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Early use of vasopressor

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https://www.readbyqxmd.com/read/29319648/resuscitative-endovascular-balloon-occlusion-of-the-aorta-for-hemorrhage-control-in-trauma-patients-an-evidence-based-review
#1
Molly Sambor
Traditionally, resuscitative efforts for uncontrolled noncompressible torso hemorrhage are achieved by cross-clamping the proximal aorta via thoracotomy to deliver temporary hemodynamic stability during injury repair. A less commonly used method of promoting early resuscitation and hemorrhagic control in trauma patients is resuscitative endovascular balloon occlusion of the aorta (REBOA). The focus of this literature review is to examine the effectiveness of REBOA in the management of noncompressible pelvic hemorrhage when compared with traditional methods of hemorrhage control in trauma patients...
January 2018: Journal of Trauma Nursing: the Official Journal of the Society of Trauma Nurses
https://www.readbyqxmd.com/read/29315472/early-prognostic-factors-in-septic-shock-cancer-patients-a-prospective-study-with-a-proteomic-approach
#2
D Mokart, C Saillard, C Zemmour, M Bisbal, A Sannini, L Chow-Chine, J-P Brun, M Faucher, J-M Boher, Y Toiron, C Chabannon, J-P Borg, A Gonçalves, L Camoin
BACKGROUND: Organ failures are the main prognostic factors in septic shock. The aim was to assess classical clinico-biological parameters evaluating organ dysfunctions at intensive care unit admission, combined with proteomics, on day-30 mortality in critically ill onco-hematology patients admitted to the intensive care unit for septic shock. METHODS: This was a prospective monocenter cohort study. Clinico-biological parameters were collected at admission. Plasma proteomics analyses were performed, including protein profiling using isobaric Tag for Relative and Absolute Quantification (iTRAQ) and subsequent validation by ELISA...
January 7, 2018: Acta Anaesthesiologica Scandinavica
https://www.readbyqxmd.com/read/29261831/evaluation-of-early-allograft-function-using-the-liver-graft-assessment-following-transplantation-risk-score-model
#3
Vatche G Agopian, Michael P Harlander-Locke, Daniela Markovic, Wethit Dumronggittigule, Victor Xia, Fady M Kaldas, Ali Zarrinpar, Hasan Yersiz, Douglas G Farmer, Jonathan R Hiatt, Ronald W Busuttil
Importance: Early allograft dysfunction (EAD) following a liver transplant (LT) unequivocally portends adverse graft and patient outcomes, but a widely accepted classification or grading system is lacking. Objective: To develop a model for individualized risk estimation of graft failure after LT and then compare the model's prognostic performance with the existing binary EAD definition (bilirubin level of ≥10 mg/dL on postoperative day 7, international normalized ratio of ≥1...
December 20, 2017: JAMA Surgery
https://www.readbyqxmd.com/read/29227201/early-rescue-from-acute-severe-clostridium-difficile-a-novel-treatment-strategy
#4
Biniam Kidane, Kalvin Lung, Greig McCreery, Chadia El-Khatib, Michael C Ott, Roberto Hernandez-Alejandro, Chris Vinden, Daryl Gray, Neil G Parry, Kenneth A Leslie, Tina S Mele
BACKGROUND: Severe Clostridium difficile infections (CDI) can lead to significant impediments to effective treatment. We developed a novel treatment protocol utilizing bedside gastrointestinal lavage (GIL) for the management of patients with severe, complicated CDI. We describe the development and early outcomes of non-operative bedside GIL in hospitalized patients with severe, complicated CDI following the Idea, Development, Exploration, Assessment, Long Term Study (IDEAL) framework at the Idea stage...
