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https://www.readbyqxmd.com/read/28168570/early-enteral-nutrition-in-critically-ill-patients-esicm-clinical-practice-guidelines
#1
REVIEW
Annika Reintam Blaser, Joel Starkopf, Waleed Alhazzani, Mette M Berger, Michael P Casaer, Adam M Deane, Sonja Fruhwald, Michael Hiesmayr, Carole Ichai, Stephan M Jakob, Cecilia I Loudet, Manu L N G Malbrain, Juan C Montejo González, Catherine Paugam-Burtz, Martijn Poeze, Jean-Charles Preiser, Pierre Singer, Arthur R H van Zanten, Jan De Waele, Julia Wendon, Jan Wernerman, Tony Whitehouse, Alexander Wilmer, Heleen M Oudemans-van Straaten
PURPOSE: To provide evidence-based guidelines for early enteral nutrition (EEN) during critical illness. METHODS: We aimed to compare EEN vs. early parenteral nutrition (PN) and vs. delayed EN. We defined "early" EN as EN started within 48 h independent of type or amount. We listed, a priori, conditions in which EN is often delayed, and performed systematic reviews in 24 such subtopics. If sufficient evidence was available, we performed meta-analyses; if not, we qualitatively summarized the evidence and based our recommendations on expert opinion...
March 2017: Intensive Care Medicine
https://www.readbyqxmd.com/read/28058475/strategies-for-intravenous-fluid-resuscitation-in-trauma-patients
#2
Robert Wise, Michael Faurie, Manu L N G Malbrain, Eric Hodgson
Intravenous fluid management of trauma patients is fraught with complex decisions that are often complicated by coagulopathy and blood loss. This review discusses the fluid management in trauma patients from the perspective of the developing world. In addition, the article describes an approach to specific circumstances in trauma fluid decision-making and provides recommendations for the resource-limited environment.
January 5, 2017: World Journal of Surgery
https://www.readbyqxmd.com/read/28029353/intra-abdominal-hypertension-increases-spatial-qrs-t-angle-and-elevates-st-segment-j-point-in-healthy-women-undergoing-laparoscopic-surgery
#3
Wojciech Dabrowski, Andrzej Jaroszynski, Anna Jaroszynska, Ziemowit Rzecki, Todd T Schlegel, Manu Lng Malbrain
BACKGROUND: Intra-abdominal hypertension (IAH) impairs cardiovascular function, however an effect of IAH on cardiac electrophysiology has been poorly documented. The aim of this study was to evaluate the effect of IAH following pneumoperitoneum on vectorcardiographic variables reflecting cardiac repolarisation and depolarisation. METHODS: Otherwise healthy women undergoing elective gynaecological laparoscopy were studied. Intra-abdominal pressure (IAP), spatial QRS-T angle and ST-segment J-point (STJ) were observed during surgery and the early postoperative period...
March 2017: Journal of Electrocardiology
https://www.readbyqxmd.com/read/28003877/hemodynamic-monitoring-in-the-critically-ill-an-overview-of-current-cardiac-output-monitoring-methods
#4
REVIEW
Johan Huygh, Yannick Peeters, Jelle Bernards, Manu L N G Malbrain
Critically ill patients are often hemodynamically unstable (or at risk of becoming unstable) owing to hypovolemia, cardiac dysfunction, or alterations of vasomotor function, leading to organ dysfunction, deterioration into multi-organ failure, and eventually death. With hemodynamic monitoring, we aim to guide our medical management so as to prevent or treat organ failure and improve the outcomes of our patients. Therapeutic measures may include fluid resuscitation, vasopressors, or inotropic agents. Both resuscitation and de-resuscitation phases can be guided using hemodynamic monitoring...
2016: F1000Research
https://www.readbyqxmd.com/read/27993153/hemodynamic-monitoring-in-the-era-of-evidence-based-medicine
#5
EDITORIAL
Bernd Saugel, Manu L N G Malbrain, Azriel Perel
Hemodynamic instability frequently occurs in critically ill patients. Pathophysiological rationale suggests that hemodynamic monitoring (HM) may identify the presence and causes of hemodynamic instability and therefore may allow targeting therapeutic approaches. However, there is a discrepancy between this pathophysiological rationale to use HM and a paucity of formal evidence (as defined by the strict criteria of evidence-based medicine (EBM)) for its use. In this editorial, we discuss that this paucity of formal evidence that HM can improve patient outcome may be explained by both the shortcomings of the EBM methodology in the field of intensive care medicine and the shortcomings of HM itself...
