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https://www.readbyqxmd.com/read/28742869/ultrasound-non-invasive-measurement-of-intracranial-pressure-in-neurointensive-care-a-prospective-observational-study
#1
Chiara Robba, Danilo Cardim, Tamara Tajsic, Justine Pietersen, Michael Bulman, Joseph Donnelly, Andrea Lavinio, Arun Gupta, David K Menon, Peter J A Hutchinson, Marek Czosnyka
BACKGROUND: The invasive nature of the current methods for monitoring of intracranial pressure (ICP) has prevented their use in many clinical situations. Several attempts have been made to develop methods to monitor ICP non-invasively. The aim of this study is to assess the relationship between ultrasound-based non-invasive ICP (nICP) and invasive ICP measurement in neurocritical care patients. METHODS AND FINDINGS: This was a prospective, single-cohort observational study of patients admitted to a tertiary neurocritical care unit...
July 2017: PLoS Medicine
https://www.readbyqxmd.com/read/28742550/can-concurrent-abnormalities-in-free-light-chains-and-immunoglobulin-concentrations-identify-a-target-population-for-immunoglobulin-trials-in-sepsis
#2
Manu Shankar-Hari, Mervyn Singer, Jo Spencer
OBJECTIVES: Light chains κ and λ are immunoglobulin constituents but also circulate independently in blood as free light chains. We investigated whether a concomitant abnormality in free light chain and immunoglobulin levels could identify a high risk of death sepsis subpopulation to inform future IV immunoglobulin trials. We tested whether light chain allelic inclusion occurs in circulating B cells. DESIGN: Prospective cohort study. SETTING: Adult general ICUs...
July 22, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28742535/-anonymous-meltdown-content-themes-emerging-in-a-nonfacilitated-peer-only-unstructured-asynchronous-online-support-group-for-family-caregivers
#3
Cynthia A Diefenbeck, Paula R Klemm, Evelyn R Hayes
By providing care for loved ones in the home, family caregivers save millions of dollars for our overtaxed healthcare system. Support groups can lighten the psychological burden of caregiving. Nonprofessionally facilitated (or peer) online caregiver support groups can help meet a critical need in healthcare as a low-cost resource for caregivers. Online caregiver peer support groups can promote the health and well-being of family caregivers and, by extension, the patients themselves, resulting in cost-savings for society...
July 25, 2017: Computers, Informatics, Nursing: CIN
https://www.readbyqxmd.com/read/28742432/controversies-surrounding-critical-care-nutrition-an-appraisal-of-permissive-underfeeding-protein-and-outcomes
#4
Jayshil J Patel, Robert G Martindale, Stephen A McClave
Over the past few years, numerous studies have called into question the optimal dose, timing, composition, and advancement rate of nutrition during the early acute phase of critical illness. These studies suggest permissive underfeeding with slow advancement may be more beneficial than aggressive full feeding. These counterintuitive results were possibly explained by enhanced autophagy, less hyperglycemia, or prevention of refeeding syndrome. This review underscores the controversies surrounding permissive underfeeding, aims to answer whether permissive underfeeding is appropriate for all critically ill patients, describes the impact of optimal protein delivery on critical care outcomes, discusses nutrition risk, and cogitates on the impact of nutrition on critical care outcomes...
July 1, 2017: JPEN. Journal of Parenteral and Enteral Nutrition
https://www.readbyqxmd.com/read/28741229/inhaled-antimicrobials-for-ventilator-associated-pneumonia-practical-aspects
#5
Garyphallia Poulakou, Dimitrios K Matthaiou, David P Nicolau, Georgios Siakallis, George Dimopoulos
Positive experience with inhaled antibiotics in pulmonary infections of patients with cystic fibrosis has paved the way for their utilization in mechanically ventilated, critically ill patients with lower respiratory tract infections. A successful antibiotic delivery depends upon the size of the generated particle and the elimination of drug impaction in the large airways and the ventilator circuit. Generated droplet size is mainly affected by the type of the nebulizer employed. Currently, jet, ultrasonic, and vibrating mesh nebulizers are marketed; the latter can deliver optimal antibiotic particle size...
