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https://www.readbyqxmd.com/read/28230563/implementation-of-an-early-mobility-pathway-in-neurointensive-care-unit-patients-with-external-ventricular-devices
#1
Megan Moyer, Bethany Young, Joseph Borst, William Pino, Marisa Hart, Jesse LoBreglio, Derek Zaleski, Isaira Leonor, David Kung, Michelle Smith, Eric Zager, M Sean Grady, Monisha Kumar
BACKGROUND: Patients with an external ventricular drain (EVD) may not be readily mobilized because of concerns of catheter dislodgment and/or inappropriate cerebrospinal fluid drainage. Delayed mobilization may result in longer hospital stays and an increased risk for complications related to immobility. We aimed to determine the safety, feasibility, and outcome of an EVD mobilization protocol in patients with subarachnoid hemorrhage (SAH). METHODS: A multidisciplinary group developed a formal algorithm for the mobilization of patients with SAH with EVDs...
February 23, 2017: Journal of Neuroscience Nursing: Journal of the American Association of Neuroscience Nurses
https://www.readbyqxmd.com/read/28225378/traumatic-ventricular-septal-defect-in-a-1-year-old-boy-after-accidental-chest-compression-by-an-adult
#2
Huang-Wei Wu, Jen-Hung Chien, Ken-Pen Weng, Chu-Chuan Lin, Bo-Hau Chen, Shih-Ming Huang, Yu-Chi Hung
We report a 1-year-old boy with a delayed diagnosis of traumatic ventricular septal defect (VSD) related to chest compression. His cardiac function was stable after adequate medical treatment. Spontaneous closure of traumatic VSD occurred to this patient at the age of 4 years. This is a rare case of traumatic VSD associated with accidental chest compression, which is similar to rupture of the ventricular septum after blunt chest trauma. It should be kept in mind that traumatic VSD and concomitant thoracic injuries can develop during chest compression...
February 21, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/28224110/comparison-of-inhaled-milrinone-nitric-oxide-and-prostacyclin-in-acute-respiratory-distress-syndrome
#3
Martin Albert, Daniel Corsilli, David R Williamson, Marc Brosseau, Patrick Bellemare, Stéphane Delisle, Anne Qn Nguyen, France Varin
AIM: To evaluate the safety and efficacy of inhaled milrinone in acute respiratory distress syndrome (ARDS). METHODS: Open-label prospective cross-over pilot study where fifteen adult patients with hypoxemic failure meeting standard ARDS criteria and monitored with a pulmonary artery catheter were recruited in an academic 24-bed medico-surgical intensive care unit. Random sequential administration of iNO (20 ppm) or nebulized epoprostenol (10 μg/mL) was done in all patients...
February 4, 2017: World Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/28219895/impact-of-practice-based-management-of-pa-pressures-in-2000-patients-implanted-with-the-cardiomems-sensor
#4
J Thomas Heywood, Rita Jermyn, David Shavelle, William T Abraham, Arvind Bhimaraj, Kunjan Bhatt, Fareed Sheikh, Eric Eichorn, Sumant Lamba, Rupinder Bharmi, Rahul Agarwal, Charisma Kumar, Lynne W Stevenson
Background -Elevated pulmonary artery (PA) pressures in patients with heart failure (HF) are associated with a high risk for hospitalization and mortality. Recent clinical trial evidence demonstrated a direct relationship between lowering remotely monitored PA pressures and HF hospitalization risk reduction using a novel implantable PA pressure monitoring system (CardioMEMS HF System, St Jude Medical). This study examines PA pressure changes in the first 2,000 US patients implanted in general practice use. Methods -De-identified data from the remote monitoring Merlin...
February 20, 2017: Circulation
https://www.readbyqxmd.com/read/28219828/treating-cognitive-impairment-with-transcranial-low-level-laser-therapy
#5
Jack C de la Torre
This report examines the potential of low level laser therapy (LLLT) to alter brain cell function and neurometabolic pathways using red or near infrared (NIR) wavelengths transcranially for the prevention and treatment of cognitive impairment. Although laser therapy on human tissue has been used for a number of medical conditions since the late 1960s, it is only recently that several clinical studies have shown its value in raising neurometabolic energy levels that can improve cerebral hemodynamics and cognitive abilities in humans...
