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https://www.readbyqxmd.com/read/28719490/identification-of-hypotensive-emergency-department-patients-with-cardiogenic-etiologies
#1
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/28716046/blood-volume-monitored-regulation-of-ultrafiltration-to-decrease-the-dry-weight-in-fluid-overloaded-hemodialysis-patients-a-randomized-controlled-trial
#2
Marlies Antlanger, Peter Josten, Michael Kammer, Isabella Exner, Katharina Lorenz-Turnheim, Manfred Eigner, Gernot Paul, Renate Klauser-Braun, Gere Sunder-Plassmann, Marcus D Säemann, Manfred Hecking
BACKGROUND: Because chronic fluid volume overload is associated with higher mortality, we tested whether blood-volume monitored regulation of ultrafiltration and dialysate conductivity (UCR) and/or regulation of ultrafiltration and temperature (UTR) would facilitate dry weight reduction, in comparison to conventional dialysis (CONV). METHODS: We carried out a multicenter, 4-week, randomized controlled trial in hemodialysis patients ≥15% above normal extracellular fluid volume (ECV), per bioimpedance spectroscopy, who were randomized 1:1:1...
July 17, 2017: BMC Nephrology
https://www.readbyqxmd.com/read/28708472/rectal-instillation-of-cold-fluids-for-targeted-temperature-management-after-cardiac-arrest-a-case-report
#3
Andrej Markota, Jure Fluher, Andreja Sinkovič
The optimal method of temperature management after cardiac arrest remains unknown. Methods that are most effective are usually invasive and expensive. Noninvasive methods are not as effective and obstruct access to the patient. Temperature management via rectal cooling offers some potential advantages in survivors of cardiac arrest, namely, relatively large volumes of temperature-controlled fluids can be instilled, access to the patient is not obstructed, and fluid overload can be ameliorated by removal of a fraction of instilled fluid...
July 14, 2017: Therapeutic Hypothermia and Temperature Management
https://www.readbyqxmd.com/read/28701841/continuous-renal-replacement-therapy-applications-on-extracorporeal-membrane-oxygenation-circuit
#4
Ayse Filiz Yetimakman, Murat Tanyildiz, Selman Kesici, Esra Kockuzu, Benan Bayrakci
BACKGROUND AND AIMS: Continuous venovenous hemofiltration or hemodiafiltration is used frequently in pediatric patients, but experience of continuous renal replacement therapy (CRRT) application on extracorporeal membrane oxygenation (ECMO) circuit is still limited. Among several methods used for applying CRRT on ECMO patients, we aim to share our experience on inclusion of a CRRT device in the ECMO circuit which we believe is easier and safer to apply. MATERIALS AND METHODS: The data were collected on demographics, outcomes, and details of the treatment of ECMO patients who had CRRT...
June 2017: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/28701807/natriuretic-peptides-as-biomarkers-for-congestive-states-the-cardiorenal-divergence
#5
REVIEW
Abhilash Koratala, Amir Kazory
Congestion represents the primary reason for hospitalization of patients with heart failure and is associated with adverse outcomes. Fluid overload has been shown to be inadequately addressed in a significant subset of these patients in part due to lack of robust, reliable, and readily available biomarkers for objective assessment and monitoring of therapy. Natriuretic peptides have long been used in this setting, often in conjunction with other assessment tools such as imaging studies. Patients presenting with concomitant cardiac and renal dysfunction represent a unique population with regard to congestion in that the interactions between the heart and the kidney can affect the utility and performance of biomarkers of fluid overload...
2017: Disease Markers
https://www.readbyqxmd.com/read/28701164/effects-from-a-90-day-inhalation-toxicity-study-with-cerium-oxide-and-barium-sulfate-nanoparticles-in-rats
#6
Daniela Schwotzer, Heinrich Ernst, Dirk Schaudien, Heiko Kock, Gerhard Pohlmann, Clemens Dasenbrock, Otto Creutzenberg
BACKGROUND: Nanomaterials like cerium oxide and barium sulfate are frequently processed in industrial and consumer products and exposure of humans and other organisms is likely. Generally less information is given on health effects and toxicity, especially regarding long-term exposure to low nanoparticle doses. Since inhalation is still the major route of uptake the present study focused on pulmonary effects of CeO2NM-212 (0.1, 0.3, 1.0, 3.0 mg/m(3)) and BaSO4NM-220 nanoparticles (50...