July 24, 2017: Drugs
https://www.readbyqxmd.com/read/28739243/heaven-criteria-derivation-of-a-new-difficult-airway-prediction-tool
#6
Daniel P Davis, David J Olvera
OBJECTIVE: Airway management is vitally important in the management of critically ill and injured patients. Current tools to predict the difficult airway have limited application in the emergency airway situation. The aim of this study was to derive a novel difficult airway prediction tool for emergency intubation. METHODS: A retrospective descriptive analysis was performed in a population of air medical rapid sequence intubation patients requiring more than 1 attempt...
July 2017: Air Medical Journal
https://www.readbyqxmd.com/read/28739066/a-turkish-version-of-the-critical-care-pain-observation-tool-reliability-and-validity-assessment
#7
Yeşim Yaman Aktaş, Neziha Karabulut
PURPOSE: The study aim was to evaluate the validity and reliability of the Critical-Care Pain Observation Tool in critically ill patients. DESIGN: A repeated measures design was used for the study. METHODS: A convenience sample of 66 patients who had undergone open-heart surgery in the cardiovascular surgery intensive care unit in Ordu, Turkey, was recruited for the study. The patients were evaluated by using the Critical-Care Pain Observation Tool at rest, during a nociceptive procedure (suctioning), and 20 minutes after the procedure while they were conscious and intubated after surgery...
August 2017: Journal of Perianesthesia Nursing: Official Journal of the American Society of PeriAnesthesia Nurses
https://www.readbyqxmd.com/read/28738937/percutaneous-tracheostomy-under-bronchoscopic-visualization-does-not-affect-short-term-or-long-term-complications
#8
Thomas S Easterday, Joshua W Moore, Meredith H Redden, David V Feliciano, Vernon J Henderson, Timothy Humphries, Katherine E Kohler, Philip T Ramsay, Stanston D Spence, Mark Walker, Amy D Wyrzykowski
Percutaneous tracheostomy is a safe and effective bedside procedure. Some advocate the use of bronchoscopy during the procedure to reduce the rate of complications. We evaluated our complication rate in trauma patients undergoing percutaneous tracheostomy with and without bronchoscopic guidance to ascertain if there was a difference in the rate of complications. A retrospective review of all tracheostomies performed in critically ill trauma patients was performed using the trauma registry from an urban, Level I Trauma Center...
July 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/28738787/procalcitonin-guided-antibiotic-therapy-in-critically-ill-adults-a-meta-analysis
#9
Tao Zhang, Yan Wang, Qianting Yang, Yalin Dong
BACKGROUND: As a novel biomarker of inflammation, procalcitonin (PCT) has proven useful to guide antibiotic therapy in intensive care unit (ICU). However, there are controversial on mortality. The aim of this study was to evaluate the utility of PCT-guided antibiotic therapy in critically ill adults and determine whether studies are sufficient. METHODS: A systematic search in PubMed, Embase and Cochrane was performed. We included only randomized controlled trials which compared the safety and efficacy between PCT-guided or standard antibiotic therapy groups in ICU adults...
July 24, 2017: BMC Infectious Diseases
https://www.readbyqxmd.com/read/28737575/diabetes-is-not-associated-with-increased-90-day-mortality-risk-in-critically-ill-patients-with-sepsis
#10
Lonneke A van Vught, Rebecca Holman, Evert de Jonge, Nicolette F de Keizer, Tom van der Poll
OBJECTIVES: To determine the association of pre-existing diabetes, hyperglycemia, and hypoglycemia during the first 24 hours of ICU admissions with 90-day mortality in patients with sepsis admitted to the ICU. DESIGN: We used mixed effects logistic regression to analyze the association of diabetes, hyperglycemia, and hypoglycemia with 90-day mortality (n = 128,222). SETTING: All ICUs in the Netherlands between January 2009 and 2014 that participated in the Dutch National Intensive Care Evaluation registry...
