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https://www.readbyqxmd.com/read/28346236/current-concepts-in-ischemic-hepatitis
#1
Joseph M Lightsey, Don C Rockey
PURPOSE OF REVIEW: The current review seeks to define ischemic hepatitis and its associated comorbidities. It means to review the pathophysiology, clinical presentation, clinical course, outcomes, and any potential therapies. RECENT FINDINGS: Ischemic hepatitis has long been associated with cardiovascular disease; recent reports have found a substantial link between preexisting cardiovascular disease and the risk for developing ischemic hepatitis. A proposed mechanism by which hepatic congestion predisposes the liver to hemodynamic injury further defines this link...
March 24, 2017: Current Opinion in Gastroenterology
https://www.readbyqxmd.com/read/28344751/management-of-critically-ill-patients-with-diabetes
#2
REVIEW
Livier Josefina Silva-Perez, Mario Alberto Benitez-Lopez, Joseph Varon, Salim Surani
Disorders of glucose homeostasis, such as stress-induced hypoglycemia and hyperglycemia, are common complications in patients in the intensive care unit. Patients with preexisting diabetes mellitus (DM) are more susceptible to hyperglycemia, as well as a higher risk from glucose overcorrection, that may results in severe hypoglycemia. In critically ill patients with DM, it is recommended to maintain a blood glucose range between 140-180 mg/dL. In neurological patients and surgical patients, tighter glycemic control (i...
March 15, 2017: World Journal of Diabetes
https://www.readbyqxmd.com/read/28344147/evaluation-of-deprescribing-amiodarone-after-new-onset-atrial-fibrillation-in-critical-illness
#3
Areerut Leelathanalerk, Wannisa Dongtai, Yvonne Huckleberry, Brian Kopp, John Bloom, Joseph Alpert
BACKGROUND: Recent studies have shed light on the continued prescription of inpatient medications upon hospital discharge despite the original intent of short-term inpatient therapy. Amiodarone, an antiarrhythmic associated with significant adverse effects with long-term use, is commonly used for new-onset atrial fibrillation in critical illness (NAFCI). While it is often preferred in this setting of hemodynamic instability, a prescription for long-term use should be carefully considered, preferably by a cardiologist...
March 23, 2017: American Journal of Medicine
https://www.readbyqxmd.com/read/28343681/ultrasound-evaluation-of-diaphragm-function-and-its-application-in-critical-patients-mechanical-ventilation-and-brachial-plexus-block
#4
F de B de la Quintana Gordon, B Nacarino Alcorta, M Fajardo Pérez
Before diaphragm ultrasonography, assessment of diaphragm function was very difficult due to the complex nature of its exploration. The use of this new technique has shed light on diagnostic problems and treatment with an improvement in final outcomes for critically ill patients, in whom the incidence of diaphragm weakness or dysfunction has been underestimated. Better knowledge of diaphragm function enables us earlier diagnosis by quantification of diaphragm contractile activity or evaluation of functional status after delivery of plexus block anaesthesia, facilitating therapeutic decisions...
March 23, 2017: Revista Española de Anestesiología y Reanimación
https://www.readbyqxmd.com/read/28343448/hemoadsorption-by-cytosorb-in-septic-patients-a-case-series
#5
Klaus Kogelmann, Dominik Jarczak, Morten Scheller, Matthias Drüner
BACKGROUND: Septic shock, defined as life-threatening organ dysfunction caused by a dysregulated host response to infection, is a highly lethal condition that causes substantial morbidity and mortality among critically ill patients. One of the hallmarks of sepsis is the excessive release of cytokines and other inflammatory mediators causing refractory hypotension, tissue damage, metabolic acidosis and ultimately multiple organ failure. In this context, cytokine reduction by hemoadsorption represents a new concept for blood purification, developed to attenuate the overwhelming systemic levels of pro-inflammatory and anti-inflammatory mediators released in the early phase of sepsis...
March 27, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/28343416/cuff-leak-test-for-the-diagnosis-of-post-extubation-stridor
#6
David Schnell, Benjamin Planquette, Asaël Berger, Sybille Merceron, Julien Mayaux, Lucas Strasbach, Stéphane Legriel, Sandrine Valade, Michael Darmon, Ferhat Meziani
BACKGROUND: Cuff leak test was developed to predict the occurrence of post-extubation stridor (PES). This study evaluated the diagnostic performance of this test in unselected critically ill patients. METHODS: Multicenter prospective study including unselected ventilated patients at the time of their first planned extubation. The diagnostic performance of 4 different cuff leak tests was assessed. RESULTS: Post-extubation stridor occurred in 34 (9...
