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https://www.readbyqxmd.com/read/27908340/end-points-of-sepsis-resuscitation
#1
REVIEW
John C Greenwood, Clinton J Orloski
Resuscitation goals for the patient with sepsis and septic shock are to return the patient to a physiologic state that promotes adequate end-organ perfusion along with matching metabolic supply and demand. Ideal resuscitation end points should assess the adequacy of tissue oxygen delivery and oxygen consumption, and be quantifiable and reproducible. Despite years of research, a single resuscitation end point to assess adequacy of resuscitation has yet to be found. Thus, the clinician must rely on multiple end points to assess the patient's overall response to therapy...
February 2017: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/27903260/clinical-physiologic-and-radiographic-factors-contributing-to-development-of-hypoxemia-in-moderate-to-severe-copd-a-cohort-study
#2
J Michael Wells, Raul San Jose Estepar, Merry-Lynn N McDonald, Surya P Bhatt, Alejandro A Diaz, William C Bailey, Francine L Jacobson, Mark T Dransfield, George R Washko, Barry J Make, Richard Casaburi, Edwin J R van Beek, Eric A Hoffman, Frank C Sciurba, James D Crapo, Edwin K Silverman, Craig P Hersh
BACKGROUND: Hypoxemia is a major complication of COPD and is a strong predictor of mortality. We previously identified independent risk factors for the presence of resting hypoxemia in the COPDGene cohort. However, little is known about characteristics that predict onset of resting hypoxemia in patients who are normoxic at baseline. We hypothesized that a combination of clinical, physiologic, and radiographic characteristics would predict development of resting hypoxemia after 5-years of follow-up in participants with moderate to severe COPD METHODS: We analyzed 678 participants with moderate-to-severe COPD recruited into the COPDGene cohort who completed baseline and 5-year follow-up visits and who were normoxic by pulse oximetry at baseline...
December 1, 2016: BMC Pulmonary Medicine
https://www.readbyqxmd.com/read/27894154/perfusion-controlled-mobilization-after-lower-extremity-free-flaps-pushing-the-limits-of-time-and-intensity
#3
Ulf Dornseifer, Charlotte Kleeberger, Lukas Kargl, Markus Schönberger, Daniel Rohde, Milomir Ninkovic, Arndt Schilling
Background The current standard to gradually adapt the fragile perfusion in lower extremity free flaps to an upright posture is the dangling maneuver. This type of flap training neither fits the orthostatic target load of an upright posture, nor does it assist in mobilizing the patients effectively. In this study, we quantitatively analyzed training effects of an early and full mobilization on flap perfusion. Methods A total of 15 patients with gracilis flaps for distal lower extremity reconstruction were included...
November 28, 2016: Journal of Reconstructive Microsurgery
https://www.readbyqxmd.com/read/27888413/improving-manual-oxygen-titration-in-preterm-infants-by-training-and-guideline-implementation
#4
Henriëtte A van Zanten, Steffen C Pauws, Evelien C Beks, Ben J Stenson, Enrico Lopriore, Arjan B Te Pas
: To study oxygen saturation (SpO2) targeting before and after training and guideline implementation of manual oxygen titration, two cohorts of preterm infants <30 weeks of gestation needing respiratory support and oxygen therapy were compared. The percentage of the time spent with SpO2 within the target range (85-95%) was calculated (%SpO2-wtr). SpO2 was collected every minute when oxygen is >21%. ABCs where oxygen therapy was given were identified and analyzed. After training and guideline implementation the %SpO2-wtr increased (median interquartile range (IQR)) 48...
November 26, 2016: European Journal of Pediatrics
https://www.readbyqxmd.com/read/27881420/elongation-of-long-chain-fatty-acid-family-member-6-elovl6-driven-fatty-acid-metabolism-regulates-vascular-smooth-muscle-cell-phenotype-through-amp-activated-protein-kinase-kr%C3%A3-ppel-like-factor-4-ampk-klf4-signaling
#5
Hiroaki Sunaga, Hiroki Matsui, Saki Anjo, Mas Risky A A Syamsunarno, Norimichi Koitabashi, Tatsuya Iso, Takashi Matsuzaka, Hitoshi Shimano, Tomoyuki Yokoyama, Masahiko Kurabayashi
BACKGROUND: Fatty acids constitute the critical components of cell structure and function, and dysregulation of fatty acid composition may exert diverging vascular effects including proliferation, migration, and differentiation of vascular smooth muscle cells (VSMCs). However, direct evidence for this hypothesis has been lacking. We investigated the role of elongation of long-chain fatty acid member 6 (Elovl6), a rate-limiting enzyme catalyzing the elongation of saturated and monounsaturated long-chain fatty acid, in the regulation of phenotypic switching of VSMC...