July 21, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28737574/is-there-a-role-for-enterohormones-in-the-gastroparesis-of-critically-ill-patients
#11
Carlos A Santacruz, Amanda Quintairos, Claudia Righy, Ilaria A Crippa, Lucio Couto, Virginie Imbault, Mongkolpun Wasineeart, Mathieu De Ryckere, Jean-Charles Preiser
OBJECTIVES: Delayed gastric emptying occurs in critically ill patients and impairs the delivery, digestion, and absorption of enteral feeding. A pathophysiologic role of the enterohormones peptide YY and ghrelin is supported by preclinical data. To compare the circulating plasma levels of peptide YY and ghrelin in control subjects and in critically ill patients, during feeding and fasting, and to search for a correlation with gastric emptying. DESIGN: A prospective observational trial...
July 21, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28737058/external-validity-of-electronic-sniffers-for-automated-recognition-of-acute-respiratory-distress-syndrome
#12
Andrew C McKown, Ryan M Brown, Lorraine B Ware, Jonathan P Wanderer
INTRODUCTION: Automated electronic sniffers may be useful for early detection of acute respiratory distress syndrome (ARDS) for institution of treatment or clinical trial screening. METHODS: In a prospective cohort of 2929 critically ill patients, we retrospectively applied published sniffer algorithms for automated detection of acute lung injury to assess their utility in diagnosis of ARDS in the first 4 ICU days. Radiographic full-text reports were searched for "edema" OR ("bilateral" AND "infiltrate") and a more detailed algorithm for descriptions consistent with ARDS...
January 1, 2017: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/28737047/the-role-of-mucoactive-agents-in-the-mechanically-ventilated-patient-a-review-of-the-literature
#13
Bradley L Icard, Edmundo Rubio
The management of airway secretions in the mechanically ventilated patient is a routine task throughout all intensive care units. The current treatment strategies are primarily based on anecdotal experiences rather than statistical evidence. Areas Covered: This review article evaluates the data from published trials surrounding mucoactive agents and their use in the critically ill patient population. We completed an extensive search through PUBMED and CINAHL via EBSCO, along with the Cochran library to find all trials using mucoactive agents in the critically ill patient population...
July 24, 2017: Expert Review of Respiratory Medicine
https://www.readbyqxmd.com/read/28736789/spiritual-distress-and-spiritual-care-in-advanced-heart-failure
#14
REVIEW
Ronald Gillilan, Sameena Qawi, Audrey J Weymiller, Christina Puchalski
As patients face serious and chronic illness, they are confronted with the realities of dying. Spiritual and existential issues are particularly prominent near the end of life and can result in significant distress. It is critical that healthcare professionals know how to address patients' and families' spiritual concerns, diagnose spiritual distress and attend to the deep suffering of patients in a way that can result in a better quality of life for patients and families. Tools such as the FICA spiritual history tool help clinicians invite patients and families to share their spiritual or existential concerns as well as sources of hope and meaning which can help them cope better with their illness...
July 24, 2017: Heart Failure Reviews
https://www.readbyqxmd.com/read/28736305/better-with-ultrasound-pleural-procedures-in-critically-ill-patients
#15
REVIEW
Scott J Millington, Seth Koenig
Procedures designed to drain fluid or air from the pleural spaces can be technically challenging in patients who are critically ill, and are associated with significant complications. Many individual ultrasound techniques have been described, each with the goal of making pleural drainage procedures safer. This article presents a systemic approach for incorporating many of these tools into procedures such as diagnostic thoracentesis, therapeutic drainage, or pleural catheter insertion. A series of illustrative figures and narrated video presentations are included to demonstrate many of the described techniques...
