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https://www.readbyqxmd.com/read/28632609/unwrapping-an-eras-bundle-goal-directed-fluid-therapy-ileus
#1
Jonathan P Wanderer, James P Rathmell
No abstract text is available yet for this article.
July 2017: Anesthesiology
https://www.readbyqxmd.com/read/28625234/-effect-of-global-end-diastolic-volume-index-guidance-fluid-resuscitation-in-elderly-patients-with-septic-shock
#2
Shuang Ma, Rumin Zhang, Shifu Wang, Meiling Zhao, Lei Wang, Yun Zhang
OBJECTIVE: To evaluate the effect of global end diastolic volume index (GEDVI) on fluid resuscitation in elderly patients with septic shock. METHODS: A prospective randomized controlled trial (RCT) was conducted. Septic shock patients over 65 years admitted to intensive care unit (ICU) of Shandong Province, Zibo Central Hospital from January 2013 to December 2015 were enrolled. The patients were randomly divided into control group and observation group, 20 cases in each group...
June 2017: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
https://www.readbyqxmd.com/read/28624521/semanticized-autobiographical-memory-and-the-default-executive-coupling-hypothesis-of-aging
#3
R Nathan Spreng, Amber W Lockrow, Elizabeth DuPre, Roni Setton, Karen A P Spreng, Gary R Turner
As we age, the architecture of cognition undergoes a fundamental transition. Fluid intellectual abilities decline while crystalized abilities remain stable or increase. This shift has a profound impact across myriad cognitive and functional domains, yet the neural mechanisms remain under-specified. We have proposed that greater connectivity between the default network and executive control regions in lateral prefrontal cortex may underlie this shift, as older adults increasingly rely upon accumulated knowledge to support goal-directed behavior...
June 14, 2017: Neuropsychologia
https://www.readbyqxmd.com/read/28621012/supporting-people-with-aphasia-to-settle-into-a-new-way-to-be-speech-and-language-therapists-views-on-providing-psychosocial-support
#4
Sarah Northcott, Alan Simpson, Becky Moss, Nafiso Ahmed, Katerina Hilari
BACKGROUND: People with aphasia are at risk of becoming depressed and isolated. Online surveys have found that the majority of speech and language therapists (SLTs) lack confidence in addressing the psychological needs of people with aphasia. AIMS: To explore how SLTs conceptualize the scope of their role; barriers and facilitators to SLTs addressing psychosocial needs; and SLTs' experiences of specialist training and support, and working with mental health professionals (MHPs)...
June 16, 2017: International Journal of Language & Communication Disorders
https://www.readbyqxmd.com/read/28616213/postoperative-goal-directed-therapy-and-development-of-acute-kidney-injury-following-major-elective-noncardiac-surgery-post-hoc-analysis-of-pom-o-randomized-controlled-trial
#5
Amour Patel, John R Prowle, Gareth L Ackland
Background: The role of goal-directed therapy (GDT) in preventing creatinine rise following noncardiac surgery is unclear. We performed a post-hoc analysis of a randomized controlled trial to assess the relationship between postoperative optimization of oxygen delivery and development of acute kidney injury (AKI)/creatinine rise following noncardiac surgery. Methods: Patients were randomly assigned immediately postoperatively to receive either fluid and/or dobutamine therapy to maintain/restore their preoperative oxygen delivery, or protocolized standard care (oxygen delivery only recorded)...
June 2017: Clinical Kidney Journal
https://www.readbyqxmd.com/read/28605442/perioperative-goal-directed-therapy-with-uncalibrated-pulse-contour-methods-impact-on-fluid-management-and-postoperative-outcome
#6
F Michard, M T Giglio, N Brienza
Previous meta-analyses suggest that perioperative goal-directed therapy (GDT) is useful to decrease postoperative morbidity. Most GDT studies analysed were done with pulmonary artery catheters, oesophageal Doppler and calibrated pulse contour methods. Uncalibrated pulse contour (uPC) techniques are an appealing alternative but their accuracy has been questioned. The effects of GDT on fluid management (volumes and volume variability) remain unclear. We performed a meta-analysis of randomized controlled trials investigating the effects of GDT with uPC methods on postoperative outcome...