July 12, 2017: Particle and Fibre Toxicology
https://www.readbyqxmd.com/read/28699323/intra-procedural-continuous-dialysis-to-facilitate-interventional-catheterization-in-pediatric-patients-with-severe-renal-failure
#7
Angeline D Opina, Athar M Qureshi, Eileen Brewer, Ewa Elenberg, Sarah Swartz, Mini Michael, Henri Justino
BACKGROUND: Interventional catheterization procedures may be needed for patients with severe renal failure who are dependent on dialysis. To avoid the risk of fluid overload and electrolyte derangement during complex procedures in this oliguric/anuric patient population, we performed intra-procedural dialysis, either continuous renal replacement therapy (CRRT) or continous cycling peritoneal dialysis (CCPD). METHODS: We performed a retrospective review of a cohort of pediatric patients, ages 0-18 years, with dialysis-dependent renal failure who received CRRT or CCPD during catheterization procedures from January 2013 to March 2016...
July 12, 2017: Catheterization and Cardiovascular Interventions
https://www.readbyqxmd.com/read/28692675/cardio-haemodynamic-assessment-and-venous-lactate-in-severe-dengue-relationship-with-recurrent-shock-and-respiratory-distress
#8
Sophie Yacoub, Trieu Huynh Trung, Phung Khanh Lam, Vuong Huynh Ngoc Thien, Duong Ha Thi Hai, Tu Qui Phan, Oanh Pham Kieu Nguyet, Nguyen Than Ha Quyen, Cameron Paul Simmons, Christopher Broyd, Gavin Robert Screaton, Bridget Wills
BACKGROUND: Dengue can cause plasma leakage that may lead to dengue shock syndrome (DSS). In approximately 30% of DSS cases, recurrent episodes of shock occur. These patients have a higher risk of fluid overload, respiratory distress and poor outcomes. We investigated the association of echocardiographically-derived cardiac function and intravascular volume parameters plus lactate levels, with the outcomes of recurrent shock and respiratory distress in severe dengue. METHODS/PRINCIPLE FINDINGS: We performed a prospective observational study in Paediatric and adult ICU, at the Hospital for Tropical Diseases (HTD), Ho Chi Minh City, Vietnam...
July 10, 2017: PLoS Neglected Tropical Diseases
https://www.readbyqxmd.com/read/28683729/crrtnet-a-prospective-multi-national-observational-study-of-continuous-renal-replacement-therapy-practices
#9
Michael Heung, Sean M Bagshaw, Andrew A House, Luis A Juncos, Robin Piazza, Stuart L Goldstein
BACKGROUND: Continuous renal replacement therapy (CRRT) is the recommended modality of dialysis for critically ill patients with hemodynamic instability. Yet there remains significant variability in how CRRT is prescribed and delivered, and limited evidence-basis to guide practice. METHODS: This is a prospective, multi-center observational study of patients undergoing CRRT. Initial enrollment phase will occur at 4 academic medical centers in North America over 5 years, with a target enrollment of 2000 patients...
July 6, 2017: BMC Nephrology
https://www.readbyqxmd.com/read/28682031/-the-peritoneal-ultrafiltration-in-patients-with-cardio-renal-disease
#10
Roberto Corciulo, Simone Corciulo
In Italy, the congestive heart failure is the leading cause of hospitalization and despite advances in therapy, the long-term prognosis is poor. Congestive heart failure is associated with advanced varying degrees of chronic renal disease that identify the cardio-renal syndrome type 2. High-dose diuretic therapy often fail to solve the water overload that is frequently the cause of death. The resistance to diuretics aggravates the state of the patient's edema and consequently morbidity and mortality. In the acute stage, the extracorporeal ultrafiltration unable to repair over hydration but needs frequent access weekly or midweek at the dialysis center...