February 13, 2017: Journal of Photochemistry and Photobiology. B, Biology
https://www.readbyqxmd.com/read/28219329/ultrafiltration-rate-is-an-important-determinant-of-microcirculatory-alterations-during-chronic-renal-replacement-therapy
#6
Gerke Veenstra, Andrius Pranskunas, Inga Skarupskiene, Vidas Pilvinis, Marc H Hemmelder, Can Ince, E Christiaan Boerma
BACKGROUND: Hemodialysis (HD) with ultrafiltration (UF) in chronic renal replacement therapy is associated with hemodynamic instability, morbidity and mortality. Sublingual Sidestream Dark Field (SDF) imaging during HD revealed reductions in microcirculatory blood flow (MFI). This study aims to determine underlying mechanisms. METHODS: The study was performed in the Medical Centre Leeuwarden and the Lithuanian University of Health Sciences. Patients underwent 4-h HD session with linear UF...
February 20, 2017: BMC Nephrology
https://www.readbyqxmd.com/read/28217067/septo-optic-dysplasia-de-morsier-s-syndrome
#7
Pedro Reis, Joana Mourão
Septo-optic dysplasia (SOD)/de Morsier's syndrome is characterized by optic nerve hypoplasia, pituitary endocrine dysfunction, and midline brain abnormalities. Hypopituitarism, hypothyroidism, hypogonadism, and adrenal insufficiency can lead to severe hypoglycemia, adrenal crisis, seizures, and sudden death. Anesthetic management of SOD was associated with high perioperative mortality. A 9-year-old male child proposed for dental treatments/extractions. Medical history of SOD with hypopituitarism, hypothyroidism, and delayed psychomotor development was observed...
January 2017: Saudi Journal of Anaesthesia
https://www.readbyqxmd.com/read/28214966/anomalous-coronary-arteries-and-myocardial-bridges-risk-stratification-in-children-using-novel-cardiac-catheterization-techniques
#8
Hitesh Agrawal, Silvana Molossi, Mahboob Alam, S Kristen Sexson-Tejtel, Carlos M Mery, E Dean McKenzie, Charles D Fraser, Athar M Qureshi
The evaluation of the vast majority of children with anomalous aortic origin of a coronary artery (AAOCA) and/or myocardial bridges is performed with non-invasive testing. However, a subset of these patients may benefit from invasive testing for risk stratification. All patients included in the Coronary Anomalies Program (CAP) at Texas Children's Hospital who underwent cardiac catheterization were included. Techniques included selective coronary angiograms (SCA), intravascular ultrasound (IVUS), and fractional flow reserve (FFR) measurements with provocative testing using adenosine and/or dobutamine infusions...
February 18, 2017: Pediatric Cardiology
https://www.readbyqxmd.com/read/28211296/recommendations-for-the-medical-management-of-chronic-venous-disease-the-role-of-micronized-purified-flavanoid-fraction-mpff
#9
Ronald Bush, Anthony Comerota, Mark Meissner, Joseph D Raffetto, Steven R Hahn, Katherine Freeman
Scope A systematic review of the clinical literature concerning medical management of chronic venous disease with the venoactive therapy Micronized Purified Flavonoid Fraction was conducted in addition to an investigation of the hemodynamics and mechanism of chronic venous disease. Methods The systematic review of the literature focused on the use of Micronized Purified Flavonoid Fraction (diosmin) which has recently become available in the US, in the management of chronic venous disease. The primary goal was to assess the level of evidence of the role of Micronized Purified Flavonoid Fraction in the healing of ulcers, and secondarily on the improvement of the symptoms of chronic venous disease such as edema...
April 2017: Phlebology
https://www.readbyqxmd.com/read/28207536/cervical-plexus-anesthesia-versus-general-anesthesia-for-anterior-cervical-discectomy-and-fusion-surgery-a-randomized-clinical-trial
#10
Hui Wang, Lei Ma, Dalong Yang, Tao Wang, Qian Wang, Lijun Zhang, Wenyuan Ding
Both general anesthesia (GA) and cervical plexus anesthesia (CPA) can be used for anterior cervical discectomy and fusion (ACDF) surgery. The aim of this study was to evaluate the influence of anesthetic techniques on perioperative mortality and morbidity in patients undergoing cervical surgery.From January 2008 to December 2015, 356 patients who underwent 1-level ACDF for cervical spinal myelopathy were prospectively reviewed. They were assigned to receive GA (group A) and CPA (group B). The analgesic efficacy of the block was assessed by anesthesia preparation time, the maximum heart rate, and mean arterial blood pressure changes compared with the baseline, time of postoperative revival, and duration of recovery stay...