June 11, 2017: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/28602158/effect-of-perioperative-goal-directed-hemodynamic-therapy-on-postoperative-recovery-following-major-abdominal-surgery-a-systematic-review-and-meta-analysis-of-randomized-controlled-trials
#7
Yanxia Sun, Fang Chai, Chuxiong Pan, Jamie Lee Romeiser, Tong J Gan
BACKGROUND: Goal-directed hemodynamic therapy (GDHT) has been used in the clinical setting for years. However, the evidence for the beneficial effect of GDHT on postoperative recovery remains inconsistent. The aim of this systematic review and meta-analysis was to evaluate the effect of perioperative GDHT in comparison with conventional fluid therapy on postoperative recovery in adults undergoing major abdominal surgery. METHODS: Randomized controlled trials (RCTs) in which researchers evaluated the effect of perioperative use of GDHT on postoperative recovery in comparison with conventional fluid therapy following abdominal surgery in adults (i...
June 12, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/28572520/clinical-management-of-sepsis
#8
S M Lam, A Cw Lau, R Pk Lam, W W Yan
Sepsis is a common cause of hospital admission worldwide and contributes significantly to morbidity and mortality. The definition of sepsis has evolved from the 1991 American College of Chest Physicians/Society of Critical Care Medicine definition based on the criteria of systemic inflammatory response syndrome, to the 2016 Sepsis-3 definition that incorporates the Sequential Organ Failure Assessment score. The landmark trial on protocolised early goal-directed therapy was published in 2001, but three subsequent multicentre randomised controlled trials (ProCESS, ARISE, and ProMISe) in 2014-2015 did not confirm a survival benefit with protocolised care...
June 2017: Hong Kong Medical Journal, Xianggang Yi Xue za Zhi
https://www.readbyqxmd.com/read/28562384/personalized-hemodynamic-management
#9
Bernd Saugel, Jean-Louis Vincent, Julia Y Wagner
PURPOSE OF REVIEW: To describe personalized hemodynamic management of critically ill patients in the operating room and the ICU. RECENT FINDINGS: Several recent clinical studies have investigated different strategies for optimizing blood pressure (BP) and flow in the operating room and in the ICU. In the past, (early) goal-directed hemodynamic treatment strategies often used predefined fixed population-based 'normal' values as hemodynamic targets. Most hemodynamic variables, however, have large interindividual variability and are dependent on several biometric factors...
May 27, 2017: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/28558654/a-pragmatic-multi-center-trial-of-goal-directed-fluid-management-based-on-pulse-pressure-variation-monitoring-during-high-risk-surgery
#10
Luiz Marcelo Sá Malbouisson, João Manoel Silva, Maria José Carvalho Carmona, Marcel Rezende Lopes, Murilo Santucci Assunção, Jorge Luís Dos Santos Valiatti, Claudia Marques Simões, José Otavio Costa Auler
BACKGROUND: Intraoperative fluid therapy guided by mechanical ventilation-induced pulse-pressure variation (PPV) may improve outcomes after major surgery. We tested this hypothesis in a multi-center study. METHODS: The patients were included in two periods: a first control period (control group; n = 147) in which intraoperative fluids were given according to clinical judgment. After a training period, intraoperative fluid management was titrated to maintain PPV < 10% in 109 surgical patients (PPV group)...
May 30, 2017: BMC Anesthesiology
https://www.readbyqxmd.com/read/28542848/change-of-transfusion-and-treatment-paradigm-in-major-trauma-patients
#11
P Stein, A Kaserer, K Sprengel, G A Wanner, B Seifert, O M Theusinger, D R Spahn
Trauma promotes trauma-induced coagulopathy, which requires urgent treatment with fixed-ratio transfusions of red blood cells, fresh frozen plasma and platelet concentrates, or goal-directed administration of coagulation factors based on viscoelastic testing. This retrospective observational study compared two time periods before (2005-2007) and after (2012-2014) the implementation of changes in trauma management protocols which included: use of goal-directed coagulation management; admission of patients to designated trauma centres; whole-body computed tomography scanning on admission; damage control surgery; permissive hypotension; restrictive fluid resuscitation; and administration of tranexamic acid...