March 2017: Giornale Italiano di Nefrologia: Organo Ufficiale Della Società Italiana di Nefrologia
https://www.readbyqxmd.com/read/28682030/-hemodialysis-and-cardiovascular-outcome
#11
Laura Panicali, Fabiana Brigante, Elena Mancini
Hemodialysis patients often present multiple comorbidities and have a high mortality rate (15-20% per year), mostly due to cardiovascular events. Besides predisposing pathological conditions related to uremia (heart failure, coronary heart disease, left ventricular hypertrophy, arrhythmias), they also have specific risk factors linked to the hemodialysis (HD) treatment in itself: chronic inflammation, fluid overload, autonomic nervous system dysfunction, arterovenous fistula. These factors may affect the hemodynamic compensatory systems (vascular refilling, arteriolar and venous tone, autonomic nervous system response) to fluid removal, with high risk of intra-dialysis hypotension (IDH) episodes or arrhythmic events...
March 2017: Giornale Italiano di Nefrologia: Organo Ufficiale Della Società Italiana di Nefrologia
https://www.readbyqxmd.com/read/28682027/-pulmonary-congestion-and-hypertension-in-hemodialysis-patients
#12
Francesca Mallamaci, Giovanni Tripepi
Mild to moderate volume expansion is a frequent complication in dialysis patients and acute volume overload, such as acute pulmonary oedema, is one of the most worrying medical emergency in these patients. Estimated systolic blood pressure in the pulmonary artery (ePASP) is an important risk factor of mortality and cardiovascular (CV) events in the general population and in patients on dialysis. Therefore, the assessment of body water in dialysis patients is useful both from the clinical point of view for monitoring fluids as well as for prognostic purposes...
March 2017: Giornale Italiano di Nefrologia: Organo Ufficiale Della Società Italiana di Nefrologia
https://www.readbyqxmd.com/read/28676037/challenges-and-outcomes-of-haemodialysis-among-patients-presenting-with-kidney-diseases-in-dodoma-tanzania
#13
Alfred J Meremo, David P Ngilangwa, Masumbuko Y Mwashambwa, Matobogolo B Masalu, Janet Kapinga, Rehema Tagalile, Issa Sabi
BACKGROUND: Kidney Diseases contribute a significant proportion to the global burden of non-communicable diseases. Haemodialysis services as the main modality of renal replacement therapy in most resource limited countries is only available in few cities and at higher costs. The aim of this study was to determine the challenges and outcomes of patients who were on haemodialysis at the University of Dodoma (UDOM) haemodialysis unit in Tanzania. METHODS: In this retrospective study; we reviewed haemodialysis registers and charts of 116 patients dialyzed from January 2013 to June 2015 at The UDOM haemodialysis unit...
July 4, 2017: BMC Nephrology
https://www.readbyqxmd.com/read/28666072/special-situations-intradialytic-hypertension-chronic-hypertension-and-intradialytic-hypotension
#14
Peter Noel Van Buren, Jula K Inrig
Hypertension is a comorbidity that is present in the majority of end-stage renal disease patients on maintenance hemodialysis. This population is particularly unique because of the dynamic nature of blood pressure (BP) during dialysis. Modest BP decreases are expected in most hemodialysis patients, but intradialytic hypotension and intradialytic hypertension are two special situations that deviate from this as either an exaggerated or paradoxical response to the dialysis procedure. Both of these phenomena are particularly important because they are associated with increased mortality risk compared to patients with modest decreases in BP during dialysis...
June 30, 2017: Seminars in Dialysis
https://www.readbyqxmd.com/read/28665906/characteristics-of-patients-with-congestive-heart-failure-or-chronic-obstructive-pulmonary-disease-readmissions-within-30-days-following-an-acute-exacerbation
#15
Austin Castillo, Hawa Edriss, Kavitha Selvan, Kenneth Nugent
BACKGROUND: The Hospital Readmissions Reduction Program targets Medicare patients with congestive heart failure (CHF) and chronic obstructive pulmonary disease (COPD) and penalizes hospitals that have increased 30-day readmission rates for these patients. The main goals of this study were to determine the clinical explanations for readmissions within 30 days, to identify possible deficiencies in patient care, and to identify typical characteristics of patients who were readmitted to the hospital...