December 20, 2016: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/27836253/bi-manual-proximal-external-aortic-compression-after-major-abdominal-pelvic-trauma-and-during-ambulance-transfer-a-simulation-study
#6
M J Douma, D O'Dochartaigh, P G Brindley
BACKGROUND: Applying manual pressure after hemorrhage is intuitive, cost-free, and logistically-simple. When direct abdominal-pelvic compression fails, clinicians can attempt indirect proximal-external-aortic-compression (PEAC), while expediting transfer and definitive rescue. This study quantifies the sustainability of simulated bi-manual PEAC both immediately on scene and during subsequent ambulance transfer. The goal is to understand when bi-manual PEAC might be clinically-useful, and when to prioritize compression-devices or endovascular-occlusion...
January 2017: Injury
https://www.readbyqxmd.com/read/27832556/can-femoral-venous-pressure-be-used-as-an-estimate-for-standard-vesical-intra-abdominal-pressure-measurement
#7
A E Howard, A Regli, E Litton, M M Malbrain, A-M Palermo, B L De Keulenaer
Intra-abdominal hypertension (IAH) is highly prevalent in critically ill patients admitted to the intensive care unit and is associated with an increased morbidity and mortality. The present study investigated whether femoral venous pressure (FVP) can be used as a surrogate parameter for intra-abdominal pressure (IAP) measured via the bladder in IAH grade II (IAP <20 mmHg) or grade III (IAP ≥20 mmHg). This was a single-centre prospective study carried out in a tertiary adult intensive care unit. IAP was measured via the bladder with a urinary catheter with simultaneous recording of the FVP via a femoral central line...
November 2016: Anaesthesia and Intensive Care
https://www.readbyqxmd.com/read/27680808/f2-maternal-body-fluid-composition-in-uncomplicated-pregnancies-and-preeclampsia-a-bioelectrical-impedance-analysis
#8
A S Staelens, S Vonck, G Molenberghs, M Lng Malbrain, W Gyselaers
INTRODUCTION: Body fluid composition (BFC) changes during the course of pregnancy and evidence is growing that these changes are different in uncomplicated pregnancies compared to hypertensive pregnancies. METHODS: The aim of this study was to evaluate the changes in maternal BFC during the course of uncomplicated pregnancy (UP) using bioimpedance analysis, as a reference to measurements in hypertensive pregnancies. BFC was assessed using a multiple frequency bioelectrical impedance analyser...
August 2016: Journal of Maternal-fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/27525683/maternal-body-fluid-composition-in-uncomplicated-pregnancies-and-preeclampsia-a-bioelectrical-impedance-analysis
#9
Anneleen S Staelens, Sharona Vonck, Geert Molenberghs, Manu L N G Malbrain, Wilfried Gyselaers
OBJECTIVES: Body fluid composition changes during the course of pregnancy and there is evidence to suggest that these changes are different in uncomplicated pregnancies compared to hypertensive pregnancies. The aim of this study was to evaluate the changes in maternal body fluid composition during the course of an uncomplicated pregnancy and to assess differences in uncomplicated pregnancies versus hypertensive pregnancies by using a bio-impedance analysis technique. STUDY DESIGN: Body fluid composition of each patient was assessed using a multiple frequency bioelectrical impedance analyser...
September 2016: European Journal of Obstetrics, Gynecology, and Reproductive Biology
https://www.readbyqxmd.com/read/27354300/optimization-of-indirect-pressure-in-order-to-temporize-life-threatening-haemorrhage-a-simulation-study
#10
Matthew J Douma, Domhnall O'Dochartaigh, Peter G Brindley
BACKGROUND: Minimizing haemorrhage using direct pressure is intuitive and widely taught. In contrast, this study examines the use of indirect-pressure, specifically external aortic compression (EAC). Indirect pressure has great potential for temporizing bleeds not amenable to direct tamponade i.e. abdominal-pelvic, junctional, and multi-site trauma. However, it is currently unclear how to optimize this technique. METHODS: We designed a model of central vessel compression using the Malbrain intra-abdominal pressure monitor and digital weigh scale...
