Young
Goran Mitrić, Andrew Udy, Hiran Bandeshe, Pierre Clement, Rob Boots
BACKGROUND: Atrial fibrillation is a common rhythm disturbance in the general medical-surgical intensive care unit. Amiodarone is a popular drug in this setting but evidence to inform clinical practice remains scarce. We aimed to identify whether variation in the clinical use of amiodarone was associated with recurrent atrial fibrillation. METHODS: This was a retrospective audit of 177 critically ill patients who developed new-onset atrial fibrillation after admission to a tertiary level medical-surgical trauma intensive care unit...
April 2, 2016: Critical Care: the Official Journal of the Critical Care Forum
Marilù Giacalone, Rita Martinelli, Antonio Abramo, Antonio Rubino, Vittorio Pavoni, Pietro Iacconi, Francesco Giunta, Francesco Forfori
BACKGROUND: Thiamine plays a critical role in energy metabolism. Critically ill patients may have thiamine deficiency and increased mortality due to potentially irreversible consequences. The aim of this study was to show the impact of thiamine deficiency in a series of patients and the rapid response to thiamine replacement, showing the changes in clinical and metabolic conditions over time. METHODS: We described 3 cases of hospitalized patients who had received parenteral nutrition (PN) without vitamin supplementation...
February 2015: Nutrition in Clinical Practice
Han Chen, Rong-Guo Yu, Ning-Ning Yin, Jian-Xin Zhou
INTRODUCTION: Extracorporeal membrane oxygenation (ECMO) is used in critically ill patients presenting acute cardiac and/or pulmonary dysfunctions, who are at high risk of developing acute kidney injury and fluid overload. Continuous renal replacement therapy (CRRT) is commonly used in intensive care units (ICU) to provide renal replacement and fluid management. We conducted a review to assess the feasibility, efficacy and safety of the combination of ECMO and CRRT and to illustrate the indications and methodology of providing renal replacement therapy during the ECMO procedure...
December 8, 2014: Critical Care: the Official Journal of the Critical Care Forum
Josi Vidart, Simone Magagnin Wajner, Rogério Sarmento Leite, André Manica, Beatriz D Schaan, P Reed Larsen, Ana Luiza Maia
CONTEXT: The acute phase of the nonthyroidal illness syndrome (NTIS) is characterized by low T3 and high rT3 levels, affecting up to 75% of critically ill patients. Oxidative stress has been implicated as a causative factor of the disturbed peripheral thyroid hormone metabolism. OBJECTIVE: The objective of the study was to investigate whether N-acetylcysteine (NAC), a potent intracellular antioxidant, can prevent NTIS in patients with acute myocardial infarction...
December 2014: Journal of Clinical Endocrinology and Metabolism
Tobias Wollersheim, Janine Woehlecke, Martin Krebs, Jida Hamati, Doerte Lodka, Anja Luther-Schroeder, Claudia Langhans, Kurt Haas, Theresa Radtke, Christian Kleber, Claudia Spies, Siegfried Labeit, Markus Schuelke, Simone Spuler, Joachim Spranger, Steffen Weber-Carstens, Jens Fielitz
IMPORTANCE: Intensive care unit (ICU)-acquired muscle wasting is a devastating complication leading to persistent weakness and functional disability. The mechanisms of this myopathy are unclear, but a disturbed balance of myosin heavy chain (MyHC) is implicated. OBJECTIVE: To investigate pathways of myosin turnover in severe critically ill patients at high risk of ICU-acquired weakness. DESIGN: Prospective, mechanistic, observational study...
April 2014: Intensive Care Medicine
Philip C Spinella, Allan Doctor
The philosophy of damage control resuscitation (DCR) and remote damage control resuscitation (RDCR) can be summarized by stating that the goal is to prevent death from hemorrhagic shock by "staying out of trouble instead of getting out of trouble." In other words, it is preferred to arrest the progression of shock, rather than also having to reverse this condition after significant tissue damage and organ injury cascades are established. Moreover, to prevent death from exsanguination, a balanced approach to the treatment of both shock and coagulopathy is required...
May 2014: Shock
Christian Overgaard-Steensen, Troels Ring
Disturbances in sodium concentration are common in the critically ill patient and associated with increased mortality. The key principle in treatment and prevention is that plasma [Na+] (P-[Na+]) is determined by external water and cation balances. P-[Na+] determines plasma tonicity. An important exception is hyperglycaemia, where P-[Na+] may be reduced despite plasma hypertonicity. The patient is first treated to secure airway, breathing and circulation to diminish secondary organ damage. Symptoms are critical when handling a patient with hyponatraemia...
February 27, 2013: Critical Care: the Official Journal of the Critical Care Forum
Wassif Samuel Wassif, Andrew Rashad Ross
Few organ systems are spared the progressive deterioration seen in critically ill patients with anorexia nervosa. Most of the endocrine disturbances discussed are due to starvation and represent appropriate metabolic adaptation of the body to food restriction and negative energy balance. In a starving patient, a lowered metabolic rate, increased cortisol and growth hormone level and reduced fertility are all appropriate adaptations to an abnormal and highly stressful state. Most metabolic abnormalities can be reversed with a well-planned refeeding program and nutritional recovery...