May 23, 2017: Anaesthesia
https://www.readbyqxmd.com/read/28516217/prenatal-surgery-for-myelomeningocele-review-of-the-literature-and-future-directions
#12
Gregory G Heuer, Julie S Moldenhauer, N Scott Adzick
Open spina bifida or myelomeningocele (MMC) is one of the most common serious congenital malformations. Historically, this condition has been treated with closure of the MMC defect shortly after birth. The goal of postnatal closure is to cover the exposed spinal cord and prevent infection. However, postnatal surgery does not reverse or prevent the neurologic injury seen in MMC, reverse hindbrain herniation, or prevent hydrocephalus. The neurologic defects result from primary incomplete neurulation and secondary chronic prenatal damage to the exposed neural elements through mechanical and chemical trauma...
May 17, 2017: Child's Nervous System: ChNS: Official Journal of the International Society for Pediatric Neurosurgery
https://www.readbyqxmd.com/read/28503840/a-critical-note-on-treatment-of-a-severe-diltiazem-intoxication-high-dose-calcium-and-glucagon-infusions
#13
N M Van Veggel, G J Van der Veen, T C Jansen, E M Westerman
The morbidity and mortality of a severe calcium channel blocker intoxication is high due to serious toxic cardiac effects. Its treatment is supported by low-quality evidence from heterogeneous literature. We describe a case of a severe diltiazem intoxication and critically appraise the efficacy and role of high-dose calcium and glucagon infusions. A 53-year-old woman was admitted to the emergency department with a cardiogenic shock with complete AV block, not responding to atropine, isoprenaline and an external pacemaker...
May 15, 2017: Basic & Clinical Pharmacology & Toxicology
https://www.readbyqxmd.com/read/28502585/frontoparietal-neurostimulation-modulates-working-memory-training-benefits-and-oscillatory-synchronization
#14
Kevin T Jones, Dwight J Peterson, Kara J Blacker, Marian E Berryhill
There is considerable interest in maintaining working memory (WM) because it is essential to accomplish most cognitive tasks, and it is correlated with fluid intelligence and ecologically valid measures of daily living. Toward this end, WM training protocols aim to improve WM capacity and extend improvements to unpracticed domains, yet success is limited. One emerging approach is to couple WM training with transcranial direct current stimulation (tDCS). This pairing of WM training with tDCS in longitudinal designs promotes behavioral improvement and evidence of transfer of performance gains to untrained WM tasks...
July 15, 2017: Brain Research
https://www.readbyqxmd.com/read/28500653/blood-transfusion-in-the-surgical-treatment-of-adolescent-idiopathic-scoliosis-a-single-center-experience-of-patient-blood-management-in-210-cases
#15
Søren Ohrt-Nissen, Naeem Bukhari, Casper Dragsted, Martin Gehrchen, Pär I Johansson, Jesper Dirks, Jakob Stensballe, Benny Dahl
BACKGROUND: The surgical treatment of adolescent idiopathic scoliosis can be associated with substantial blood loss, requiring allogeneic red blood cell (RBC) transfusion. This study describes the use of RBC and the effect of a standardized perioperative patient blood management program. STUDY DESIGN AND METHODS: Patients treated with posterior instrumented fusion were consecutively enrolled over a 6-year period. Patient blood management strategies were implemented in 2011, including prophylactic tranexamic acid, intraoperative permissive hypotension, restrictive fluid therapy (including avoidance of synthetic colloids), restrictive RBC trigger according to institutional standardized protocol, the use of cell savage, and goal-directed therapy according to thrombelastography...
