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https://www.readbyqxmd.com/read/27910086/higher-vs-lower-haemoglobin-threshold-for-transfusion-in-septic-shock-subgroup-analyses-of-the-triss-trial
#1
S L Rygård, L B Holst, J Wetterslev, P I Johansson, A Perner
BACKGROUND: Using a restrictive transfusion strategy appears to be safe in sepsis, but there may be subgroups of patients who benefit from transfusion at a higher haemoglobin level. We explored if subgroups of patients with septic shock and anaemia had better outcome when transfused at a higher vs. a lower haemoglobin threshold. METHODS: In post-hoc analyses of the full trial population of 998 patients from the Transfusion Requirements in Septic Shock (TRISS) trial, we investigated the intervention effect on 90-day mortality in patients with severe comorbidity (chronic lung disease, haematological malignancy or metastatic cancer), in patients who had undergone surgery (elective or acute) and in patients with septic shock as defined by the new consensus definition: lactate above 2 mmol/l and the need for vasopressors to maintain a mean arterial pressure above 65 mmHg...
December 2, 2016: Acta Anaesthesiologica Scandinavica
https://www.readbyqxmd.com/read/27909593/our-anaesthetic-experiences-in-patients-undergoing-percutaneous-mitraclip-implantation
#2
Ezgi Erkılıç, Elvin Kesimci, Cihan Döğer, Tülin Gümüş, Süleyman Ellik, Orhan Kanbak
OBJECTIVE: Percutaneous mitraclip implantation system, is a new technique developed for patients with high surgical risks. It is generally performed in a catheterisation laboratory with the guidance of fluoroscopy and transesophageal echocardiography. In this study, we aimed to share our experiences on anaesthetic in patients undergoing mitraclip implantation under general anaesthesia. METHODS: Eighty four patients with severe, symptomatic mitral insufficiency, who had undergone MitraClip implantation under general anaesthesia between July 2012 and March 2015 (54 male, 30 female; mean age: 68...
August 2016: Turkish Journal of Anaesthesiology and Reanimation
https://www.readbyqxmd.com/read/27908339/vasopressors-and-inotropes-in-sepsis
#3
REVIEW
Leeanne Stratton, David A Berlin, John E Arbo
Vasopressor and inotropes are beneficial in shock states. Norepinephrine is considered the first-line vasopressor for patients with sepsis-associated hypotension. Dobutamine is considered the first-line inotrope in sepsis, and should be considered for patients with evidence of myocardial dysfunction or ongoing signs of hypoperfusion. Vasopressor and inotrope therapy has complex effects that are often difficult to predict; emergency providers should consider the physiology and clinical trial data. It is essential to continually reevaluate the patient to determine if the selected treatment is having the intended result...
February 2017: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/27904524/integration-of-medical-therapy-and-mechanical-circulatory-support-in-the-management-of-acute-heart-failure
#4
Patrick Horn, Malte Kelm, Ralf Westenfeld
Acute heart failure is still characterized by poor prognosis with high mortality. Diagnosis is based on clinical symptoms and hemodynamic measurements. Early coronary revascularization in cardiogenic shock complicating myocardial infarction improves outcome. The further contemporary therapeutic options in the management of acute heart failure are limited to a merely symptomatic effect with relief of dyspnea, reduction of volume overload and improvement of hemodynamic parameters by vasodilators (in hypertension) or inotropic and vasopressor agents (in hypotension)...
December 1, 2016: Archives of Medical Science: AMS
https://www.readbyqxmd.com/read/27903001/right-in-front-of-our-eyes-evolution-of-streptococcal-toxic-shock-syndrome-with-ischemic-optic-neuropathy
#5
Salaheldin M Elhamamsy, Mazen O Al-Qadi, Taro Minami, Marguerite Neill
INTRODUCTION: Toxic shock syndrome occurs from dysregulation of host inflammatory responses. Toxin- producing strains of Group A streptococcus cause TSS. Ischemic optic neuropathy rarely complicates septic shock. We present a rare case of streptococcal pharyngitis complicated by septic arthritis and TSS with reversible blindness due to non-arteritic ischemic optic neuropathy. CASE: A 28-year-old man drove to our ED with exudative pharyngitis. A rapid streptococcal test was positive...
