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https://www.readbyqxmd.com/read/29126689/the-feasibility-and-impact-of-routine-combined-limited-transthoracic-echocardiography-and-lung-ultrasound-on-diagnosis-and-management-of-patients-admitted-to-icu-a-prospective-observational-study
#1
Kavi Haji, Darsim Haji, David J Canty, Alistair G Royse, Dhaksha Tharmaraj, Meor Azraee, Lynda Hopkins, Collin F Royse
OBJECTIVES: Limited transthoracic echocardiography (TTE) and lung ultrasound increasingly is performed in the intensive care unit (ICU), though used in a goal-directed rather than routine manner. DESIGN: Prospective observational study. SETTINGS: Tertiary ICU. PARTICIPANTS: Ninety-three critically ill participants within 24 hours of admission to ICU. METHODS: A treating intensivist documented a clinical diagnosis and management plan before and after combined limited TTE and lung ultrasound...
August 18, 2017: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/29120938/fibrinogen-on-admission-in-trauma-score-early-prediction-of-low-plasma-fibrinogen-concentrations-in-trauma-patients
#2
Tobias Gauss, Sébastien Campion, Sébastien Kerever, Mathilde Eurin, Mathieu Raux, Anatole Harrois, Catherine Paugam-Burtz, Sophie Hamada
BACKGROUND: Early recognition of low fibrinogen concentrations in trauma patients is crucial for timely haemostatic treatment and laboratory testing is too slow to inform decision-making. OBJECTIVE: To develop a simple clinical tool to predict low fibrinogen concentrations in trauma patients on arrival. DESIGN: Retrospective cohort study. SETTING: Three designated level 1 trauma centres in the Paris Region, from January 2011 to December 2013...
November 8, 2017: European Journal of Anaesthesiology
https://www.readbyqxmd.com/read/29098290/fluid-structure-interaction-models-of-bicuspid-aortic-valves-the-effects-of-non-fused-cusp-angles
#3
Karin Lavon, Rotem Halevi, Gil Marom, Sagit Ben Zekry, Ashraf Hamdan, Hans Joachim Schäfers, Ehud Raanani, Rami Haj-Ali
Bicuspid aortic valve (BAV) is the most common type of congenital heart disease, occurring in 0.5-2% of the population, where the valve has only two rather than the three normal cusps. Valvular pathologies, such as aortic regurgitation and aortic stenosis, are associated with BAVs, thereby increasing the need for a better understanding of BAV kinematics and geometrical characteristics. The aim of this study is to investigate the influence of the non-fused cusp (NFC) angle in BAV type-1 configuration on the valve's structural and hemodynamic performance...
November 2, 2017: Journal of Biomechanical Engineering
https://www.readbyqxmd.com/read/29094511/a-comparison-of-nanoparticullate-cpg-immunotherapy-with-and-without-allergens-in-spontaneously-equine-asthma-affected-horses-an-animal-model
#4
John Klier, Sabine Geis, Jeanette Steuer, Katharina Geh, Sven Reese, Sebastian Fuchs, Ralf S Mueller, Gerhard Winter, Heidrun Gehlen
INTRODUCTION: New therapeutic strategies to modulate the immune response of human and equine allergic asthma are still under extensive investigation. Immunomodulating agents stimulating T-regulatory cells offer new treatment options beyond conventional symptomatic treatment or specific immunotherapy for human and equine allergic airway diseases, with the goal of a homoeostatic T-helper cell balance. The aim of this study was to evaluate the effects of a nebulized gelatin nanoparticle-CpG formulation (CpG-GNP) with and without specific allergens for the treatment of spontaneous allergic equine asthma as a model for human asthma...
