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https://www.readbyqxmd.com/read/29456602/review-of-management-in-cardiotoxic-overdose-and-efficacy-of-delayed-intralipid-use
#1
Edward Walter, James McKinlay, Jade Corbett, Justin Kirk-Bayley
We present the case of a 51-year-old woman admitted to our intensive care unit following an intentional overdose of a calcium channel antagonist and a beta blocker. The resultant hypotension was reversed with glucagon, noradrenaline, calcium and high-dose insulin. Despite these interventions, she remained vasoplegic and received a delayed, standard dose of intralipid. Subsequently, the vasoplegia resolved rapidly, and the vasopressor was stopped. Here, we review the management of overdose of calcium channel and beta-adrenergic receptor blockers, concentrating on the pharmacology of lipid emulsion therapy...
February 2018: Journal of the Intensive Care Society
https://www.readbyqxmd.com/read/29456349/effects-of-crystalloid-preloading-20-ml-kg-on-hemodynamics-in-relation-to-postural-changes-in-patients-undergoing-neurosurgical-procedures-in-sitting-position
#2
M Ranjith, Prasanna Udupi Bidkar, K Narmadalakshmi, Praveen R Talawar
Background: Hemodynamic disturbances are common during positioning the patients from supine to sitting for neurosurgical procedures. The reported incidence of hypotension varies from 5% to 32%. The aim of the study was to study the effect of crystalloid preloading on hemodynamic parameters during positioning the patient from supine to sitting position. Materials and Methods: In this prospective observational trial, 20 patients were enrolled. Two patients had a patent foramen ovale on transesophageal echocardiography and were excluded from the study...
January 2018: Journal of Neurosciences in Rural Practice
https://www.readbyqxmd.com/read/29455308/fluid-therapy-and-outcome-a-prospective-observational-study-in-65-german-intensive-care-units-between-2010-and-2011
#3
Christian Ertmer, Bernhard Zwißler, Hugo Van Aken, Michael Christ, Fabian Spöhr, Axel Schneider, Robert Deisz, Matthias Jacob
BACKGROUND: Outcome data on fluid therapy in critically ill patients from randomised controlled trials may be different from data obtained by observational studies under "real-life" conditions. We conducted this prospective, observational study to investigate current practice of fluid therapy (crystalloids and colloids) and associated outcomes in 65 German intensive care units (ICUs). In total, 4545 adult patients who underwent intravenous fluid therapy were included. The main outcome measures were 90-day mortality, ICU mortality and acute kidney injury (AKI)...
February 17, 2018: Annals of Intensive Care
https://www.readbyqxmd.com/read/29454654/invasive-pulmonary-aspergillosis-and-influenza-co-infection-in-immunocompetent-hosts-case-reports-and-review-of-the-literature
#4
Melisa M Shah, Eric I Hsiao, Carl M Kirsch, Amit Gohil, Supriya Narasimhan, David A Stevens
Invasive pulmonary aspergillosis (IPA) is classically considered an illness of severely immunocompromised patients with limited host defenses. However, IPA has been reported in immunocompetent but critically ill patients. This report describes two fatal cases of pathologically confirmed IPA in patients with influenza in the intensive care unit. One patient had influenza B infection, whereas the other had influenza A H1N1. Both patients died despite broad-spectrum antimicrobials, mechanical ventilation, and vasopressor support...
February 2, 2018: Diagnostic Microbiology and Infectious Disease
https://www.readbyqxmd.com/read/29452598/7-versus-14-days-of-antibiotic-treatment-for-critically-ill-patients-with-bloodstream-infection-a-pilot-randomized-clinical-trial
#5
Nick Daneman, Asgar H Rishu, Ruxandra Pinto, Pierre Aslanian, Sean M Bagshaw, Alex Carignan, Emmanuel Charbonney, Bryan Coburn, Deborah J Cook, Michael E Detsky, Peter Dodek, Richard Hall, Anand Kumar, Francois Lamontagne, Francois Lauzier, John C Marshall, Claudio M Martin, Lauralyn McIntyre, John Muscedere, Steven Reynolds, Wendy Sligl, Henry T Stelfox, M Elizabeth Wilcox, Robert A Fowler
BACKGROUND: Shorter-duration antibiotic treatment is sufficient for a range of bacterial infections, but has not been adequately studied for bloodstream infections. Our systematic review, survey, and observational study indicated equipoise for a trial of 7 versus 14 days of antibiotic treatment for bloodstream infections; a pilot randomized clinical trial (RCT) was a necessary next step to assess feasibility of a larger trial. METHODS: We conducted an open, pilot RCT of antibiotic treatment duration among critically ill patients with bloodstream infection across 11 intensive care units (ICUs)...
