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https://www.readbyqxmd.com/read/28730906/mortality-intensive-care-treatment-and-cost-evaluation-role-of-a-polymerase-chain-reaction-assay-in-patients-with-sepsis
#1
Markota Andrej, Sinkovič Andreja
Objective We examined whether patients with a positive SeptiFast (SF) assay (LightCycler SeptiFast; Roche Diagnostics, Basel, Switzerland) developed higher long-term mortality, a more difficult course of treatment, and a higher antimicrobial treatment cost than patients with a negative SF assay. Methods We performed a post-hoc analysis of data collected in a 1-year prospective interventional study of adults with severe sepsis and septic shock. In addition to the standard treatment, an additional 5 ml of blood was obtained for an SF assay, and the antimicrobial treatment was changed according to the SF results...
January 1, 2017: Journal of International Medical Research
https://www.readbyqxmd.com/read/28726362/early-hypertension-after-vasopressor-weaning-during-septic-shock-associated-factors-and-prognostic-significance
#2
Rostane Gaci, Jérémie Lemarie, Marie Conrad, Aurélie Cravoisy, Pierre E Bollaert, Sébastien Gibot
BACKGROUND: During septic shock, early development of hypertension after vasopressors weaning seems paradoxical. The aim of this study was to authenticate this empirical observation, identify associated factors and document its prognostic significance. METHODS: We conducted a descriptive, retrospective study in a medical ICU of a teaching hospital among adult patients with septic shock. RESULTS: From 01.01.2013 to 31.12.2014, 262 consecutive patients over 18 years of age were admitted because of septic shock; 195 of them were successfully weaned from vasopressors...
July 20, 2017: Minerva Anestesiologica
https://www.readbyqxmd.com/read/28725211/critical-evaluation-of-the-lund-concept-for-treatment-of-severe-traumatic-head-injury-25%C3%A2-years-after-its-introduction
#3
REVIEW
Per-Olof Grände
When introduced in 1992, the Lund concept (LC) was the first complete guideline for treatment of severe traumatic brain injury (s-TBI). It was a theoretical approach, based mainly on general physiological principles-i.e., of brain volume control and optimization of brain perfusion and oxygenation of the penumbra zone. The concept gave relatively strict outlines for cerebral perfusion pressure, fluid therapy, ventilation, sedation, nutrition, the use of vasopressors, and osmotherapy. The LC strives for treatment of the pathophysiological mechanisms behind symptoms rather than just treating the symptoms...
2017: Frontiers in Neurology
https://www.readbyqxmd.com/read/28721327/two-catastrophes-in-one-patient-drug-reaction-with-eosinophilia-and-systemic-symptoms-and-toxic-shock-syndrome
#4
Moayed Ibrahim, Diana L Nunley
A 70-year-old, immunocompromised patient presented to the emergency room (ER) five weeks after she was started on clopidogrel. She complained of skin eruption, mouth ulcers, fatigue, and myalgia over the past two weeks. Labs showed severe hyponatremia, acute kidney injury, rhabdomyolysis, hyperkalemia, and elevated liver enzymes. She was treated with steroids and discharged after her condition improved. However, a month later, she returned to the ER, complaining of nausea, vomiting, diarrhea, dizziness, chills, and shortness of breath over the past two days...
June 15, 2017: Curēus
https://www.readbyqxmd.com/read/28720600/is-the-mechanism-of-re-expansion-pulmonary-oedema-in-a-heart-lung-interaction
#5
Candy Masego Mokotedi, Martin Balik
The mechanism of re-expansion pulmonary oedema (Re-PE) is unclear. There are multiple variables in play when evaluating the response to evacuation of pleural fluid. We present an educational case of a critically ill patient admitted for respiratory failure who was fully dependent on ventricular pacing set at a constant rate throughout the episode of Re-PE. The transthoracic echocardiography (TTE) showed an ejection fraction of 38%, moderate mitral regurgitation (MR), mildly dilated right ventricle and moderate pulmonary hypertension...