November 1, 2017: Immunity, Inflammation and Disease
https://www.readbyqxmd.com/read/29077720/goal-directed-therapy-for-suspected-acute-bacterial-meningitis-in-adults-and-adolescents-in-sub-saharan-africa
#5
Emma C Wall, Mavuto Mukaka, Brigitte Denis, Veronica S Mlozowa, Malango Msukwa, Khumbo Kasambala, Mulinda Nyrienda, Theresa J Allain, Brian Faragher, Robert S Heyderman, David G Lalloo
BACKGROUND: Mortality from acute bacterial meningitis (ABM) in sub-Saharan African adults and adolescents exceeds 50%. We tested if Goal Directed Therapy (GDT) was feasible for adults and adolescents with clinically suspected ABM in Malawi. MATERIALS AND METHODS: Sequential patient cohorts of adults and adolescents with clinically suspected ABM were recruited in the emergency department of a teaching hospital in Malawi using a before/after design. Routine care was monitored in year one (P1)...
2017: PloS One
https://www.readbyqxmd.com/read/29068831/crystalloid-versus-colloid-for-intraoperative-goal-directed-fluid-therapy-using-a-closed-loop-system-a-randomized-double-blinded-controlled-trial-in-major-abdominal-surgery
#6
Alexandre Joosten, Amelie Delaporte, Brigitte Ickx, Karim Touihri, Ida Stany, Luc Barvais, Luc Van Obbergh, Patricia Loi, Joseph Rinehart, Maxime Cannesson, Philippe Van der Linden
BACKGROUND: The type of fluid and volume regimen given intraoperatively both can impact patient outcome after major surgery. This two-arm, parallel, randomized controlled, double-blind, bi-center superiority study tested the hypothesis that when using closed-loop assisted goal-directed fluid therapy, balanced colloids are associated with fewer postoperative complications compared to balanced crystalloids in patients having major elective abdominal surgery. METHODS: One hundred and sixty patients were enrolled in the protocol...
October 25, 2017: Anesthesiology
https://www.readbyqxmd.com/read/29067620/what-is-enhanced-recovery-and-how-can-i-do-it
#7
Bradford J Kim, Thomas A Aloia
BACKGROUND: Enhanced recovery (ER) and fast-track protocols were initially implemented in the perioperative management of the surgical patient over 20 years ago. These standardized protocols are now broadly implemented across most surgical specialties for its many benefits. ER is well known for its positive effects on decreasing length of stay and complications. However, patient-centric outcomes for adequate pain control, functional recovery, costs, and overall patient experience are less considered...
October 24, 2017: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
https://www.readbyqxmd.com/read/29059118/early-haemorrhage-control-and-management-of-trauma-induced-coagulopathy-the-importance-of-goal-directed-therapy
#8
Jakob Stensballe, Hanne H Henriksen, Pär I Johansson
PURPOSE OF REVIEW: The aim of this study was to discuss the recent developments in trauma-induced coagulopathy and the evolvement of goal-directed therapy. RECENT FINDINGS: Mortality from major trauma continues to be a worldwide problem, and massive haemorrhage remains a major cause in 40% of potentially preventable trauma deaths. Development of trauma-induced coagulopathy challenges 25-35% of the patients further increasing trauma mortality. The pathophysiology of coagulopathy in trauma reflects at least two distinct mechanisms: Acute traumatic coagulopathy, consisting of endogenous heparinization, activation of the protein C pathway, hyperfibrinolysis and platelet dysfunction, and resuscitation associated coagulopathy...
December 2017: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/29047195/hepatic-transudation-barrier-properties
#9
R M Dongaonkar, R H Stewart, C M Quick, K L Uray, C S Cox, G A Laine
OBJECTIVE: Fluid and protein continuously transudes from the surface of the liver. Despite a common understanding that transudation plays a critical role in hepatic interstitial and peritoneal fluid balance, transudation from the entire liver has not been studied. Therefore, the goal of the present work was to provide the first direct measurement of the hepatic transudation rate and transudation barrier properties. METHODS: Transudation rates were determined by collecting transudate from the entire liver...