December 1, 2016: Rhode Island Medical Journal
https://www.readbyqxmd.com/read/27902530/cardiac-troponin-release-is-associated-with-biomarkers-of-inflammation-and-ventricular-dilatation-during-critical-illness
#6
Marlies Ostermann, Salma Ayis, Emma Tuddenham, Jessica Lo, Katie Lei, John Smith, Barnaby Sanderson, Carl Moran, Paul Collinson, Janet Peacock, Andrew Rhodes, David Treacher
INTRODUCTION: Troponin release is common during critical illness. We hypothesized that there was an association between cardiac troponin T (cTnT) and biomarkers of systemic inflammation and ventricular dilatation. METHODS: In an observational prospective cohort study, we enrolled consecutive adult patients admitted for non-cardiac reasons to the Intensive Care Unit (ICU) in 2 tertiary care centers. We measured cTnT, C-reactive protein (CRP), Interleukin-6 (IL-6), procalcitonin (PCT) and N-terminal pro brain natriuretic peptide (NT-proBNP) daily in the first week, and on alternate days in the second week...
November 29, 2016: Shock
https://www.readbyqxmd.com/read/27898415/hypotension-and-adverse-outcomes-in-prematurity-comparing-definitions
#7
Deidre St Peter, Christiana Gandy, Suma B Hoffman
BACKGROUND: In the premature neonate, there is no consensus regarding normal blood pressure (BP). The most common definition used is a mean arterial BP (MAP) less than the gestational age (GA); however, studies indicate that the neuroprotective mechanism of autoregulation is lost below a MAP of 30 mm Hg. OBJECTIVE: To determine whether hypotension defined as MAP <30 mm Hg or MAP less than the infant's GA better predicts adverse outcomes of intraventricular hemorrhage (IVH) and death...
November 30, 2016: Neonatology
https://www.readbyqxmd.com/read/27891260/intravenous-vitamin-c-administered-as-adjunctive-therapy-for-recurrent-acute-respiratory-distress-syndrome
#8
Amit Bharara, Catherine Grossman, Daniel Grinnan, Aamer Syed, Bernard Fisher, Christine DeWilde, Ramesh Natarajan, Alpha A Berry Fowler
This case report summarizes the first use of intravenous vitamin C employed as an adjunctive interventional agent in the therapy of recurrent acute respiratory distress syndrome (ARDS). The two episodes of ARDS occurred in a young female patient with Cronkhite-Canada syndrome, a rare, sporadically occurring, noninherited disorder that is characterized by extensive gastrointestinal polyposis and malabsorption. Prior to the episodes of sepsis, the patient was receiving nutrition via chronic hyperalimentation administered through a long-standing central venous catheter...
2016: Case Reports in Critical Care
https://www.readbyqxmd.com/read/27890467/use-of-hyperbaric-oxygen-therapy-and-pegylated-carboxyhemoglobin-bovine-in-a-jehovah-s-witness-with-life-threatening-anemia-following-postpartum-hemorrhage
#9
K Thenuwara, J Thomas, M Ibsen, U Ituk, K Choi, E Nickel, M J Goodheart
We present a case of a Jehovah's Witness patient who refused blood products, with the exception of albumin and clotting factors, and underwent cesarean section under spinal anesthesia complicated by postpartum hemorrhage. She was fluid resuscitated and treated with multiple uterotonics and internal iliac artery embolization. Because of agitation she required emergency tracheal intubation. Her hemoglobin concentration dropped from a preoperative value of 12mg/dL to 3mg/dL on postoperative day one. She was acidotic, requiring vasopressors for hemodynamic stability and remained ventilated and sedated...
October 24, 2016: International Journal of Obstetric Anesthesia
https://www.readbyqxmd.com/read/27887981/predictors-of-mortality-in-the-critically-ill-cirrhotic-patient-is-the-model-for-end-stage-liver-disease-enough
#10
Alagappan Annamalai, Megan Y Harada, Melissa Chen, Tram Tran, Ara Ko, Eric J Ley, Miriam Nuno, Andrew Klein, Nicholas Nissen, Mazen Noureddin
BACKGROUND: Critically ill cirrhotics urgently require liver transplantation but are at high risk for perioperative mortality. The Model for End-Stage Liver Disease (MELD) score, recently updated to incorporate serum sodium, estimates survival probability in patients with cirrhosis but needs further evaluation in the critically ill. The purpose of this study was to evaluate the predictive power of intensive care unit (ICU) admission MELD scores and identify clinical risk factors associated with increased mortality...