November 23, 2016: Journal of the American Heart Association
https://www.readbyqxmd.com/read/27853941/pulse-oximeter-saturation-target-limits-for-preterm-infants-a-survey-among-european-neonatal-intensive-care-units
#6
Maurice J Huizing, Eduardo Villamor-Martínez, Máximo Vento, Eduardo Villamor
: The optimum range of pulse oximeter oxygen saturation (SpO2) for preterm infants remains controversial. Between November 2015 and February 2016, we conducted a web-based survey aimed to investigate the current and former practices on SpO2 targets in European neonatal intensive care units (NICUs). We obtained valid responses from 193 NICUs, treating 8590 newborns ≤28 weeks per year, across 27 countries. Forty different saturation ranges were reported, ranging from 82-93 to 94-99%...
November 16, 2016: European Journal of Pediatrics
https://www.readbyqxmd.com/read/27834782/alarms-oxygen-saturations-and-spo2-averaging-time-in-the-nicu
#7
C McClure, S Young Jang, K Fairchild
BACKGROUND: Alarm overload is a significant concern in the Neonatal Intensive Care Unit (NICU). Selecting a longer oxygen saturation (SpO2) averaging time will reduce the number of alarms but may mask fluctuations in oxygenation. OBJECTIVE: Characterize bedside monitor alarms in the NICU and estimate the impact of longer SpO2 averaging time and alarm delay. METHODS: All bedside monitor alarms were analyzed over a 12-month period in the University of Virginia NICU, using the default averaging time (8 seconds) and SpO2 alarm limits set at 88-95% for infants on supplemental oxygen...
November 9, 2016: Journal of Neonatal-perinatal Medicine
https://www.readbyqxmd.com/read/27809868/efficacy-of-naloxone-in-reducing-postictal-central-respiratory-dysfunction-in-patients-with-epilepsy-study-protocol-for-a-double-blind-randomized-placebo-controlled-trial
#8
Sylvain Rheims, Luc Valton, Véronique Michel, Louis Maillard, Vincent Navarro, Philippe Convers, Fabrice Bartolomei, Arnaud Biraben, Arielle Crespel, Philippe Derambure, Bertrand de Toffol, Edouard Hirsch, Philippe Kahane, Martine Lemesle Martin, Didier Tourniaire, Sébastien Boulogne, Catherine Mercier, Pascal Roy, Philippe Ryvlin
BACKGROUND: Generalized tonic-clonic seizures (GTCSs) are the main risk factor for sudden unexpected death in epilepsy (SUDEP). Experimental and clinical data strongly suggest that the majority of SUDEP results from a postictal respiratory dysfunction progressing to terminal apnea. Postictal apnea could partly derive from a seizure-induced massive release of endogenous opioids. The main objective of this study is to evaluate the efficacy of an opioid antagonist, naloxone, administered in the immediate aftermath of a GTCS, in reducing the severity of the postictal central respiratory dysfunction...
November 3, 2016: Trials
https://www.readbyqxmd.com/read/27794080/automatic-oxygen-titration-during-walking-in-subjects-with-copd-a-randomized-crossover-controlled-study
#9
François Lellouche, Erwan L'Her, Pierre-Alexandre Bouchard, Cynthia Brouillard, François Maltais
BACKGROUND: Arterial oxygen desaturation frequently occurs in patients with COPD during daily activities at home. Oxygen flow is usually set at fixed and low rates for ambulatory patients. We evaluated an innovative closed-loop system (FreeO2) that automatically adjusts the oxygen flow to the patient's needs in subjects with COPD during walking followed by recovery time, such as during ambulatory conditions. METHODS: Patients with COPD who exhibited oxygen desaturation on exertion were included in the study...
November 2016: Respiratory Care
https://www.readbyqxmd.com/read/27790498/massive-pulmonary-embolism-in-a-patient-using-warfarin-at-therapeutic-dose
#10
Sunnetcioglu Aysel, Esen Ramazan, Arisoy Ahmet
Warfarin sodium is commonly used for the prevention and treatment of thromboembolism. The efficacy of warfarin therapy depends on maintaining the International Normalised Ratio (INR) within the target range for the indication. A 56-year-old male presented to the emergency department with dyspnea and chest pain, together with pain and swelling in both legs. The patient had been taking warfarin at the therapeutic dose since having undergone an aortic valve replacement four years ago. His vital signs were an arterial pressure of 60/30 heart rate of 138 beats per minute, respiratory rate of 30 per minute and oxygen saturation of 60%...