October 19, 2017: Microcirculation: the Official Journal of the Microcirculatory Society, Inc
https://www.readbyqxmd.com/read/29047069/postoperative-visceral-tissue-edema-assessed-by-computed-tomography-is-a-predictor-for-severe-complications-after-pancreaticoduodenectomy
#10
Atsushi Shimizu, Manabu Kawai, Seiko Hirono, Ken-Ichi Okada, Motoki Miyazawa, Yuji Kitahata, Masaki Ueno, Shinya Hayami, Atsushi Miyamoto, Yoshiki Kimoto, Toshio Shimokawa, Hiroki Yamaue
BACKGROUND/AIMS: In pancreatoduodenectomy (PD), the adverse impact of tissue edema owing to intraoperative fluid overload remains unclear. This study aims to evaluate how visceral tissue edema due to fluid overload affects severe postoperative complications after PD. It aims to clarify the usefulness of assessment by computed tomography (CT) of postoperative tissue edema. METHODS: We classified 200 patients who underwent PD as either liberal fluid management (LFM) group (n = 100) or goal-directed fluid therapy (GDFT) group (n = 100), based on intraoperative fluid management...
October 18, 2017: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
https://www.readbyqxmd.com/read/29033715/has-goal-directed-fluid-therapy-and-glycocalyx-a-role-in-enhanced-recovery-after-anesthesia
#11
EDITORIAL
Abdelazeem Eldawlatly
No abstract text is available yet for this article.
October 2017: Saudi Journal of Anaesthesia
https://www.readbyqxmd.com/read/29028286/doppler-guided-goal-directed-fluid-therapy-does-not-affect-intestinal-cell-damage-but-increases-global-gastrointestinal-perfusion-in-colorectal-surgery-a-randomized-controlled-trial
#12
Kostan W Reisinger, Henriette M Willigers, Jochen Jansen, Wim A Buurman, Maarten F Von Meyenfeldt, Geerard L Beets, Martijn Poeze
Individualized, goal-directed fluid therapy (GDFT) based on Doppler measurements of stroke volume has been proposed as a treatment strategy in terms of reducing complications, mortality and length of hospital stay in major bowel surgery. We studied the effect of Doppler guided GDFT on intestinal damage as compared with standard post-operative fluid replacement. STUDY DESIGN: Patients undergoing elective colorectal resection for malignancy were randomized to standard intra- and postoperative fluid therapy or standard fluid therapy with additional Doppler guided GDFT...
October 13, 2017: Colorectal Disease: the Official Journal of the Association of Coloproctology of Great Britain and Ireland
https://www.readbyqxmd.com/read/29023316/septic-shock-resuscitation-in-the-first-hour
#13
Nicholas Simpson, Francois Lamontagne, Manu Shankar-Hari
PURPOSE OF REVIEW: We reviewed the recent advances in the initial approach to resuscitation of sepsis and septic shock patients. RECENT FINDINGS: Sepsis and septic shock are life-threatening emergencies. Two key interventions in the first hour include timely antibiotic therapy and resuscitation. Before any laboratory results, the need for resuscitation is considered if a patient with suspected infection has low blood pressure (BP) or impaired peripheral circulation found at clinical examination...
December 2017: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/28992877/perioperative-fluid-management-in-major-hepatic-resection-an-integrative-review
#14
REVIEW
Osamu Yoshino, Marcos Vinicius Perini, Christopher Christophi, Laurence Weinberg
BACKGROUND: Fluid intervention and vasoactive pharmacological support during hepatic resection depend on the preference of the attending clinician, institutional resources, and practice culture. Evidence-based recommendations to guide perioperative fluid management are currently limited. Therefore, we provide a contemporary clinical integrative overview of the fundamental principles underpinning fluid intervention and hemodynamic optimization for adult patients undergoing major hepatic resection...
October 15, 2017: Hepatobiliary & Pancreatic Diseases International: HBPD INT
https://www.readbyqxmd.com/read/28988460/toolbox-of-assessment-tools-of-technical-skills-in-otolaryngology-head-and-neck-surgery-a-systematic-review
#15
REVIEW
Mathilde Labbé, Meredith Young, Lily H P Nguyen
OBJECTIVE: To support the development of programs of assessment of technical skills in the operating room (OR), we systematically reviewed the literature to identify assessment tools specific to otolaryngology-head and neck surgery (OTL-HNS) core procedures and summarized their characteristics. METHODS: We systematically searched Embase, MEDLINE, PubMed, and Cochrane to identify and report on assessment tools that can be used to assess residents' technical surgical skills in the operating room for OTL-HNS core procedures...