July 18, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28719490/identification-of-hypotensive-emergency-department-patients-with-cardiogenic-etiologies
#6
Daniel J Henning, Kathleen E Kearney, M Kennedy Hall, Claudius Mahr, Nathan I Shapiro, Graham Nichol
OBJECTIVE: Identify predictors of cardiogenic etiology among Emergency Department (ED) patients with hypotension, and use these predictors to create a clinical tool to discern cardiogenic etiology of hypotension. METHODS: This secondary analysis evaluated a prospective cohort of consecutive patients with hypotension in an urban, academic, tertiary care ED from November 2012 to September 2013. We included adults with hypotension, defined as a new vasopressor requirement, systolic blood pressure (SBP) < 90 mmHg after at least 1L of crystalloid or 2 units packed red blood cells, or SBP < 90 mmHg and fluids withheld due to concern for fluid overload...
July 17, 2017: Shock
https://www.readbyqxmd.com/read/28719483/difficult-intubation-and-ventilation-in-an-infant-with-retropharyngeal-abscess-with-mediastinal-extension
#7
Michael A Bruno, Tomas Drabek, Mioara D Manole
A previously healthy 7-month-old male infant presented for evaluation of fever, deceased oral intake, and intermittent noisy breathing. Physical examination revealed neck tenderness. Soft tissue neck radiographs and computed tomography (CT) scan supported a diagnosis of retropharyngeal swelling with extension to the superior mediastinum. Surgical exploration was planned, and endotracheal intubation was performed in the operating room. Significant cardiorespiratory derangements developed immediately after the tracheal tube was inserted, including hypotension, hypoxia, and bradycardia with signs of cardiac ischemia...
July 17, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/28718036/paravertebral-blocks-reduce-narcotic-use-without-affecting-perfusion-in-patients-undergoing-autologous-breast-reconstruction
#8
Elizabeth B Odom, Nili Mehta, Rajiv P Parikh, Ryan Guffey, Terence M Myckatyn
BACKGROUND: Autologous breast reconstruction offers excellent long term outcomes after mastectomy. However, maintaining adequate postoperative analgesia remains challenging. Use of paravertebral blocks (PVBs) reduces postoperative narcotic use and length of stay, and enhanced recovery protocols with mixed analgesia methods are gaining popularity, but few studies have explored the intraoperative effects of these interventions. METHODS: Patients who underwent abdominally based autologous breast reconstruction between 2010 and 2016 were compiled into a retrospective database...
July 17, 2017: Annals of Surgical Oncology
https://www.readbyqxmd.com/read/28717524/anasarca-fever-thrombocytopenia-organomegaly-and-multiorgan-failure-in-a-24-year-old-pregnant-woman
#9
Guillaume Morel, Joy Mootien, Philippe Guiot, Khaldoun Kuteifan
TAFRO syndrome is a distinct idiopathic multicentric Castleman disease characterized by the association of thrombocytopenia, anasarca, fever, reticulin fibrosis, and organomegaly. We report the first case occurring in a Caucasian pregnant woman. At 34 weeks of gestation, our patient presented with all clinical and biological symptoms compatible with a TAFRO syndrome. Tough quick cesarean section was performed as symptoms got worse with onset of multiorgan failure requiring mechanical ventilation for acute respiratory distress, continuous renal replacement, and vasopressors...
2017: Case Reports in Critical Care
https://www.readbyqxmd.com/read/28716047/protocol-adherence-for-continuously-titrated-interventions-in-randomized-trials-an-overview-of-the-current-methodology-and-case-study
#10
F Lauzier, N K Adhikari, A Seely, K K Y Koo, E P Belley-Côté, K E A Burns, D J Cook, F D'Aragon, B Rochwerg, M E Kho, S J W Oczkowksi, E H Duan, M O Meade, A G Day, F Lamontagne
BACKGROUND: The standard definition for protocol adherence is the proportion of all scheduled doses that are delivered. In clinical research, this definition has several limitations when evaluating protocol adherence in trials that study interventions requiring continuous titration. DISCUSSION: Building upon a specific case study, we analyzed a recent trial of a continuously titrated intervention to assess the impact of different definitions of protocol deviations on the interpretation of protocol adherence...