September 2016: Journal of Clinical and Diagnostic Research: JCDR
https://www.readbyqxmd.com/read/27788834/more-is-not-always-better-at-least-when-it-comes-to-oxygen-saturation-target-goals
#11
Clyde J Wright
No abstract text is available yet for this article.
November 2016: Journal of Pediatrics
https://www.readbyqxmd.com/read/27782315/minimally-circulatory-assisted-on-pump-beating-coronary-artery-bypass-grafting-for-patients-with-complex-conditions-for-off-pump-surgery
#12
Tomohiro Mizuno, Koso Egi, Kenji Sakai, Keiji Oi, Tsuyoshi Hachimaru, Tohru Makita, Kiyotoshi Oishi, Hirokuni Arai
Off-pump coronary artery bypass grafting (OPCAB) in patients with acute myocardial infarction (AMI) is difficult because of circulatory deterioration during displacement of the heart. At our institution, we performed minimally circulatory-assisted on-pump beating coronary artery bypass grafting (MICAB) in these patients. During MICAB, support flow was controlled at a minimal level to maintain a systemic blood pressure of approximately 100 mm Hg and a pulmonary arterial systolic pressure of <30 mm Hg, providing optimal pulsatile circulation for end-organ perfusion and prevention of heart congestion...
October 26, 2016: Artificial Organs
https://www.readbyqxmd.com/read/27774825/optimum-treatment-of-vasopressor-dependent-distributive-shock
#13
Jean-Louis Vincent, Marc Leone
Distributive shock is associated with decreased systemic vascular resistance and altered oxygen extraction. Septic shock is the most frequent form of distributive shock. In shock states, duration of hypotension is associated with poor outcomes. The speed at which treatment to restore adequate perfusion pressure is initiated is, therefore, important to improve survival. Areas covered: This review presents an overview of the literature related to the management of vasopressor-dependent distributive shock, and in particular the relationship between arterial pressure and organ perfusion and function...
November 7, 2016: Expert Review of Anti-infective Therapy
https://www.readbyqxmd.com/read/27756324/acid-sphingomyelinase-as-target-of-lycium-chinense-promising-new-action-for-cell-health
#14
Maria Rachele Ceccarini, Michela Codini, Samuela Cataldi, Samuele Vannini, Andrea Lazzarini, Alessandro Floridi, Massimo Moretti, Milena Villarini, Bernard Fioretti, Tommaso Beccari, Elisabetta Albi
BACKGROUND: Sphingomyelin plays very important roles in cell function under physiological and pathological conditions. Physical and chemical stimuli produce reactive oxygen species that stimulate acid sphingomyelinase to induce apoptosis. Antioxidant plants of the traditional Chinese Pharmacopoeia, such as Lycium Barbarum and Lycium Chinense, have become increasingly popular in Western countries. We investigated the effects of Lycium Chinense on acid sphingomyelinase and sphingomyelin species in relation to gene expression...
October 19, 2016: Lipids in Health and Disease
https://www.readbyqxmd.com/read/27722456/triggering-apoptosis-in-cancer-cells-with-an-analogue-of-cribrostatin-6-that-elevates-intracellular-ros
#15
D J Asby, M G Radigois, D C Wilson, F Cuda, C L L Chai, A Chen, A S Bienemann, M E Light, D C Harrowven, A Tavassoli
Elevation of reactive oxygen species (ROS) is both a consequence and driver of the upregulated metabolism and proliferation of transformed cells. The resulting increase in oxidative stress is postulated to saturate the cellular antioxidant machinery, leaving cancer cells susceptible to agents that further elevate their intracellular oxidative stress. Several small molecules, including the marine natural product cribrostatin 6, have been demonstrated to trigger apoptosis in cancer cells by increasing intracellular ROS...
October 4, 2016: Organic & Biomolecular Chemistry
https://www.readbyqxmd.com/read/27720550/igf-i-in-the-clinics-use-in-retinopathy-of-prematurity
#16
Ann Hellström, David Ley, Ingrid Hansen-Pupp, Boubou Hallberg, Luca A Ramenghi, Chatarina Löfqvist, Lois E H Smith, Anna-Lena Hård
Retinopathy of prematurity is a potentially blinding disease, which is associated with low neonatal IGF-I serum concentrations and poor growth. In severe cases impaired retinal vessel growth is followed by pathologic neovascularization, which may lead to retinal detachment. IGF-I may promote growth even in catabolic states. Treating preterm infants with recombinant human (rh) IGF-I to concentrations normally found during gestation has been suggested to have a preventative effect on ROP. A recent phase 2 study treating infants (gestational age between 23weeks+0days and 27weeks +6days) with rhIGF-I/IGF binding protein-3 until 30 postmenstrual weeks showed no effect on ROP but a 53% reduction in severe bronchopulmonary dysplasia and 44% reduction in severe intraventricular hemorrhage...