February 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28197295/spontaneous-coronary-artery-dissection-the-phantom-menace
#11
Nikolaos Spinthakis, Nada Abdulkareem, Mohamed Farag, Diana A Gorog
We present a case of a 66-year-old lady with chest pain, without dynamic 12-lead electrocardiographic (ECG) changes and normal serial troponin. Coronary angiography revealed a linear filing defect in the first obtuse marginal branch of the circumflex artery indicating coronary artery dissection, with superadded thrombus. She was managed medically with dual antiplatelet therapy and has responded well. Spontaneous coronary artery dissection (SCAD) is a rare cause of cardiac chest pain, which can be missed without coronary angiography...
December 2016: Cardiology Research
https://www.readbyqxmd.com/read/28190707/safety-and-efficacy-of-percutaneous-microwave-hepatic-ablation-near-the-heart
#12
George A Carberry, Amanda R Smolock, Mircea Cristescu, Shane A Wells, Timothy J Ziemlewicz, Meghan G Lubner, J Louis Hinshaw, Christopher L Brace, Fred T Lee
PURPOSE: To evaluate safety and efficacy of percutaneous hepatic microwave (MW) ablation performed near the heart. MATERIALS AND METHODS: This study reviewed 118 consecutive peripheral (ablation zone margins within 5 mm of liver capsule) percutaneous MW hepatic ablations performed between June 2010 and August 2015. Ablation zones of 27 tumors (22.8%) extended to ≤ 5 mm from myocardium, and these ablations comprised the study group; the remaining ablations formed the control group...
February 9, 2017: Journal of Vascular and Interventional Radiology: JVIR
https://www.readbyqxmd.com/read/28190438/therapeutic-hypothermia-protocols
#13
N Badjatia
The application of targeted temperature management has become common practice in the neurocritical care setting. It is important to recognize the pathophysiologic mechanisms by which temperature control impacts acute neurologic injury, as well as the clinical limitations to its application. Nonetheless, when utilizing temperature modulation, an organized approach is required in order to avoid complications and minimize side-effects. The most common clinically relevant complications are related to the impact of cooling on hemodynamics and electrolytes...
2017: Handbook of Clinical Neurology
https://www.readbyqxmd.com/read/28187752/targeting-urine-output-and-30-day-mortality-in-goal-directed-therapy-a-systematic-review-with-meta-analysis-and-meta-regression
#14
Esther N van der Zee, Mohamud Egal, Diederik Gommers, A B Johan Groeneveld
BACKGROUND: Oliguria is associated with a decreased kidney- and organ perfusion, leading to organ damage and increased mortality. While the effects of correcting oliguria on renal outcome have been investigated frequently, whether urine output is a modifiable risk factor for mortality or simply an epiphenomenon remains unclear. We investigated whether targeting urine output, defined as achieving and maintaining urine output above a predefined threshold, in hemodynamic management protocols affects 30-day mortality in perioperative and critical care...
February 10, 2017: BMC Anesthesiology
https://www.readbyqxmd.com/read/28187374/the-strengths-and-weaknesses-of-non-invasive-parameters-obtained-by-echocardiography-and-cardiopulmonary-exercise-testing-in-comparison-with-the-hemodynamic-assessment-by-the-right-heart-catheterization-in-patients-with-pulmonary-hypertension
#15
Katarzyna Ptaszyńska-Kopczyńska, Anna Krentowska, Emilia Sawicka, Anna Skoneczny, Małgorzata Jasiewicz, Małgorzata Knapp, Włodzimierz J Musiał, Bożena Sobkowicz, Karol A Kamiński
PURPOSE: Pulmonary hypertension (PH) diagnosis requires invasive assessment by right heart catheterization (RHC), but screening and monitoring are performed using non-invasive methods: echocardiography and cardiopulmonary exercise testing (CPET). The aim of the study was to assess correlations between the parameters obtained in non-invasive testing and RHC in patients with PH of different etiologies. MATERIAL/METHODS: The study included 53 medical records of PH patients (32 women) aged 29-81 years...