January 1, 2017: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/28342442/comparison-of-qsofa-and-sirs-for-predicting-adverse-outcomes-of-patients-with-suspicion-of-sepsis-outside-the-intensive-care-unit
#7
Eli J Finkelsztein, Daniel S Jones, Kevin C Ma, Maria A Pabón, Tatiana Delgado, Kiichi Nakahira, John E Arbo, David A Berlin, Edward J Schenck, Augustine M K Choi, Ilias I Siempos
BACKGROUND: The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) Task Force recently introduced a new clinical score termed quick Sequential (Sepsis-related) Organ Failure Assessment (qSOFA) for identification of patients at risk of sepsis outside the intensive care unit (ICU). We attempted to compare the discriminatory capacity of the qSOFA versus the Systemic Inflammatory Response Syndrome (SIRS) score for predicting mortality, ICU-free days, and organ dysfunction-free days in patients with suspicion of infection outside the ICU...
March 26, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/28341612/impact-of-%C3%AE-lactam-antibiotic-therapeutic-drug-monitoring-on-dose-adjustments-in-critically-ill-patients-undergoing-continuous-renal-replacement-therapy
#8
Caleb J P Economou, Gloria Wong, Brett McWhinney, Jacobus P J Ungerer, Jeffrey Lipman, Jason A Roberts
The objective of this study was to describe the effect of therapeutic drug monitoring (TDM) and dose adjustments of β-lactam antibiotics administered to critically ill patients undergoing continuous renal replacement therapy (CRRT) in a 30-bed tertiary intensive care unit (ICU). β-Lactam TDM data in our tertiary referral ICU were retrospectively reviewed. Clinical, demographic and dosing data were collected for patients administered β-lactam antibiotics while undergoing CRRT. The target trough concentration range was 1-10× the minimum inhibitory concentration (MIC)...
March 21, 2017: International Journal of Antimicrobial Agents
https://www.readbyqxmd.com/read/28341498/natural-history-of-iatrogenic-pediatric-femoral-artery-injury
#9
Elizabeth A Andraska, Tatum Jackson, Huiting Chen, Katherine A Gallagher, Jonathan L Eliason, Dawn M Coleman
INTRODUCTION: Iatrogenic femoral artery trauma complicates the course of critically-ill neonates and children. Complications from persistent arterial occlusion include claudication and limb length discrepancies. Data supporting risk factors for such and need for revascularization are lacking. METHODS: Review of a prospectively maintained database at a tertiary institution of iatrogenic pediatric femoral artery injuries incurred between 2013-2014 was performed. Additional injuries were identified by review of pediatric arterial duplex performed between 2008-2013...
March 21, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/28341258/treatment-costs-of-burn-victims-in-a-university-hospital
#10
Elza H T Anami, Elisangela F Zampar, Marcos T Tanita, Lucienne T Q Cardoso, Tiemi Matsuo, Cintia Magalhães C Grion
OBJECTIVES: To analyze the direct costs of treating critically ill patients in the intensive care unit of a center specializing in treating burns. METHODS: This is a prospective cohort study of 180 patients from May 2011 to May 2013. Clinical and demographic data were collected in addition to data for the calculation of severity scores. The costs related to daily clinical and surgical treatment were evaluated until hospital outcome. The costs were grouped into five blocks: Clinical support, Drugs and blood products, Medical procedures, Specific burn procedures and Hospital fees...
March 2017: Burns: Journal of the International Society for Burn Injuries
https://www.readbyqxmd.com/read/28338497/using-selective-serotonin-reuptake-inhibitors-and-serotonin-norepinephrine-reuptake-inhibitors-in-critical-care-a-systematic-review-of-the-evidence-for-benefit-or-harm
#11
John M Kelly, Gordon D Rubenfeld, Neil Masson, Arimie Min, Neill K J Adhikari
OBJECTIVE: Selective serotonin reuptake inhibitor/serotonin-norepinephrine reuptake inhibitors are among the most commonly prescribed drugs in patients admitted to the ICU. Our objective was to systematically review available literature for evidence of benefit or harm in ICU patients resulting from chronic effects, continued use, or withdrawal. DATA SOURCES: Medline, Embase, and Cochrane Central Register of Controlled Trials (1990 to November 2014). STUDY SELECTION: We searched for studies of ICU patients with recorded selective serotonin reuptake inhibitor/serotonin-norepinephrine reuptake inhibitor prescription before or during admission, and reporting morbidity, mortality, adverse events, and resource measures like ICU length of stay...