July 2017: Quality Management in Health Care
https://www.readbyqxmd.com/read/28665828/monitoring-volume-status-using-bioelectrical-impedance-analysis-in-chronic-hemodialysis-patients
#16
Chae Rim Kim, Jung-Ho Shin, Jin Ho Hwang, Su Hyun Kim
Fluid overload can be an independent risk factor of cardiovascular events and all-cause death in end-stage renal disease (ESRD) patients on chronic hemodialysis. We performed a retrospective study to investigate whether intermittent control of fluid status decreases the rate of these complications using bioelectrical impedance analysis (BIA). In ESRD patients on chronic hemodialysis, we identified the ratio of extracellular water to total body water (ECW/TBW) every 6 months using InBody S10 (Biospace, Seoul, Korea), which was measured within 30 minutes after dialysis initiation on the first dialysis day of the week...
June 24, 2017: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
https://www.readbyqxmd.com/read/28664677/comparative-evaluation-of-torasemide-and-spironolactone-on-adverse-cardiac-remodeling-in-a-rat-model-of-dilated-cardiomyopathy
#17
Somasundaram Arumugam, Remya Sreedhar, Vengadeshprabhu Karuppagounder, Meilei Harima, Masahiko Nakamura, Hiroshi Suzuki, Hirohito Sone, Kenichi Watanabe
BACKGROUND: Chronic heart failure (CHF) involves fluid retention and volume overload, leading to impaired cardiac function. In these conditions, diuretic agents are most commonly used to treat edema and thereby reducing the volume load on the failing heart. There are several other beneficial effects of diuretics apart from their action on urinary excretion. METHODS: In order to identify the effects of diuretic agents on adverse cardiac remodeling in CHF, the present study was carried out, where we have compared the effects of torasemide and spironolactone in a rat model of dilated cardiomyopathy induced by porcine cardiac myosin mediated experimental autoimmune myocarditis...
June 30, 2017: Cardiovascular Therapeutics
https://www.readbyqxmd.com/read/28647145/total-peak-shape-analysis-detection-and-quantitation-of-concurrent-fronting-tailing-and-their-effect-on-asymmetry-measurements
#18
M Farooq Wahab, Darshan C Patel, Daniel W Armstrong
Most peak shapes obtained in separation science depart from linearity for various reasons such as thermodynamic, kinetic, or flow based effects. An indication of the nature of asymmetry often helps in problem solving e.g. in column overloading, slurry packing, buffer mismatch, and extra-column band broadening. However, existing tests for symmetry/asymmetry only indicate the skewness in excess (tail or front) and not the presence of both. Two simple graphical approaches are presented to analyze peak shapes typically observed in gas, liquid, and supercritical fluid chromatography as well as capillary electrophoresis...
August 4, 2017: Journal of Chromatography. A
https://www.readbyqxmd.com/read/28643378/effects-of-weight-based-ultrafiltration-rate-limits-on-intradialytic-hypotension-in-hemodialysis
#19
James L Pirkle, Mary E Comeau, Carl D Langefeld, Gregory B Russell, Somer S Balderston, Barry I Freedman, John M Burkart
INTRODUCTION: High ultrafiltration (UF) rates can result in intradialytic hypotension and are associated with increased mortality. The effects of a weight-based UF rate limit on intradialytic hypotension and the potential for unwanted fluid weight gain and hospitalizations for volume overload are unknown. METHODS: This retrospective cohort study examined 123 in-center hemodialysis patients at one facility who transitioned to 13 mL/kg/h maximum UF rates. Patients were studied for an 8 week UF rate limit exposure period and compared to the 8-week period immediately prior, during which the cohort served as its own historical control...
June 23, 2017: Hemodialysis International
https://www.readbyqxmd.com/read/28638567/nephrology-key-information-for-internists
#20
Sohail Abdul Salim, Juan A Medaura, Bharat Malhotra, Vishnu Garla, Shradha Ahuja, Nicki Lawson, Amaleswari Pamarthy, Hardik Sonani, Karthik Kovvuru, Venkataraman Palabindala
Hospitalists and primary care physicians encounter renal disease daily. Although most cases of acute kidney injury (AKI) are secondary to dehydration and resolve by giving fluids, many cases of AKI are due to not uncommon but unfamiliar causes needing nephrology evaluation. Common indications to consult a nephrologist on an emergency basis include hyperkalemia or volume overload in end stage renal disease patients (ESRD). Other causes of immediate consultation are cresenteric glomerulonephritis / rapidly progressive glomerulonephritis in which renal prognosis of the patient depends on timely intervention...
March 2017: Journal of Community Hospital Internal Medicine Perspectives
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