July 17, 2017: BMC Medical Research Methodology
https://www.readbyqxmd.com/read/28713516/sequential-compression-pump-effect-on-hypotension-due-to-spinal-anesthesia-for-cesarean-section-a-double-blind-clinical-trial
#11
Fatemeh Javaherforoosh Zadeh, Mostafa Alqozat, Reza Akhond Zadeh
BACKGROUND: Spinal anesthesia (SA) is a standard technique for cesarean section. Hypotension presents an incident of 80-85% after SA in pregnant women. OBJECTIVE: To determine the effect of intermittent pneumatic compression of lower limbs on declining spinal anesthesia induced hypotension during cesarean section. METHODS: This double-blind clinical prospective study was conducted on 76 non-laboring parturient patients, aged 18-45 years, with the American Society of Anesthesiologist physical status I or II who were scheduled for elective cesarean section at Razi Hospital, Ahvaz, Iran from December 21, 2015 to January 20, 2016...
May 2017: Electronic Physician
https://www.readbyqxmd.com/read/28711369/predicting-failure-to-rescue-after-abdominal-aortic-aneurysm-repair-in-elderly-patients
#12
Caitlin W Hicks, Anna O'Kelly, Tammam Obeid, Satinderjit Locham, Mahmoud B Malas
BACKGROUND: We aim to describe trends in failure to rescue (FTR) among elderly patients undergoing elective open aortic aneurysm repair (OAR) and endovascular aortic aneurysm repair (EVAR). MATERIALS AND METHODS: All patients aged ≥80 y recorded in the Vascular Quality Initiative database (2002-2014) undergoing nonruptured infrarenal AAA repair were included. Primary outcome was FTR, defined as percentage of deaths in patients who had a complication within 30 d of surgery...
July 12, 2017: Journal of Surgical Research
https://www.readbyqxmd.com/read/28710027/admission-lactate-predicts-poor-prognosis-independently-of-the-crb-curb-65-scores-in-community-acquired-pneumonia
#13
Frederik S Frenzen, Ulrike Kutschan, Nils Meiswinkel, Bernhard Schulte-Hubbert, Santiago Ewig, Martin Kolditz
OBJECTIVES: Community-acquired pneumonia (CAP) is associated with a high risk of respiratory failure or septic organ dysfunction. Lactate is an established early marker of prognosis and sepsis severity, but few data exist in patients with CAP. METHODS: We performed a retrospective cohort study of consecutive adult CAP patients without treatment restrictions or direct ICU admission. Lactate was measured as point of care test within the capillary admission blood gas analysis and its prognostic value was compared to the CRB/CURB-65 criteria by multivariate and ROC curve analysis...
July 11, 2017: Clinical Microbiology and Infection
https://www.readbyqxmd.com/read/28707996/effect-of-the-degree-of-head-elevation-on-the-incidence-and-severity-of-venous-air-embolism-in-cranial-neurosurgical-procedures-with-patients-in-the-semisitting-position
#14
Hatice Türe, M Volkan Harput, Nural Bekiroğlu, Özgül Keskin, Özge Köner, Uğur Türe
OBJECTIVE The semisitting position of a patient confers numerous advantages in various neurosurgical procedures, but venous air embolism is one of the associated complications of this position. To date, no prospective studies of the relationship between the degree of head elevation and the rate and severity of venous air embolism for patients undergoing a procedure in this position have been performed. In this study, the authors compared changes in the severity of venous air embolism according to the degree of head elevation (30° or 45°) in patients undergoing an elective cranial neurosurgical procedure in the semisitting position...
July 14, 2017: Journal of Neurosurgery
https://www.readbyqxmd.com/read/28705745/massive-diltiazem-and-metoprolol-overdose-rescued-with-extracorporeal-life-support
#15
James A Chenoweth, Daniel K Colby, Mark E Sutter, Joshua B Radke, Jonathan B Ford, J Nilas Young, John R Richards
The management of overdoses of cardioactive medications in the emergency department can be challenging. The reversal of severe toxicity from one or more types of cardioactive medication may fail maximal medical therapies and require extreme invasive measures such as transvenous cardiac pacing and extracorporeal life support. We present a case of massive diltiazem and metoprolol overdose refractory to maximal medical therapy, including intravenous calcium, glucagon, vasopressors, high dose insulin, and lipid emulsion...