February 17, 2018: Trials
https://www.readbyqxmd.com/read/29445506/ulinastatin-did-not-reduce-mortality-in-elderly-multiple-organ-failure-patients-a-retrospective-observational-study-in-a-single-center-icu
#6
Masatoshi Uchida, Toshikazu Abe, Kazuyuki Ono, Nanako Tamiya
Aim: Our aim was to evaluate the effect of ulinastatin on 28-day mortality in patients who developed multiple organ failure (MOF) related to their acute illness and were admitted to the intensive care unit (ICU). Methods: We carried out a retrospective observational study of MOF patients in a general ICU of a tertiary care hospital in Japan from January 2009 to December 2012. The primary outcome was 28-day all-cause mortality. Secondary outcomes were ventilator-free days, ICU-free days, and vasopressor-free days at day 28...
January 2018: Acute Medicine & Surgery
https://www.readbyqxmd.com/read/29444562/fluid-resuscitation-during-early-sepsis-a-need-for-individualization
#7
Mathieu Jozwiak, Olfa Hamzaoui, Xavier Monnet, Jean-Louis Teboul
The prognosis of septic shock is tightly linked to the earliness of both appropriate antibiotic therapy and early hemodynamic resuscitation. This latter is essentially based on fluid and vasopressors administration. The step-by-step strategy, called "early goal-directed therapy" (EGDT) developed in 2001 and endorsed by the Surviving Sepsis Campaign (SSC) between 2004 and 2016 is no longer recommended. Indeed, recent multicenter randomized clinical trials showed no reduction in all-cause mortality, duration of organ support and in-hospital length of stay with EGDT in comparison with standard care...
February 14, 2018: Minerva Anestesiologica
https://www.readbyqxmd.com/read/29441350/perioperative-goal-directed-therapy-using-invasive-uncalibrated-pulse-contour-analysis
#8
Bernd Saugel, Daniel A Reuter
"Perioperative goal-directed therapy" (PGDT) aims at an optimization of basic and advanced global hemodynamic variables to maintain adequate oxygen delivery to the end-organs. PGDT protocols help to titrate fluids, vasopressors, or inotropes to hemodynamic target values. There is considerable evidence that PGDT can improve patient outcome in high-risk patients if both fluids and inotropes are administered to target hemodynamic variables reflecting blood flow. Despite this evidence, PGDT strategies aiming at an optimization of blood flow seem to be not well implemented in routine clinical care...
2018: Frontiers in Medicine
https://www.readbyqxmd.com/read/29438568/haemodynamic-assessment-and-support-in-sepsis-and-septic-shock-in-resource-limited-settings
#9
David Misango, Rajyabardhan Pattnaik, Tim Baker, Martin W Dünser, Arjen M Dondorp, Marcus J Schultz
Background: Recommendations for haemodynamic assessment and support in sepsis and septic shock in resource-limited settings are largely lacking. Methods: A task force of six international experts in critical care medicine, all of them members of the Global Intensive Care Working Group of the European Society of Intensive Care Medicine and with extensive bedside experience in resource-limited intensive care units, reviewed the literature and provided recommendations regarding haemodynamic assessment and support, keeping aspects of efficacy and effectiveness, availability and feasibility and affordability and safety in mind...
February 9, 2018: Transactions of the Royal Society of Tropical Medicine and Hygiene
https://www.readbyqxmd.com/read/29437714/symmetrical-peripheral-gangrene-of-bilateral-feet-and-unilateral-hand-after-administration-of-vasopressors-during-septic-shock
#10
Naeemah Ruffin, Chirag V Vasa, Sarah Breakstone, Wayne Axman
We report a case of a 75-year-old Hispanic man treated for septic shock after undergoing surgery for impacted renal stones. He was given vasopressors and later developed symmetrical peripheral gangrene (SPG) on both his feet and left hand. SPG is a serious and rare condition presenting clinically as an acute onset of ischaemia with no vessel occlusion. Vasopressors are identified as a contributing factor in SPG development. The patient ultimately underwent transmetatarsal amputations of both feet and amputation of three digits on his left hand...