September 2016: Injury
https://www.readbyqxmd.com/read/26983963/the-neglected-role-of-abdominal-compliance-in-organ-organ-interactions
#11
REVIEW
Manu L N G Malbrain, Yannick Peeters, Robert Wise
This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency medicine 2016. Other selected articles can be found online at http://www.biomedcentral.com/collections/annualupdate2016. Further information about the Annual Update in Intensive Care and Emergency Medicine is available from http://www.springer.com/series/8901.
March 16, 2016: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/26891380/decompressive-laparotomy-for-abdominal-compartment-syndrome
#12
J J De Waele, E Kimball, M Malbrain, I Nesbitt, J Cohen, V Kaloiani, R Ivatury, M Mone, D Debergh, M Björck
BACKGROUND: The effect of decompressive laparotomy on outcomes in patients with abdominal compartment syndrome has been poorly investigated. The aim of this prospective cohort study was to describe the effect of decompressive laparotomy for abdominal compartment syndrome on organ function and outcomes. METHODS: This was a prospective cohort study in adult patients who underwent decompressive laparotomy for abdominal compartment syndrome. The primary endpoints were 28-day and 1-year all-cause mortality...
February 18, 2016: British Journal of Surgery
https://www.readbyqxmd.com/read/26849559/mechanical-intestinal-obstruction-in-a-porcine-model-effects-of-intra-abdominal-hypertension-a-preliminary-study
#13
L Correa-Martín, E Párraga, F M Sánchez-Margallo, R Latorre, O López-Albors, R Wise, M L N G Malbrain, G Castellanos
INTRODUCTION: Mechanical intestinal obstruction is a disorder associated with intra-abdominal hypertension and abdominal compartment syndrome. As the large intestine intraluminal and intra-abdominal pressures are increased, so the patient's risk for intestinal ischaemia. Previous studies have focused on hypoperfusion and bacterial translocation without considering the concomitant effect of intra-abdominal hypertension. The objective of this study was to design and evaluate a mechanical intestinal obstruction model in pigs similar to the human pathophysiology...
2016: PloS One
https://www.readbyqxmd.com/read/26661527/the-effects-of-advanced-monitoring-on-hemodynamic-management-in-critically-ill-patients-a-pre-and-post-questionnaire-study
#14
Azriel Perel, Bernd Saugel, Jean-Louis Teboul, Manu L N G Malbrain, Francisco Javier Belda, Enrique Fernández-Mondéjar, Mikhail Kirov, Julia Wendon, Roger Lussmann, Marco Maggiorini
In critically ill patients, many decisions depend on accurate assessment of the hemodynamic status. We evaluated the accuracy of physicians' conventional hemodynamic assessment and the impact that additional advanced monitoring had on therapeutic decisions. Physicians from seven European countries filled in a questionnaire in patients in whom advanced hemodynamic monitoring using transpulmonary thermodilution (PiCCO system; Pulsion Medical Systems SE, Feldkirchen, Germany) was going to be initialized as part of routine care...
October 2016: Journal of Clinical Monitoring and Computing
https://www.readbyqxmd.com/read/26588484/cardiac-ultrasonography-in-the-critical-care-setting-a-practical-approach-to-asses-cardiac-function-and-preload-for-the-non-cardiologist
#15
REVIEW
Guy L J Vermeiren, Manu L N G Malbrain, Jeroen M J B Walpot
Cardiac ultrasonography has become an indispensible tool in the management of hemodynamically unstable critically ill patients. Some consider it as the modern stethoscope. Echocardiography is non-invasive and safe while the modern portable devices allow to be used at the bedside in order to provide fast, specific and vital information regarding the hemodynamic status, as well as the function, structure and anatomy of the heart. In this review, we will give an overview of cardiac function in general followed by an assessment of left ventricular function using echocardiography with calculation of cardiac output, left ventricular ejection fraction (EF), fractional shortening, fractional area contraction, M mode EF, 2D planimetry and 3D volumetry...
2015: Anaesthesiology Intensive Therapy
https://www.readbyqxmd.com/read/26588483/intravenous-balanced-solutions-from-physiology-to-clinical-evidence
#16
REVIEW
Thomas Langer, Alessandro Santini, Eleonora Scotti, Niels Van Regenmortel, Manu L N G Malbrain, Pietro Caironi
"Balanced" solutions are commonly defined as intravenous fluids having an electrolyte composition close to that of plasma. As such, they should minimally affect acid-base equilibrium, as compared to the commonly reported 0.9% NaCl-related hyperchloremic metabolic acidosis. Recently, the term "balanced" solution has been also employed to indicate intravenous fluids with low chloride content, being the concentration of this electrolyte the most altered and supra-physiologic in 0.9% NaCl as compared to plasma, and based upon a suggested detrimental effect on renal function associated with hyperchloremia...