October 8, 2017: Laryngoscope
https://www.readbyqxmd.com/read/28981592/comparison-of-two-stroke-volume-variation-based-goal-directed-fluid-therapies-for-supratentorial-brain-tumour-resection-a-randomized-controlled-trial
#16
C Y Wu, Y S Lin, H M Tseng, H L Cheng, T S Lee, P L Lin, W H Chou, Y J Cheng
Background: The optimal volume status for neurosurgery has yet to be determined. We compared two fluid protocols based on different stroke volume variation (SVV) cut-offs for goal-directed fluid therapy (GDFT) during supratentorial brain tumour resection. Methods: A randomized, single-blind, open-label trial was conducted. Eighty adult patients undergoing elective supratentorial brain tumour resection were randomly divided into a low SVV and a high SVV group. The SVV cut-offs were used to determine when to initiate colloid infusion...
November 1, 2017: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/28976345/-impact-of-a-goal-directed-therapy-in-the-implementation-of-an-eras-enhanced-recovery-after-surgery-protocol-in-laparoscopic-radical-cystectomy
#17
Rafael Uña Orejón, Ivan Huercio Martinez, Estrella Mateo Torres, Cristina Jofré Escudero, Juan Gomez Rivas, Jesús Diez Sebastián, Maria Prado Ureta Tolsada
OBJECTIVES: The intraoperative goaldirected fluid therapy (GDT) has become the base of perioperative management in the fast-track protocols. This program using technology to estimate cardiac output, with the aim of minimizing splanchnic hypoperfusion. However, there is insufficient evidence to confirm its application in radical laparoscopic cystectomy. METHODS: In a retrospective study, we have included 52 patients that were scheduled for radical cystectomy. In group A (n=32) patients were treated following GDT...
October 2017: Archivos Españoles de Urología
https://www.readbyqxmd.com/read/28969329/perioperative-goal-directed-therapy-with-uncalibrated-pulse-contour-methods-impact-on-fluid-management-and-postoperative-outcome
#18
A Perel
No abstract text is available yet for this article.
September 1, 2017: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/28960303/interstitial-igg-antibody-pharmacokinetics-assessed-by-combined-in-vivo-and-physiologically-based-pharmacokinetic-modelling-approaches
#19
Miro J Eigenmann, Tine V Karlsen, Ben-Fillippo Krippendorff, Olav Tenstad, Ludivine Fronton, Michael B Otteneder, Helge Wiig
KEY POINTS: For therapeutic antibodies, total tissue concentrations are frequently reported as a lump sum measure of the antibody in residual plasma, interstitial fluid and cells. In terms of correlating antibody exposure to a therapeutic effect, however, interstitial pharmacokinetics might be more relevant. In the present study, we collected total tissue and interstitial antibody biodistribution data in mice and assessed the composition of tissue samples aiming to correct total tissue measurements for plasma and cellular content...
September 27, 2017: Journal of Physiology
https://www.readbyqxmd.com/read/28956761/apobec3a-is-upregulated-by-human-cytomegalovirus-hcmv-in-the-maternal-fetal-interface-acting-as-an-innate-anti-hcmv-effector
#20
Yiska Weisblum, Esther Oiknine-Djian, Zichria Zakay-Rones, Olesya Vorontsov, Ronit Haimov-Kochman, Yuval Nevo, David Stockheim, Simcha Yagel, Amos Panet, Dana G Wolf
Human cytomegalovirus (HCMV) is the leading cause of congenital infection and is associated with a wide range of neurodevelopmental disabilities and intrauterine growth restriction. Yet our current understanding of the mechanisms modulating transplacental HCMV transmission is poor. The placenta, given its critical function in protecting the fetus, has evolved effective yet largely uncharacterized innate immune barriers against invading pathogens. Here we show that the intrinsic cellular restriction factor apolipoprotein B editing catalytic subunit-like 3A (APOBEC3A [A3A]) is profoundly upregulated following ex vivo HCMV infection in human decidual tissues-constituting the maternal aspect of the placenta...
December 1, 2017: Journal of Virology
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