July 6, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28704246/the-effect-of-glycopyrrolate-on-the-incidence-of-hypotension-and-vasopressor-requirement-during-spinal-anesthesia-for-cesarean-delivery-a-meta-analysis
#16
Selina D Patel, Ashraf S Habib, Sioned Phillips, Brendan Carvalho, Pervez Sultan
BACKGROUND: The objective of this meta-analysis was to determine the efficacy of glycopyrrolate at reducing spinal hypotension during cesarean delivery. METHODS: A literature search was performed to identify randomized controlled trials investigating the effect of glycopyrrolate on spinal-induced hypotension during cesarean delivery. Primary outcomes were intraoperative hypotension and vasopressor requirement (phenylephrine equivalents). Secondary outcomes included heart rate (HR), nausea and vomiting, dry mouth, and Apgar scores...
July 10, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28702881/-angiotensin%C3%A2-ii-as-an-alternative-nonadrenergic-vasopressor-results-of-a-randomized-double-blind-placebo-controlled-efficacy-study
#17
M Dünser, J Meier
No abstract text is available yet for this article.
July 12, 2017: Medizinische Klinik, Intensivmedizin und Notfallmedizin
https://www.readbyqxmd.com/read/28701197/a-case-of-bowel-perforation-due-to-traumatic-hernia-at-a-pelvic-fracture-site-a-case-report-and-review-of-the-literature
#18
Ryota Tanaka, Hisashi Nagahara, Kiyoshi Maeda, Hiroshi Ohtani, Masatsune Shibutani, Tatsuro Tamura, Tetsuro Ikeya, Kenji Sugano, Yasuhito Iseki, Katsunobu Sakurai, Sadaaki Yamazoe, Kenjiro Kimura, Takahiro Toyokawa, Ryosuke Amano, Naoshi Kubo, Hiroaki Tanaka, Kazuya Muguruma, Kosei Hirakawa, Masaichi Ohira
BACKGROUND: Common complications of pelvic fractures include visceral injury, large-volume hemorrhage, genitourinary injury, rectal injury, and pulmonary embolism. On the other hand, traumatic hernia is a rare complication, especially in association with pelvic fractures. We report a case of bowel perforation due to traumatic hernia at a pelvic fracture site. CASE PRESENTATION: A 65-year-old female was presented at our hospital for further examination and treatment of ileus...
July 12, 2017: BMC Surgery
https://www.readbyqxmd.com/read/28700610/perioperative-hemodynamics-and-risk-for-delirium-and-new-onset-dementia-in-hip-fracture-patients-a-prospective-follow-up-study
#19
Bjørn Erik Neerland, Maria Krogseth, Vibeke Juliebø, Anette Hylen Ranhoff, Knut Engedal, Frede Frihagen, Johan Ræder, Torgeir Bruun Wyller, Leiv Otto Watne
BACKGROUND: Delirium is common in hip fracture patients and many risk factors have been identified. Controversy exists regarding the possible impact of intraoperative control of blood pressure upon acute (delirium) and long term (dementia) cognitive decline. We explored possible associations between perioperative hemodynamic changes, use of vasopressor drugs, risk of delirium and risk of new-onset dementia. METHODS: Prospective follow-up study of 696 hip fracture patients, assessed for delirium pre- and postoperatively, using the Confusion Assessment Method...
2017: PloS One
https://www.readbyqxmd.com/read/28694703/secondary-sclerosing-cholangitis-in-critically-ill-patients-current-perspectives
#20
REVIEW
Hafsteinn O Gudnason, Einar S Björnsson
Secondary sclerosing cholangitis (SSC) is a term used for a group of chronic cholestatic disease affecting the intra- and/or extrahepatic biliary tree with inflammation and progressive stricture formation, which can lead to biliary cirrhosis. A newly recognized form of SSC is secondary sclerosing cholangitis in critically ill patients (SSC-CIP). Pathogenesis is believed to involve ischemic injury of intrahepatic bile ducts associated with prolonged hypotension, vasopressors administration, and/or mechanical ventilation in patients treated in the intensive care unit (ICU)...
2017: Clinical and Experimental Gastroenterology
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