June 14, 2016: Advances in Medical Sciences
https://www.readbyqxmd.com/read/28184956/-hemorrhagic-shock-general-principles
#16
T I Eiben, V Fuhrmann, B Saugel, S Kluge
Bleeding associated with hemorrhagic shock is often seen in emergency medical services or in the intensive care unit. Identifying the origin of the bleeding and additional disorders helps to determine the degree of the hemorrhagic shock. In order to be effective, the initial therapy until blood products are available needs to be differentiated to be effective in terms of hemodynamic stabilization and coagulation. Crystalloidal and colloidal solutions should be used carefully since those solutions bear a risk within themselves...
February 9, 2017: Der Internist
https://www.readbyqxmd.com/read/28184350/severe-cerebral-vasospasm-in-patients-with-hyperthyroidism
#17
Hyuk-Jin Oh, Seok-Mann Yoon, Jae-Sang Oh, Jai-Joon Shim, Hack-Gun Bae
Cerebral vasospasm associated with hyperthyroidism has not been reported to cause cerebral infarction. The case reported here is therefore the first of cerebral infarction co-existing with severe vasospasm and hyperthyroidism. A 30-year-old woman was transferred to our hospital in a stuporous state with right hemiparesis. At first, she complained of headache and dizziness. However, she had no neurological deficits or radiological abnormalities. She was diagnosed with hyperthyroidism 2 months ago, but she had discontinued the antithyroid medication herself three days ago...
December 2016: Journal of Cerebrovascular and Endovascular Neurosurgery
https://www.readbyqxmd.com/read/28183560/anesthesia-and-brugada-syndrome-a-12-year-case-series
#18
Mélanie Duque, Luís Santos, Sandy Ribeiro, Dora Catré
STUDY OBJECTIVE: The aim of this 12-year case series was to review the drugs used during anesthetic management of patients with diagnosis of or risk criteria for Brugada syndrome (BrS), and to document any possible association between these drugs and arrhythmogenic activity or unexplained hemodynamic instability. DESIGN: A retrospective clinical observational study. SETTING: Tertiary hospital. PATIENTS: Thirty-one patients met our inclusion criteria: 20 belonging to group D (diagnosed BrS) and 11 to group R (risk of BrS)...
February 2017: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/28181385/hemodynamic-profile-and-behavioral-characteristics-during-induction-of-anesthesia-in-pediatric-patients-with-attention-deficit-hyperactivity-disorder
#19
Richard S Cartabuke, Joseph D Tobias, Julie Rice, Dmitry Tumin
AIM: There is no consensus regarding the administration of stimulant drugs preoperatively, particularly in pediatric patients diagnosed with ADHD. The primary objective of the current study was to assess differences in blood pressure and heart rate before and after induction of anesthesia between patients on chronic amphetamine or methylphenidate therapy who receive their normal dose preoperatively compared to patients in whom the prescribed medication was withheld. Secondary objectives were to assess the anxiety level during the induction of anesthesia and the effect of premedication with midazolam...
February 8, 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/28171856/the-safety-of-laryngeal-mask-airway-assisted-bronchoscopy-versus-standard-nasal-bronchoscopy
#20
Daniel Alon, Barak Pertzov, Evgeni Gershman, Miryam Frishman, Nader Abdel Rahman, Dror Rosengarten, Mordechai R Kramer
BACKGROUND: The use of laryngeal mask airway (LMA) for fiberoptic bronchoscopy was first described in 1982. The LMA was found to be beneficial in operator view, flexibility, and also in maintaining stable oxygen saturation. Despite its advantages, the use of LMA has not become widespread. OBJECTIVE: The aim of this paper was to evaluate the safety of LMA-assisted bronchoscopy compared to standard nasal bronchoscopy. METHODS: We conducted a prospective randomized trial...
February 8, 2017: Respiration; International Review of Thoracic Diseases
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