December 11, 2017: Surgical Infections
https://www.readbyqxmd.com/read/29221274/predictors-of-high-flow-nasal-cannula-failure-in-immunocompromised-patients-with-acute-respiratory-failure-due-to-non-hiv-pneumocystis-pneumonia
#5
Won-Young Kim, Heungsup Sung, Sang-Bum Hong, Chae-Man Lim, Younsuck Koh, Jin Won Huh
Background: To evaluate the predictors of high flow nasal cannula (HFNC) failure in pneumocystis pneumonia (PCP) patients with acute respiratory failure (ARF). Methods: Fifty-two non-HIV-related PCP subjects were divided into a HFNC success group (44%) and a HFNC failure group (who required mechanical ventilation (MV) despite HFNC application) (56%). The clinical characteristics and physiologic effects were retrospectively reviewed and compared between the groups...
September 2017: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/29216937/-significance-of-peripheral-perfusion-index-in-early-diagnosis-and-goal-directed-therapy-of-septic-shock-patients-a-prospective-single-blind-randomized-controlled-trial
#6
Yuanfeng Shi, Ruihong Yin, Yanli Wang, Jiguang Li, Xiaobing Chen, Yongpeng Xie, Caihong Gu, Xiuzhen Zou, Kexi Liu
OBJECTIVE: To investigate the application of peripheral perfusion index (PPI) in early diagnosis and goal-directed therapy of septic shock, and to provide reference for the early clinical diagnosis and treatment of septic shock. METHODS: A prospective single-blind randomized controlled trial (RCT) was conducted. Adult patients with sepsis admitted to emergency medical department and intensive care unit (ICU) of the First People's Hospital of Lianyungang City in Jiangsu Province from January 2013 to December 2016 were enrolled...
December 2017: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
https://www.readbyqxmd.com/read/29212618/altered-cerebral-perfusion-in-infants-born-preterm-compared-with-infants-born-full-term
#7
Marine Bouyssi-Kobar, Jonathan Murnick, Marie Brossard-Racine, Taeun Chang, Eman Mahdi, Marni Jacobs, Catherine Limperopoulos
OBJECTIVES: To compare regional cerebral cortical blood flow (CBF) in infants born very preterm at term-equivalent age (TEA) and healthy newborns born full term and to examine the impact of clinical risk factors on CBF in the cohort born preterm. STUDY DESIGN: This prospective, cross-sectional study included infants born very preterm (gestational age at birth <32 weeks; birth weight <1500 g) and healthy infants born full term. Using noninvasive 3T arterial spin labeling magnetic resonance imaging, we quantified regional CBF in the cerebral cortex: sensorimotor/auditory/visual cortex, superior medial/dorsolateral prefrontal cortex, anterior cingulate cortex (ACC)/posterior cingulate cortex, insula, and lateral posterior parietal cortex, as well as in the brainstem, and deep gray matter...
November 30, 2017: Journal of Pediatrics
https://www.readbyqxmd.com/read/29200062/is-compliance-with-surgical-care-improvement-project-cardiac-scip-card-2-measures-for-perioperative-%C3%AE-blockers-associated-with-reduced-incidence-of-mortality-and-cardiovascular-related-critical-quality-indicators-after-noncardiac-surgery
#8
Miklos D Kertai, Mary Cooter, Richard J Pollard, William Buhrman, Solomon Aronson, Joseph P Mathew, Mark Stafford-Smith
BACKGROUND: While continuation of β-blockers (BBs) perioperatively has become a national quality improvement measure, the relationship between BB withdrawal and mortality and cardiovascular-related critical quality indicators has not been studied in a contemporary cohort of patients undergoing noncardiac surgery. METHODS: For this retrospective study, the quality assurance database of a large community-based anesthesiology group practice was used to identify 410,288 surgical cases, 18 years of age or older, who underwent elective or emergent noncardiac surgical procedures between January 1, 2009, and December 31, 2014...
November 30, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29193942/-perioperative-management-protocol-of-patients-undergoing-microsurgical-flaps-in-main-healthcare-centers
#9
Alejandro Cruz-Segura, Pedro Grajeda-López
Microsurgery is one of the most fertile and innovative area in reconstructive surgery. Today it is considered an indispensable technique in plastic surgery with flaps survival rates over 95% in main healthcare centers. The factors involved in achieving these results are: the improvement of the surgical technique, adequate patient selection and careful perioperative care. Perioperative care starts at the initial assessment of the patient where it's very important to consider the indications and contraindications of these procedures...