September 28, 2016: Growth Hormone & IGF Research
https://www.readbyqxmd.com/read/27716370/near-infrared-spectroscopy-for-assessing-tissue-oxygenation-and-microvascular-reactivity-in-critically-ill-patients-a-prospective-observational-study
#17
Abele Donati, Elisa Damiani, Roberta Domizi, Claudia Scorcella, Andrea Carsetti, Stefania Tondi, Valentina Monaldi, Erica Adrario, Rocco Romano, Paolo Pelaia, Mervyn Singer
BACKGROUND: Impaired microcirculatory perfusion and tissue oxygenation during critical illness are associated with adverse outcome. The aim of this study was to detect alterations in tissue oxygenation or microvascular reactivity and their ability to predict outcome in critically ill patients using thenar near-infrared spectroscopy (NIRS) with a vascular occlusion test (VOT). METHODS: Prospective observational study in critically ill adults admitted to a 12-bed intensive care unit (ICU) of a University Hospital...
October 1, 2016: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/27716227/modified-mallampati-classification-in-determining-the-success-of-unsedated-transesophageal-echocardiography-procedure-in-patients-with-heart-disease-simple-but-efficient
#18
Jureerat Khongkaew, Dujdao Sahasthas, Tharrittawadha Potat, Phatchara Thammawirat
BACKGROUND: The transesophageal echocardiograhpy (TEE) has been studied worldwide. However, identifying additional factors on top of operator's experience and patient's cooperation which could influence the success of the procedure in unsedated patients with heart disease  is not well documented. METHODS: Under the cross-sectional descriptive design, 85 target patients were fulfilling the criteria: being Thai national at the age of at least 20-year-old, being performed TEE by the study participant's cardiologists, being able to communicate verbally...
October 5, 2016: Cardiovascular Ultrasound
https://www.readbyqxmd.com/read/27694098/prediction-of-sepsis-in-the-intensive-care-unit-with-minimal-electronic-health-record-data-a-machine-learning-approach
#19
Thomas Desautels, Jacob Calvert, Jana Hoffman, Melissa Jay, Yaniv Kerem, Lisa Shieh, David Shimabukuro, Uli Chettipally, Mitchell D Feldman, Chris Barton, David J Wales, Ritankar Das
BACKGROUND: Sepsis is one of the leading causes of mortality in hospitalized patients. Despite this fact, a reliable means of predicting sepsis onset remains elusive. Early and accurate sepsis onset predictions could allow more aggressive and targeted therapy while maintaining antimicrobial stewardship. Existing detection methods suffer from low performance and often require time-consuming laboratory test results. OBJECTIVE: To study and validate a sepsis prediction method, InSight, for the new Sepsis-3 definitions in retrospective data, make predictions using a minimal set of variables from within the electronic health record data, compare the performance of this approach with existing scoring systems, and investigate the effects of data sparsity on InSight performance...
September 30, 2016: JMIR Medical Informatics
https://www.readbyqxmd.com/read/27686326/association-of-microcirculation-macrocirculation-and-severity-of-illness-in-septic-shock-a-prospective-observational-study-to-identify-microcirculatory-targets-potentially-suitable-for-guidance-of-hemodynamic-therapy
#20
Timo Sturm, Julia Leiblein, Verena Schneider-Lindner, Thomas Kirschning, Manfred Thiel
PURPOSE: Clinically unapparent microcirculatory impairment is common and has a negative impact on septic shock, but specific therapy is not established so far. This prospective observational study aimed at identifying candidate parameters for microcirculatory-guided hemodynamic therapy. CLINICALTRIALSGOV: NCT01530932. MATERIALS AND METHODS: Microcirculatory flow and postcapillary venous oxygen saturation were detected during vaso-occlusive testing (VOT) on days 1 (T0), 2 (T24), and 4 (T72) in 20 patients with septic shock at a surgical intensive care unit using a laser Doppler spectrophotometry system (O2C)...
September 29, 2016: Journal of Intensive Care Medicine
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