2013: Vitamins and Hormones
Konrad, von Vigier
Electrolyte disturbances are frequently encountered in pediatric patients, not only in those with critical illness. They can manifest as lethargy, seizures, vomiting and cardiac arrhythmias. In many cases, electrolyte abnormalities are secondary to other underlying conditions, therefore clinical signs and symptoms can be predominated by the primary disease and not by the electrolyte imbalance. Clinical and laboratory evaluation must consist of a detailed history including any drug treatment, evaluation of volume status, acid-base balance, electrolytes as well as plasma and urine osmolality...
August 1, 2005: Therapeutische Umschau. Revue Thérapeutique
Hazim Kadhim, Paul Deltenre, Valérie Segers, Guillaume Sébire
Cytokines interact with neurotransmitters and modify neuronal and neuroimmune functions. Intense in situ neuronal IL-2 immunoreactivity was detected in vital human brainstem neuronal centers which are principally implicated in cardio-respiratory control mechanisms. These observations were made in critically-ill aging adult as well as in young infant patients dying from various clinico-pathological conditions. We suggested that this in situ cytokine over-expression might tip a delicate balance in molecular interactions in those vital neuro-vegetative centers, causing disturbed homeostatic control of cardio-respiratory functions and impaired arousal responses; we further hypothesized that this IL-2-induced neuro-molecular disequilibrium in the brainstem microenvironment might thus be part of a final common pathway leading to death...
June 2012: Medical Hypotheses
Dimitri Anastasopoulos, Antonios Kefaliakos, Argyris Michalopoulos
INTRODUCTION: This prospective study investigated whether plasma ionized calcium concentration abnormalities and other electrolyte disturbances represent risk factors for the development of critical illness polyneuromyopathy (CIPNM) in ICU patients. METHODS: One hundred and ninety consecutive adult critically ill patients with prolonged ICU stay (longer than 7 days) were prospectively evaluated. Patients with acute weakness and/or weaning difficulties were subjected to extensive electrophysiological measurements in order to establish the diagnosis of CIPNM...
2011: Critical Care: the Official Journal of the Critical Care Forum
Nicole Nigro, Beat Müller, Nils G Morgenthaler, Felix Fluri, Philipp Schütz, Stefanie Neidert, Daiana Stolz, Roland Bingisser, Michael Tamm, Mirjam Christ-Crain, Mira Katan
BACKGROUND: Sodium imbalance is common in-hospital electrolyte disturbance and is largely related to inequalities in water homeostasis. An important mechanism leading to dysnatraemic disorders is inadequately secreted plasma arginine vasopressin (AVP). Unfortunately, AVP measurement is cumbersome and not reliable. Copeptin is secreted in an equimolar ratio to AVP and is a promising marker in the differential diagnosis of hyponatraemia and possibly hypernatraemia in stable hospitalised patients...
2011: Swiss Medical Weekly
Shidasp Siami, Juliette Bailly-Salin, Andrea Polito, Raphael Porcher, Anne Blanchard, Jean-Philippe Haymann, Kathleen Laborde, Virginie Maxime, Catherine Boucly, Robert Carlier, Djillali Annane, Tarek Sharshar
OBJECTIVE: To determine whether septic shock patients have an abnormal reponse to increasing osmolarity. DESIGN: Prospective interventional study. SETTING: Intensive care unit at Raymond Poincaré and Etampes Hospitals. PATIENTS: Normonatremic patients at > 72 hrs from septic shock onset. INTERVENTION: Osmotic challenge consisting of infusing 500 mL of hypertonic saline solution (with cumulative amount of sodium not exceeding 24 g) over 120 mins...
October 2010: Critical Care Medicine
Mitchell S Buckley, Jaclyn M Leblanc, Michael J Cawley
Electrolyte imbalances are common in critically ill patients. Although multiple disease states typically encountered in the intensive care unit may be responsible for the development of electrolyte disorders, medications may contribute to these disturbances as well. Medications can interfere with the absorption of electrolytes, alter hormonal responses affecting homeostasis, as well as directly impact organ function responsible for maintaining electrolyte balance. The focus on this review is to identify commonly prescribed medications in the intensive care unit and potential electrolyte disturbances that may occur as a result of their use...
June 2010: Critical Care Medicine
Thomas Benfield, Karen Ejrnaes, Klaus Juul, Christian Østergaard, Jannik Helweg-Larsen, Nina Weis, Lea Munthe-Fog, Gitte Kronborg, Marianne Ring Andersen, Anne Tybjaerg-Hansen, Børge G Nordestgaard, Peter Garred
INTRODUCTION: Disturbance of the pro-coagulatant and anti-coagulant balance is associated with a poor outcome from critical illness. The objective of this study is to determine whether the Factor V Leiden (FVL) mutation is associated with susceptibility to or death from critical illness. METHODS: A genetic association study involving four case cohorts comprising two Gram negative sepsis, one invasive pneumococcal disease and one intensive care unit cohort with a total of 1,249 patients...
2010: Critical Care: the Official Journal of the Critical Care Forum
Gregor Lindner, Nikolaus Kneidinger, Ulrike Holzinger, Wilfred Druml, Christoph Schwarz
BACKGROUND: Hypernatremia is a serious electrolyte disturbance and an independent risk factor for mortality in critically ill patients. In many cases, hypernatremia is an iatrogenic problem that develops in the intensive care unit (ICU). STUDY DESIGN: Case series. SETTING & PARTICIPANTS: 45 patients were studied in a medical ICU. For inclusion in the study, patients needed to show an increase in serum sodium concentration to greater than 149 mEq/L from an initial concentration of less than 146 mEq/L...
October 2009: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
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