November 22, 2016: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/27887854/significant-regional-variation-exists-in-morbidity-and-mortality-after-repair-of-abdominal-aortic-aneurysm
#11
Sara L Zettervall, Peter A Soden, Dominique B Buck, Jack L Cronenwett, Phillip P Goodney, Mohammad H Eslami, Jason T Lee, Marc L Schermerhorn
OBJECTIVE: Limited data exist comparing perioperative morbidity and mortality after open and endovascular abdominal aortic aneurysm (AAA) repair (EVAR) among regions of the United States. This study evaluated the regional variation in mortality and perioperative outcomes after repair of AAAs. METHODS: The Vascular Quality Initiative (VQI) was used to identify patients undergoing open AAA repair and EVAR between 2009 and 2014. Ruptured and intact aneurysms were evaluated separately, and the analysis of intact aneurysms was limited to infrarenal AAAs...
November 22, 2016: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/27886982/impact-of-norepinephrine-weight-based-dosing-compared-with-non-weight-based-dosing-in-achieving-time-to-goal-mean-arterial-pressure-in-obese-patients-with-septic-shock
#12
Nina Vadiei, Mitchell J Daley, Manasa S Murthy, Carrie S Shuman
BACKGROUND: Currently, a lack of standardization exists in norepinephrine dosing units, the first-line vasopressor for septic shock. Timely achievement of goal mean arterial pressure (MAP) is dependent on optimal vasopressor dosing. OBJECTIVE: To determine if weight-based dosing (WBD) of norepinephrine leads to earlier time to goal MAP compared with non-WBD in obese patients with septic shock. METHODS: This was a retrospective, multicenter cohort study...
November 24, 2016: Annals of Pharmacotherapy
https://www.readbyqxmd.com/read/27879559/angiotensin-ii-in-refractory-septic-shock
#13
Elio Antonucci, Patrick J Gleeson, Filippo Annoni, Sara Agosta, Sergio Orlando, Fabio Silvio Taccone, Dimitrios Velissaris, Sabino Scolletta
Refractory septic shock is defined as persistently low mean arterial blood pressure despite volume resuscitation and titrated vasopressors/inotropes in patients with a proven or suspected infection and concomitant organ dysfunction. Its management typically requires high doses of catecholamines, which can induce significant adverse effects such as ischemia and arrhythmias. Angiotensin II (Ang II), a key product of the renin-angiotensin-aldosterone system (RAAS), is a vasopressor agent that could be used in conjunction with other vasopressors to stabilize critically ill patients during refractory septic shock, and reduce catecholamine requirements...
November 21, 2016: Shock
https://www.readbyqxmd.com/read/27879296/elevated-modified-shock-index-within-24-hours-of-icu-admission-is-an-early-indicator-of-mortality-in-the-critically-ill
#14
Nathan J Smischney, Mohamed O Seisa, Katherine J Heise, Darrell R Schroeder, Timothy J Weister, Daniel A Diedrich
PURPOSE: To assess whether exposure to modified shock index (MSI) in the first 24 hours of intensive care unit (ICU) admission is associated with increased in-hospital mortality. METHODS: Adult critically ill patients were included in a case-control design with 1:2 matching. Cases (death) and controls (alive) were abstracted by a reviewer blinded to exposure status (MSI). Cases were matched to controls on 3 factors-age, end-stage renal disease, and ICU admission diagnosis...
November 21, 2016: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/27875357/optimal-timing-of-endoscopic-retrograde-cholangiopancreatography-in-acute-cholangitis
#15
Linda A Hou, Loren Laine, Nima Motamedi, Ara Sahakian, Christianne Lane, James Buxbaum
OBJECTIVES: Acute cholangitis mandates resuscitation, antibiotic therapy, and biliary decompression. Our aim was to define the optimal timing of endoscopic retrograde cholangiopancreatography (ERCP) for patients with acute cholangitis. METHODS: Clinical data on all cases of cholangitis managed by ERCP were prospectively collected from September 2010 to July 2013. The clinical impact of the time to ERCP, defined as the time from presentation in the emergency department to the commencement of the ERCP, was determined...