March 23, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28337082/pharmacokinetics-of-peramivir-in-an-adolescent-patient-receiving-continuous-venovenous-hemodiafiltration
#12
Ryan C Dillon, Robert Witcher, Jeffrey J Cies, Wayne S Moore, Arun Chopra
Critically ill patients requiring renal replacement therapy commonly experience pharmacokinetic alterations. This case report describes the pharmacokinetics of peramivir (Rapivab, BioCryst Pharmaceuticals, Inc, Durham, NC), the first US Food and Drug Administration-approved intravenous neuraminidase inhibitor for the treatment of influenza, in an adolescent patient receiving continuous renal replacement therapy (CRRT). A 49.5-kg, 17-year-old Caucasian female presented with fever, cough, and persistent hypoxia...
January 2017: Journal of Pediatric Pharmacology and Therapeutics: JPPT: the Official Journal of PPAG
https://www.readbyqxmd.com/read/28337077/antithrombin-iii-doses-rounded-to-available-vial-sizes-in-critically-ill-pediatric-patients
#13
Winifred M Stockton, Eimeira Padilla-Tolentino, Carolyn E Ragsdale
OBJECTIVES: Children have decreased levels of antithrombin III (AT III) compared to adults. These levels may be further decreased during acute illness. Administration of exogenous AT III can increase anticoagulant efficacy. The objective of this study was to evaluate AT III doses rounded to available vial sizes compared to partial vial doses in critically ill pediatric patients, including patients receiving extracorporeal membrane oxygenation (ECMO) and continuous renal replacement therapy (CRRT)...
January 2017: Journal of Pediatric Pharmacology and Therapeutics: JPPT: the Official Journal of PPAG
https://www.readbyqxmd.com/read/28335733/effects-of-short-term-hyperoxia-on-erythropoietin-levels-and-microcirculation-in-critically-ill-patients-a-prospective-observational-pilot-study
#14
Abele Donati, Elisa Damiani, Samuele Zuccari, Roberta Domizi, Claudia Scorcella, Massimo Girardis, Alessia Giulietti, Arianna Vignini, Erica Adrario, Rocco Romano, Laura Mazzanti, Paolo Pelaia, Mervyn Singer
BACKGROUND: The normobaric oxygen paradox states that a short exposure to normobaric hyperoxia followed by rapid return to normoxia creates a condition of 'relative hypoxia' which stimulates erythropoietin (EPO) production. Alterations in glutathione and reactive oxygen species (ROS) may be involved in this process. We tested the effects of short-term hyperoxia on EPO levels and the microcirculation in critically ill patients. METHODS: In this prospective, observational study, 20 hemodynamically stable, mechanically ventilated patients with inspired oxygen concentration (FiO2) ≤0...
March 23, 2017: BMC Anesthesiology
https://www.readbyqxmd.com/read/28335673/modifiable-risk-factors-for-delirium-in-critically-ill-trauma-patients
#15
Marc-Alexandre Duceppe, David R Williamson, Audrée Elliott, Mélissa Para, Marie-Christine Poirier, Marie-Soleil Delisle, Dan Deckelbaum, Tarek Razek, Monique Desjardins, Jean-Claude Bertrand, Francis Bernard, Philippe Rico, Lisa Burry, Anne Julie Frenette, Marc Perreault
OBJECTIVE: Intensive care unit (ICU)-acquired delirium has been associated with increased morbidity and mortality. Prevention strategies including modification of delirium risk factors are emphasized by practice guidelines. No study has specifically evaluated modifiable delirium risk factors in trauma ICU patients. Our goal was to evaluate modifiable risk factors for delirium among trauma patients admitted to the ICU. DESIGN: Prospective observational study. SETTING: Two level 1 trauma ICU centers...
January 1, 2017: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/28333761/race-ethnicity-health-insurance-and-mortality-in-older-survivors-of-critical-illness
#16
Matthew R Baldwin, Jessica L Sell, Nina Heyden, Azka Javaid, David A Berlin, Wendy C Gonzalez, Peter B Bach, Mathew S Maurer, Gina S Lovasi, David J Lederer
OBJECTIVES: To determine whether minority race or ethnicity is associated with mortality and mediated by health insurance coverage among older (≥ 65 yr old) survivors of critical illness. DESIGN: A retrospective cohort study. SETTING: Two New York City academic medical centers. PATIENTS: A total of 1,947 consecutive white (1,107), black (361), and Hispanic (479) older adults who had their first medical-ICU admission from 2006 through 2009 and survived to hospital discharge...