September 2017: Revista Médica del Instituto Mexicano del Seguro Social
https://www.readbyqxmd.com/read/29186145/respective-impact-of-implementation-of-prevention-strategies-colonization-with-multiresistant-bacteria-and-antimicrobial-use-on-the-risk-of-early-and-late-onset-vap-an-analysis-of-the-outcomerea-network
#10
Wafa Ibn Saied, Bertrand Souweine, Maité Garrouste-Orgeas, Stéphane Ruckly, Michael Darmon, Sébastien Bailly, Yves Cohen, Elie Azoulay, Carole Schwebel, Aguila Radjou, Hatem Kallel, Christophe Adrie, Anne-Sylvie Dumenil, Laurent Argaud, Guillaume Marcotte, Samir Jamali, Laurent Papazian, Dany Goldgran-Toledano, Lila Bouadma, Jean-Francois Timsit
RATIONALE: The impact of prevention strategies and risk factors for early-onset (EOP) versus late-onset (LOP) ventilator-associated pneumonia (VAP) are still debated. OBJECTIVES: To evaluate, in a multicenter cohort, the risk factors for EOP and LOP, as the evolution of prevention strategies. METHODS: 7,784 patients with mechanical ventilation (MV) for at least 48 hours were selected into the multicenter prospective OUTCOMEREA database (1997-2016)...
2017: PloS One
https://www.readbyqxmd.com/read/29176374/intraoperative-vasoplegia-methylene-blue-to-the-rescue
#11
Sharon L McCartney, Lorent Duce, Kamrouz Ghadimi
PURPOSE OF REVIEW: To evaluate the efficacy, dosing, and safety of methylene blue (MTB) in perioperative vasoplegic syndrome (VS). RECENT FINDINGS: Vasoplegic syndrome is a state of persistent hypotension with elevated cardiac output, low filling pressures, and low systemic vascular resistance (SVR). It occurs in up to 25% of patients undergoing cardiac surgery with cardiopulmonary bypass, can last up to 72 h, and is associated with a high mortality rate. MTB has been found to increase SVR and decrease vasopressor requirements in vasoplegic syndrome by inhibiting nitric oxide synthase, thus limiting the generation of nitric oxide, while inhibiting activation of soluble guanylyl cyclase and preventing vasodilation...
February 2018: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/29170346/49%C3%A2-paediatric-traumatic-cardiac-arrest-the-development-of-a-treatment-algorithm
#12
James Vassallo, Tim Nutbeam, Annette Rickard, Mark Lyttle, Jason Smith
INTRODUCTION: Paediatric Traumatic Cardiac Arrest (TCA) is a high acuity, low frequency event with fewer than 15 cases reported per year to the Trauma Audit Research Network (TARN). Traditionally survival from TCA has been reported as low, with some believing resuscitation is futile. Within the adult population there is growing evidence to suggest that with early and aggressive correction of reversible causes, survival from TCA may be comparable to that seen from medical out-of-hospital cardiac arrests...
December 2017: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/29162961/pisat-s-visual-vasopressor-injection-needle-a-new-device-for-increasing-patient-safety-in-laparoscopic-myomectomy
#13
REVIEW
Sanket V Pisat
Introduction: The use of vasopressin and other vasoconstrictive agents to reduce blood loss during laparoscopic myomectomy significantly reduces blood loss and operative time. However, serious cardiovascular complications following the use of intra-myometrial injection of vasopressin solution have also been reported. Most of these side effects are believed to be due to inadvertent intravascular injection of vasopressin solution. Aims and Objectives: To describe a new design of an injection needle, Pisat's Visual Vasopressor Injection Needle (VVIN), that can be used during laparoscopic myomectomy to minimise the incidence of an inadvertent intravascular injection of a vasoconstrictor solution...