November 21, 2016: Journal of Clinical Gastroenterology
https://www.readbyqxmd.com/read/27872804/pulmonary-hypertension-secondary-to-pulmonary-veno-occlusive-disease-complicated-by-right-heart-failure-hypotension-and-acute-kidney-injury
#16
Nima Golzy, Stuti Fernandes, Justin Sharim, Rikin Tank, Henry D Tazelaar, Howard E Epstein, Victor Tapson, Antoine Hage
Pulmonary veno-occlusive disease (PVOD) is rare condition which can lead to severe pulmonary hypertension, right ventricular dysfunction, and cardiopulmonary failure. The diagnosis of PVOD can be challenging due to its nonspecific symptoms and its similarity to idiopathic pulmonary arterial hypertension and interstitial lung disease in terms of diagnostic findings. This case describes a 57 year old female patient who presented with a 5-month history of progressive dyspnea on exertion and nonproductive cough...
2017: Respiratory Medicine Case Reports
https://www.readbyqxmd.com/read/27872408/active-expiration-and-the-measurement-of-central-venous-pressure
#17
Sheldon Magder, Karim Serri, Sara Verscheure, Renée Chauvin, Peter Goldberg
PURPOSE: To obtain a point prevalence estimate of alterations in central venous pressure (CVP) produced by active expiration in a consecutive series of intensive care patients. METHODS: We evaluated CVP tracings taken by the nurses at their morning shift change in a consecutive series of 60 cardiac surgery and 59 noncardiac surgery patients. We also assessed change in values due to the change in transducer level. Three physicians and a nurse instructor independently reviewed the tracings and determined whether there was evidence of forced expiration and whether it was type A, defined by decreasing CVP during expiration, or type B, defined by increasing CVP during expiration...
November 20, 2016: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/27871575/dose-requirements-of-alfentanil-to-eliminate-autonomic-responses-during-rapid-sequence-induction-with-thiopental-4-mg-kg-and-rocuronium-0-6-mg-kg
#18
Mohammad H Abou-Arab, Morten Rostrup, Tom Heier
STUDY OBJECTIVE: Opioids are integral part of anesthesia induction, but information on optimal dosing is limited. We aimed to determine doses of alfentanil needed to eliminate increases in 5 autonomic response variables (plasma concentrations of epinephrine, norepinephrine and vasopressin, arterial blood pressure [ABP], and heart rate) during rapid-sequence induction of anesthesia with thiopental 4 mg/kg and rocuronium 0.6 mg/kg. DESIGN: Prospective, randomized, observer-blinded, interventional clinical study...
December 2016: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/27870737/the-influence-of-body-mass-index-on-sensorimotor-block-and-vasopressor-requirement-during-spinal-anesthesia-for-elective-cesarean-delivery
#19
T C Ngaka, J F Coetzee, R A Dyer
BACKGROUND: It has been suggested that the dose requirement for spinal anesthesia (SA) is lower in obese patients for cesarean delivery (CD). In this prospective, observational, noninferiority study, we tested the hypothesis that obesity would not have a clinically important effect on vasopressor requirements or block height. METHODS: Two groups of 25 parturients, group O (body mass index [BMI] >40 kg/m) and group N (BMI <32 kg/m) requiring elective CD were recruited...
December 2016: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/27865148/plasma-adrenomedullin-in-critically-ill-patients-with-sepsis-after-major-surgery-a-pilot-study
#20
Tim-Philipp Simon, Lukas Martin, Sabine Doemming, Andreas Humbs, Christian Bruells, Ruedger Kopp, Oliver Hartmann, Joachim Struck, Andreas Bergmann, Gernot Marx, Tobias Schuerholz
PURPOSE: Adrenomedullin is released by different tissues in hypoxia, oxidative stress, and inflammation and is found in general and medical patients and, recently, in sepsis patients in emergency departments. The aim of this study was to evaluate biologically active adrenomedullin that mirrors directly the active peptide levels in plasma of surgical intensive care unit (ICU) patients with sepsis. MATERIALS AND METHODS: In this single-center observational pilot trial, 42 ICU patients with sepsis and 14 patients after major surgery were included after sepsis diagnosis or ICU admission...
October 28, 2016: Journal of Critical Care
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