March 22, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28333760/antibiotic-associated-apoptotic-enterocolitis-in-the-absence-of-a-defined-pathogen-the-role-of-intestinal-microbiota-depletion
#17
Philipp Wurm, Walter Spindelboeck, Robert Krause, Johannes Plank, Gottfried Fuchs, Mina Bashir, Wolfgang Petritsch, Bettina Halwachs, Cord Langner, Christoph Högenauer, Gregor Gorkiewicz
OBJECTIVE: Antibiotic therapy is a major risk factor for the development of diarrhea and colitis with varying severity. Often the origin of antibiotic-associated gastrointestinal deterioration remains elusive and no specific infectious agents could be discerned. PATIENTS: We represent three cases of intractable high-volume diarrhea associated with combined antibiotic and steroid therapy in critically ill patients not fitting into established disease entities. Cases presented with severe apoptotic enterocolitis resembling acute intestinal graft-versus-host-disease...
March 22, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28333347/polymyxin-resistant-carbapenem-resistant-acinetobacter-baumannii-is-eradicated-by-a-triple-combination-of-agents-that-lack-individual-activity
#18
Justin R Lenhard, Visanu Thamlikitkul, Fernanda P Silveira, Samira M Garonzik, Xun Tao, Alan Forrest, Beom Soo Shin, Keith S Kaye, Jürgen B Bulitta, Roger L Nation, Jian Li, Brian T Tsuji
Objectives: The emergence of polymyxin resistance threatens to leave clinicians with few options for combatting drug-resistant Acinetobacter baumannii . The objectives of the current investigation were to define the in vitro emergence of polymyxin resistance and identify a combination regimen capable of eradicating A. baumannii with no apparent drug susceptibilities. Methods: Two clonally related, paired, A. baumannii isolates collected from a critically ill patient who developed colistin resistance while receiving colistin methanesulfonate in a clinical population pharmacokinetic study were evaluated: an A...
February 28, 2017: Journal of Antimicrobial Chemotherapy
https://www.readbyqxmd.com/read/28333037/cerebral-hemodynamic-with-intra-aortic-balloon-pump-business-as-usual
#19
Juliana Caldas, Ronney B Panerai, Edson Bor-Seng-Shu, Juliano Almeida, Graziela Ferreira, Ligia Cunha, Ricardo Nogueira, Marcelo Oliveira, Fabio Jatene, Thompson Robinson, Ludhmila Hajjar
Intra-aortic balloon pump (IABP) is commonly used as mechanical support after cardiac surgery or cardiac shock. Although its benefits for cardiac function have been well documented, its effects on cerebral circulation are still controversial. We hypothesized that transfer function analysis (TFA) and continuous estimates of dynamic cerebral autoregulation (CA) provide consistent results in the assessment of cerebral autoregulation in patients with IABP. Continuous recordings of blood pressure (BP, intra-arterial line), end-tidal CO2, heart rate and cerebral blood flow velocity (CBFV, transcranial Doppler) were obtained i) 5 minutes with IABP ratio 1:3, ii) 5 minutes, starting 1 minute with the IABP-ON, and continuing for another 4 minutes without pump assistance (IABP-OFF)...
March 23, 2017: Physiological Measurement
https://www.readbyqxmd.com/read/28332876/evaluation-and-management-of-adrenal-insufficiency-in-critically-ill-patientsdisease-state-review
#20
Amir H Hamrahian, Maria Fleseriu
Definition of normal adrenal function in critically ill patients remains controversial, despite a large body of literature. Furthermore, evaluation of adrenal function in these patients is complex. A decrease in cortisol breakdown rather than an increase in cortisol production has been suggested as the main contributor to elevated cortisol levels in critically ill patients. The concept of relative adrenal insufficiency has multiple pathophysiological flaws and is not supported by current evidence. Patients with septic shock who are pressor-dependent or refractory to fluid resuscitation should receive a short course of hydrocortisone regardless of their serum cortisol levels or their response to a Cosyntropin stimulation test (CST)...
March 23, 2017: Endocrine Practice
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