December 2017: Journal of Obstetrics and Gynaecology of India
https://www.readbyqxmd.com/read/29151048/early-vasopressor-use-following-traumatic-injury-a-systematic-review
#14
Mathieu Hylands, Augustin Toma, Nicolas Beaudoin, Anne Julie Frenette, Frédérick D'Aragon, Émilie Belley-Côté, Emmanuel Charbonney, Morten Hylander Møller, Jon Henrik Laake, Per Olav Vandvik, Reed Alexander Siemieniuk, Bram Rochwerg, François Lauzier, Robert S Green, Ian Ball, Damon Scales, Srinivas Murthy, Joey S W Kwong, Gordon Guyatt, Sandro Rizoli, Pierre Asfar, François Lamontagne
OBJECTIVES: Current guidelines suggest limiting the use of vasopressors following traumatic injury; however, wide variations in practice exist. Although excessive vasoconstriction may be harmful, these agents may help reduce administration of potentially harmful resuscitation fluids. This systematic review aims to compare early vasopressor use to standard resuscitation in adults with trauma-induced shock. DESIGN: Systematic review. DATA SOURCES: We searched MEDLINE, EMBASE, ClinicalTrials...
November 17, 2017: BMJ Open
https://www.readbyqxmd.com/read/29128300/enteral-versus-parenteral-early-nutrition-in-ventilated-adults-with-shock-a-randomised-controlled-multicentre-open-label-parallel-group-study-nutrirea-2
#15
Jean Reignier, Julie Boisramé-Helms, Laurent Brisard, Jean-Baptiste Lascarrou, Ali Ait Hssain, Nadia Anguel, Laurent Argaud, Karim Asehnoune, Pierre Asfar, Frédéric Bellec, Vlad Botoc, Anne Bretagnol, Hoang-Nam Bui, Emmanuel Canet, Daniel Da Silva, Michael Darmon, Vincent Das, Jérôme Devaquet, Michel Djibre, Frédérique Ganster, Maité Garrouste-Orgeas, Stéphane Gaudry, Olivier Gontier, Claude Guérin, Bertrand Guidet, Christophe Guitton, Jean-Etienne Herbrecht, Jean-Claude Lacherade, Philippe Letocart, Frédéric Martino, Virginie Maxime, Emmanuelle Mercier, Jean-Paul Mira, Saad Nseir, Gael Piton, Jean-Pierre Quenot, Jack Richecoeur, Jean-Philippe Rigaud, René Robert, Nathalie Rolin, Carole Schwebel, Michel Sirodot, François Tinturier, Didier Thévenin, Bruno Giraudeau, Amélie Le Gouge
BACKGROUND: Whether the route of early feeding affects outcomes of patients with severe critical illnesses is controversial. We hypothesised that outcomes were better with early first-line enteral nutrition than with early first-line parenteral nutrition. METHODS: In this randomised, controlled, multicentre, open-label, parallel-group study (NUTRIREA-2 trial) done at 44 French intensive-care units (ICUs), adults (18 years or older) receiving invasive mechanical ventilation and vasopressor support for shock were randomly assigned (1:1) to either parenteral nutrition or enteral nutrition, both targeting normocaloric goals (20-25 kcal/kg per day), within 24 h after intubation...
November 8, 2017: Lancet
https://www.readbyqxmd.com/read/29112081/predictors-prevalence-and-outcomes-of-early-crystalloid-responsiveness-among-initially-hypotensive-patients-with-sepsis-and-septic-shock
#16
Daniel E Leisman, Martin E Doerfler, Sandra M Schneider, Kevin D Masick, Jason A D'Amore, John K D'Angelo
OBJECTIVES: The prevalence of responsiveness to initial fluid challenge among hypotensive sepsis patients is unclear. To avoid fluid overload, and unnecessary treatment, it is important to differentiate these phenotypes. We aimed to 1) determine the proportion of hypotensive sepsis patients sustaining favorable hemodynamic response after initial fluid challenge, 2) determine demographic and clinical risk factors that predicted refractory hypotension, and 3) assess the association between timeliness of fluid resuscitation and refractoriness...