July 20, 2017: Chest
https://www.readbyqxmd.com/read/28736288/rapid-decay-of-transthoracic-echocardiography-skills-at-1-month-a-prospective-observational-study
#16
Ryo Yamamoto, David Clanton, Ross E Willis, Rachelle Babbitt Jonas, Ramon F Cestero
OBJECTIVE: Focused transthoracic echocardiography (FTTE) is an emerging tool in the management of critically ill patients, but the lack of adequate training models has limited the expansion of this technology. Although basic FTTE training courses have been shown to be sufficient in developing echocardiography skills, limited data exist regarding skill retention. In an effort to develop an adequate FTTE training model, we sought to determine the degree of skill retention after FTTE training...
July 20, 2017: Journal of Surgical Education
https://www.readbyqxmd.com/read/28736005/benefits-of-intraoperative-continuous-renal-replacement-therapy-during-liver-transplantation-in-patients-with-renal-dysfunction
#17
S D Baek, M Jang, W Kim, H Yu, S Hwang, S-G Lee, G-S Hwang, E K Lee, S M Kim, J W Chang
BACKGROUND: Comparative outcomes of continuous renal replacement therapy during liver transplantation have not been investigated. We retrospectively compared the outcomes of intraoperative continuous renal replacement therapy with those of non-dialytic conservative treatment in patients with pretransplant renal dysfunction. METHODS: We analyzed 240 transplantation patients with preoperative renal dysfunction (estimated glomerular filtration rate <60 mL/min/1...
July 2017: Transplantation Proceedings
https://www.readbyqxmd.com/read/28734823/evaluation-of-early-administration-of-simvastatin-in-the-prevention-and-treatment-of-delirium-in-critically-ill-patients-undergoing-mechanical-ventilation-modus-a-randomised-double-blind-placebo-controlled-trial
#18
Valerie J Page, Annalisa Casarin, E Wesley Ely, Xiao Bei Zhao, Cliona McDowell, Lynn Murphy, Daniel F McAuley
BACKGROUND: Delirium in critically ill patients is associated with poor clinical outcomes. Neuroinflammation might be an important mechanism in the pathogenesis of delirium, and since simvastatin has anti-inflammatory properties it might reduce delirium. We aimed to establish whether early treatment with simvastatin would decrease the time that survivors of critical illness spent in delirium or coma. METHODS: We undertook this randomised, double-blind, placebo-controlled trial in a general adult intensive care unit (ICU) in Watford General Hospital (Watford, UK)...
July 19, 2017: Lancet Respiratory Medicine
https://www.readbyqxmd.com/read/28734773/epico-4-0-total-quality-in-the-management-of-invasive-candidiasis-in-critically-ill-patients-by-analysing-the-integrated-process
#19
Rafael Zaragoza, Ricard Ferrer, Pedro Llinares, Emilio Maseda, Alejandro Rodríguez, Santiago Grau, Guillermo Quindós
BACKGROUND: A high quality integrated process in the clinical setting of non-neutropenic critically ill patients at risk for invasive candidiasis is a necessary tool to improve the management of these patients. AIMS: To identify the key points on invasive candidiasis in order to develop a set of recommendations with a high level of consensus required for the creation of a total quality integrated process for the management of non-neutropenic critically ill patients at risk of invasive candidiasis...
July 19, 2017: Revista Iberoamericana de Micología
https://www.readbyqxmd.com/read/28734547/management-of-hemostatic-disorders-in-patients-with-advanced-liver-disease-admitted-to-an-intensive-care-unit
#20
REVIEW
Ton Lisman, William Bernal
Patients with liver diseases frequently acquire complex changes in their hemostatic system. Traditionally, bleeding complications in patients with liver disease were ascribed to these hemostatic changes, and liver diseases were considered as an acquired bleeding disorder. Nowadays, it is increasingly acknowledged that patients with liver diseases are in "hemostatic rebalance" due to a commensurate decline in pro- and anticoagulant drivers. Indeed, both thrombosis and bleeding may complicate liver disease. Such complications may be particularly worrisome in critically ill patients with liver disease...
June 23, 2017: Transfusion Medicine Reviews
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