February 7, 2018: BMJ Case Reports
https://www.readbyqxmd.com/read/29433732/inhibition-of-marfan-syndrome-aortic-root-dilation-by-losartan-role-of-angiotensin-ii-receptor-type-1-independent-activation-of-endothelial-function
#11
Stephanie L Sellers, Nadia Milad, Rayleigh Chan, Michael Mielnik, Una Jermilova, Paul L Huang, Rini de Crom, Jeremy A Hirota, James C Hogg, George G Sandor, Casey Van Breemen, Mitra Esfandiarei, Michael A Seidman, Pascal Bernatchez
Marfan syndrome (MFS) is a genetic disorder that frequently leads to aortic root dissection and aneurysm. Despite promising preclinical and pilot clinical data, a recent large-scale study using antihypertensive angiotensin II (AngII) receptor type 1 (ATR1) blocker losartan has failed to meet expectations at preventing MFS-associated aortic root dilation, casting doubts about optimal therapy. To study the deleterious role of normal ATR1 signaling in aortic root widening, we generated MFS mice lacking ATR1a expression in an attempt to preserve protective ATR2 signaling...
February 3, 2018: American Journal of Pathology
https://www.readbyqxmd.com/read/29432347/lactate-level-versus-lactate-clearance-for-predicting-mortality-in-patients-with-septic-shock-defined-by-sepsis-3
#12
Seung Mok Ryoo, JungBok Lee, Yoon-Seon Lee, Jae Ho Lee, Kyoung Soo Lim, Jin Won Huh, Sang-Bum Hong, Chae-Man Lim, Younsuck Koh, Won Young Kim
OBJECTIVES: This study aimed to compare the prognostic value of lactate level and lactate clearance at 6 hours after septic shock recognition. And, we performed it to determine lactate kinetics in the Sepsis-3 defined septic shock. DESIGN: This retrospective study was performed from a prospective septic shock registry. SETTINGS: This study was performed at single urban tertiary center. And, all patients were treated with protocol-driven resuscitation bundle therapy between 2010 and 2016...
February 9, 2018: Critical Care Medicine
https://www.readbyqxmd.com/read/29428034/impact-of-trauma-certified-registered-nurse-anesthetists-team-on-intra-operative-resuscitation-and-postoperative-outcomes-of-trauma-patients
#13
Juan Duchesne, Chad Majoue, Marquinn Duke, Rosemarie Robledo, Chad Achord, Leslie McHale, Brandy Davis, Lusine Nahapetyan
A Trauma Certified Registered Nurse Anesthetists Team (TCT) was created and trained to provide trauma-focused anesthesia and resuscitation. The purpose of this study was to examine patient outcomes after implementation of TCT. We conducted retrospective analyses of trauma patients managed with surgical intervention from March to December 2015. During the first five months, patients managed before the development of TCT were grouped No-TCT, patients managed after were grouped TCT. To assess outcomes, we used hospital and intensive care unit length of stay, ventilator days, and a validated 10-point intraoperative Apgar score (IOAS)...
January 1, 2018: American Surgeon
https://www.readbyqxmd.com/read/29428027/does-vasopressin-exacerbate-cerebral-edema-in-patients-with-severe-traumatic-brain-injury
#14
Casey J Allen, Ty K Subhawong, Mena M Hanna, Lydia Chelala, M Ross Bullock, Carl I Schulman, Kenneth G Proctor
Arginine vasopressin (AVP) is often used as an alternative pressor to catecholamines (CATs). However, unlike CATs, AVP is a powerful antidiuretic that could promote edema. We tested the hypothesis that AVP promoted cerebral edema and/or increased requirements for osmotherapy, relative to those who received CATs, for cerebral perfusion pressure (CPP) management after traumatic brain injury (TBI). This is a retrospective review of 286 consecutive TBI patients with intracranial pressure monitoring at a single institution from September 2008 to January 2015...
January 1, 2018: American Surgeon
https://www.readbyqxmd.com/read/29427160/metformin-associated-lactic-acidosis-a-case-report
#15
Takehide Umeda, Taro Minami, Keith Bartolomei, Eleanor Summerhill
A 54-year-old woman with type 2 diabetes mellitus, hypertension, and peripheral vascular disease developed life-threatening lactic acidosis during treatment with metformin for type 2 diabetes. The woman received metformin at 1000 mg orally twice a day for type 2 diabetes. She presented to our emergency department with a 3-day history of severe watery diarrhea, nausea, and vomiting. Her grandson whom she cared for had gastroenteritis several days prior to the onset of her symptoms. She was confused and hypotensive with a blood pressure of 70/39 mmHg...