2015: Anaesthesiology Intensive Therapy
https://www.readbyqxmd.com/read/26588481/methodological-background-and-strategy-for-the-2012-2013-updated-consensus-definitions-and-clinical-practice-guidelines-from-the-abdominal-compartment-society
#17
REVIEW
Andrew W Kirkpatrick, Derek J Roberts, Roman Jaeschke, Jan J De Waele, Bart L De Keulenaer, Juan Duchesne, Martin Bjorck, Ari Leppäniemi, Janeth C Ejike, Michael Sugrue, Michael L Cheatham, Rao Ivatury, Chad G Ball, Annika Reintam Blaser, Adrian Regli, Zsolt Balogh, Scott D'Amours, Inneke De Laet, Manu L N G Malbrain
The Abdominal Compartment Society (www.wsacs.org) previously created highly cited Consensus Definitions/Management Guidelines related to intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS). Implicit in this previous work, was a commitment to regularly reassess and update in relation to evolving research. Two years preceding the Fifth World Congress on Abdominal Compartment Syndrome, an International Guidelines committee began preparation. An oversight/steering committee formulated key clinical questions regarding IAH/ /ACS based on polling of the Executive to redundancy, structured according to the Patient, Intervention, Comparator, and Outcome (PICO) format...
2015: Anaesthesiology Intensive Therapy
https://www.readbyqxmd.com/read/26588480/from-cardiac-output-to-blood-flow-auto-regulation-in-shock
#18
REVIEW
Hollmann D Aya, Andrea Carsetti, Simone Bazurro, Davide Bastoni, Manu L N G Malbrain, Maurizio Cecconi
Shock is defined as a state in which the circulation is unable to deliver sufficient oxygen to meet the demands of the tissues, resulting in cellular dysoxia and organ failure. In this process, the factors that govern the circulation at a haemodynamic level and oxygen delivery at a microcirculatory level play a major role. This manuscript aims to review the blood flow regulation from macro- and micro-haemodynamic point of view and to discuss new potential therapeutic approaches for cardiovascular instability in patients in cardiovascular shock...
2015: Anaesthesiology Intensive Therapy
https://www.readbyqxmd.com/read/26588479/incidence-and-prognosis-of-intra-abdominal-hypertension-and-abdominal-compartment-syndrome-in-severely-burned-patients-pilot-study-and-review-of-the-literature
#19
Robert Wise, Jimmy Jacobs, Sylvain Pilate, Ann Jacobs, Yannick Peeters, Stefanie Vandervelden, Niels Van Regenmortel, Inneke De Laet, Karen Schoonheydt, Hilde Dits, Manu L N G Malbrain
BACKGROUND: Burn patients are at high risk for secondary intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) due to capillary leak and large volume fluid resuscitation. Our objective was to examine the incidence the incidence of IAH and ACS and their relation to outcome in mechanically ventilated (MV) burn patients. METHODS: This observational study included all MV burn patients admitted between April 2007 and December 2009. Various physiological parameters, intra-abdominal pressure (IAP) measurements and severity scoring indices were recorded on admission and/or each day in ICU...
2016: Anaesthesiology Intensive Therapy
https://www.readbyqxmd.com/read/26588478/a-pilot-study-on-pharmacokinetic-pharmacodynamic-target-attainment-in-critically-ill-patients-receiving-piperacillin-tazobactam
#20
Jiřina Martínková, Manu L N G Malbrain, Eduard Havel, Petr Šafránek, Jan Bezouška, Milan Kaška
BACKGROUND: In critically ill patients, multi-trauma and intensive therapy can influence the pharmacokinetics (PK) and pharmacodynamics (PD) of antibiotics with time-dependent bacterial killing. Consequently, PK/PD targets (%fT>MIC) - crucial for antimicrobial effects -may not be attained. METHODS: Two patients admitted to the surgical ICU of the University Hospital in Hradec Králove for multiple-trauma were given piperacillin/tazobactam by 1-hour IV infusion 4/0...
2016: Anaesthesiology Intensive Therapy
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