May 12, 2017: Transfusion
https://www.readbyqxmd.com/read/28484814/contemporary-approaches-to-perioperative-iv-fluid-therapy
#16
REVIEW
Paul S Myles, Sam Andrews, Jonathan Nicholson, Dileep N Lobo, Monty Mythen
BACKGROUND: Intravenous fluid therapy is required for most surgical patients, but inappropriate regimens are commonly prescribed. The aim of this narrative review was to provide evidence-based guidance on appropriate perioperative fluid management. METHOD: We did a systematic literature search of the literature to identify relevant studies and meta-analyses to develop recommendations. RESULTS: Of 275 retrieved articles, we identified 25 articles to inform this review...
May 8, 2017: World Journal of Surgery
https://www.readbyqxmd.com/read/28459732/goal-directed-fluid-therapy-does-not-reduce-primary-postoperative-ileus-after-elective-laparoscopic-colorectal-surgery-a-randomized-controlled-trial
#17
Juan C Gómez-Izquierdo, Alessandro Trainito, David Mirzakandov, Barry L Stein, Sender Liberman, Patrick Charlebois, Nicolò Pecorelli, Liane S Feldman, Franco Carli, Gabriele Baldini
BACKGROUND: Inadequate perioperative fluid therapy impairs gastrointestinal function. Studies primarily evaluating the impact of goal-directed fluid therapy on primary postoperative ileus are missing. The objective of this study was to determine whether goal-directed fluid therapy reduces the incidence of primary postoperative ileus after laparoscopic colorectal surgery within an Enhanced Recovery After Surgery program. METHODS: Randomized patient and assessor-blind controlled trial conducted in adult patients undergoing laparoscopic colorectal surgery within an Enhanced Recovery After Surgery program...
July 2017: Anesthesiology
https://www.readbyqxmd.com/read/28452499/flow-navigation-by-smart-microswimmers-via-reinforcement-learning
#18
Simona Colabrese, Kristian Gustavsson, Antonio Celani, Luca Biferale
Smart active particles can acquire some limited knowledge of the fluid environment from simple mechanical cues and exert a control on their preferred steering direction. Their goal is to learn the best way to navigate by exploiting the underlying flow whenever possible. As an example, we focus our attention on smart gravitactic swimmers. These are active particles whose task is to reach the highest altitude within some time horizon, given the constraints enforced by fluid mechanics. By means of numerical experiments, we show that swimmers indeed learn nearly optimal strategies just by experience...
April 14, 2017: Physical Review Letters
https://www.readbyqxmd.com/read/28439133/importance-of-pharmacy-involvement-in-the-treatment-of-sepsis
#19
Joseph B Cavanaugh, Jesse B Sullivan, Nicole East, Jessica N Nodzon
Purpose: A review of the impact of pharmacists on appropriate medication selection, timing of administration, and as members of a multidisciplinary sepsis response team. Summary: Early goal-directed therapy (EGDT), currently recommended by the 2013 Surviving Sepsis Campaign guidelines for the management of patients with sepsis, includes the administration of appropriate antibiotics in patients with septic shock within the first hour. Multidisciplinary teams containing pharmacists have been shown to decrease time to antibiotic delivery, time to antibiotic administration, and patient mortality...
March 2017: Hospital Pharmacy
https://www.readbyqxmd.com/read/28403397/complications-of-robotic-assisted-laparoscopic-surgery-distant-from-the-surgical-site
#20
D A Maerz, L N Beck, A J Sim, D M Gainsburg
With the ever-increasing popularity of robotic-assisted laparoscopic surgery over the past decades, the literature reporting complications distant from the surgical site involving the use of this technology has also grown. The goal of this non-systematic review is to summarise these reports with a systems-based presentation of these complications. The most commonly observed complications were related to the peripheral nervous system and the most devastating occurring in cardiac and ophthalmic systems. There were no reports of patient complications directly related to the robot itself...
April 1, 2017: British Journal of Anaesthesia
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