February 9, 2018: Drug Safety—Case Reports
https://www.readbyqxmd.com/read/29426854/association-between-plasma-cortisol-and-death-or-vasopressor-refractory-hypotension-in-preterm-neonates-a-prospective-cohort-study
#16
Monisha Rameshbabu, Venkataseshan Sundaram, Naresh Sachdeva, Rama Walia, Shiv Sajan Saini, Sourabh Dutta
OBJECTIVES: Temporal relation between adrenal insufficiency and hypotension is poorly understood. We examined the association between basal and post-stimulation cortisol and death or vasopressor refractory hypotension in preterm neonates. STUDY DESIGN: Prospective cohort study in ≤30 weeks' and/or <1,250 g weight. Primary outcome-composite of death or vasopressor refractory hypotension by day 14 of life. Plasma cortisol levels were measured at 24-36 h (T1), 72-84 h (T2) and 10 days (T3), and post-stimulation cortisol at T1 and later at T2 and T3 if the adrenal response was inadequate earlier...
February 9, 2018: Journal of Perinatology: Official Journal of the California Perinatal Association
https://www.readbyqxmd.com/read/29424795/evaluation-of-vasopressin-for-vasoplegic-shock-in-patients-with-preoperative-left-ventricular-dysfunction-after-cardiac-surgery-a-propensity-score-analysis
#17
Yongqing Cheng, Tuo Pan, Min Ge, Tao Chen, Jiaxin Ye, Lichong Lu, Cheng Chen, Qiuyan Zong, Yi Ding, Dongjin Wang
PURPOSE: Postoperative vasoplegic shock after cardiac surgery seems to be a frequent complication with poor outcomes. We hypothesized that vasopressin may increase the risk of poor outcomes in patients with preoperative Left Ventricular Dysfunction (pLVD) rather than norepinephrine. The aim of this study was to assess whether vasopressin is superior to norepinephrine to improve outcomes in patients with pLVD after cardiac surgery. METHODS: This retrospective cohort study included 1,156 patients with postoperative vasoplegic shock (mean arterial pressure <65 mmHg resistant to fluid challenge and cardiac index >2...
February 7, 2018: Shock
https://www.readbyqxmd.com/read/29423196/renal-recovery-after-severe-acute-kidney-injury-in-critically-ill-myeloma-patients-a-retrospective-study
#18
Adrien Joseph, Stephanie Harel, Marion Venot, Sandrine Valade, Eric Mariotte, Claire Pichereau, Akli Chermak, Lara Zafrani, Elie Azoulay, Emmanuel Canet
Background: Despite substantial improvements in the management of multiple myeloma, renal failure remains an important burden that tremendously impairs prognosis. The purpose of this study was to describe the characteristics and to establish prognostic factors of renal recovery in myeloma patients admitted to the intensive care unit (ICU) for acute kidney injury (AKI) Stage 3 treated with renal replacement therapy (RRT). Methods: A retrospective single-centre cohort study was performed, including consecutive myeloma patients admitted to one medical ICU between 1 January 2007 and 1 September 2015 and treated with RRT...
February 2018: Clinical Kidney Journal
https://www.readbyqxmd.com/read/29422730/acute-renal-failure-adversely-affects-survival-in-pediatric-dengue-infection
#19
Biswanath Basu, Birendranath Roy
Aims: Dengue is currently one of the most important mosquito-borne viral infections. Acute renal failure (ARF) is a serious complication among children suffering from dengue infection. Subjects and Methods: A retrospective cohort review of baseline characteristics, disease outcomes, and risk factors of dengue-infected patients, with and without renal failure (RF), were compared. Results: Among 97 children with dengue, 13.4% had RF (estimated glomerular filtration rate <60 ml/min/1...
January 2018: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/29422725/clinical-profile-intensive-care-unit-course-and-outcome-of-patients-admitted-in-intensive-care-unit-with-chikungunya
#20
Anish Gupta, Deven Juneja, Omender Singh, Suneel Kumar Garg, Varun Arora, Desh Deepak
Objective: Chikungunya is generally a mild disease, rarely requiring Intensive Care Unit (ICU) admission. However, certain populations may develop organ dysfunction necessitating ICU admission. The purpose of the study was to assess the clinical profile and course of chikungunya patients admitted to the ICU, and to ascertain factors linked with poor outcome. Methods: All patients with chikungunya admitted to ICU were included in the study. Admission Acute Physiology and Chronic Health Evaluation (APACHE) II score and sequential organ failure assessment (SOFA) score were calculated...
January 2018: Indian Journal of Critical Care Medicine
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