November 3, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/29105685/-cardiogenic-shock-from-pharmacological-treatment-to-mechanical-circulatory-support
#17
Ilaria Battistoni, Marco Marini, Alberto Lavorgna, Fabio Vagnarelli, Fabiana Lucà, Emilia Biscottini, Giorgio Caretta, Vincenza Procaccini, Letizia Riva, Gabriele Vianello, Massimo Iacoviello, Renata De Maria, Alessandro Navazio, Nadia Aspromonte, Andrea Di Lenarda, Michele Massimo Gulizia, Serafina Valente
Cardiogenic shock (CS) is a state of critical end-organ hypoperfusion due to reduced cardiac output, despite adequate filling status. The development of multiorgan dysfunction is believed to be the major contributor to the high early mortality. Little evidence exists as to which vasopressor or inotrope should best be used for early treatment; however, customized pharmacological therapy, tailored on hemodynamic monitoring, is essential to achieve normal peripheral perfusion. Moreover, an increasing number of mechanical circulatory support devices are available for hemodynamic support in patients with CS but, at present, data derived from randomized clinical trials on the effectiveness, safety, differential indications for mechanical support devices, and optimal implant timing are limited...
October 2017: Giornale Italiano di Cardiologia
https://www.readbyqxmd.com/read/29095798/relationship-between-initial-vancomycin-trough-levels-and-early-onset-vancomycin-associated-nephrotoxicity-in-critically-ill-patients
#18
Masayuki Chuma, Makoto Makishima, Toru Imai, Naohiro Tochikura, Shinichiro Suzuki, Tsukasa Kuwana, Nami Sawada, Tomohide Komatsu, Takako Sakaue, Norikazu Kikuchi, Yoshikazu Yoshida, Kosaku Kinoshita
BACKGROUND: Appropriate initial dosing of vancomycin (VCM) is important in improving survival and in preventing nephrotoxicity in critically ill patients, but the potential relationship between initial VCM trough levels and early-onset nephrotoxicity remains unclear. We examined the relationship between initial VCM trough levels and early-onset VCM-associated nephrotoxicity. METHODS: We performed a retrospective study of patients who had therapeutic drug monitoring of VCM with initial trough levels within 4 days after the beginning of VCM administration...
October 31, 2017: Therapeutic Drug Monitoring
https://www.readbyqxmd.com/read/29088951/update-on-critical-care-for-acute-spinal-cord-injury-in-the-setting-of-polytrauma
#19
John K Yue, Ethan A Winkler, Jonathan W Rick, Hansen Deng, Carlene P Partow, Pavan S Upadhyayula, Harjus S Birk, Andrew K Chan, Sanjay S Dhall
Traumatic spinal cord injury (SCI) often occurs in patients with concurrent traumatic injuries in other body systems. These patients with polytrauma pose unique challenges to clinicians. The current review evaluates existing guidelines and updates the evidence for prehospital transport, immobilization, initial resuscitation, critical care, hemodynamic stability, diagnostic imaging, surgical techniques, and timing appropriate for the patient with SCI who has multisystem trauma. Initial management should be systematic, with focus on spinal immobilization, timely transport, and optimizing perfusion to the spinal cord...
November 2017: Neurosurgical Focus
https://www.readbyqxmd.com/read/29077613/pressure-waveform-analysis
#20
Mathieu Jozwiak, Xavier Monnet, Jean-Louis Teboul
Monitoring cardiac output is of special interest for detecting early hemodynamic impairment and for guiding its treatment. Among the techniques that are available to monitor cardiac output, pressure waveform analysis estimates cardiac output from the shape of the arterial pressure curve. It is based on the general principle that the amplitude of the systolic part of the arterial curve is proportional to cardiac output and arterial compliance. Such an estimation of cardiac output has the advantage of being continuous and in real time...
October 26, 2017: Anesthesia and Analgesia
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