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Mechanical ventilation, shock, cardiac arrest

Mateusz Ostręga, Marek J Gierlotka, Grzegorz Słonka, Paweł Nadziakiewicz, Mariusz Gąsior
INTRODUCTION    There are limited data on the impact of ischemic etiology on clinical status and long-term prognosis among patients with acute severe heart failure (ASHF) not associated with acute coronary syndrome (ACS).  OBJECTIVES    To assess clinical characteristics, treatment and the 12-month mortality of patients with no-ACS ASHF according to etiology.  PATIENTS AND METHODS    The data from 112 patients with ASHF that was not associated with ACS were analyzed: 61 with ischemic (IASHF) and 51 with non-ischemic (NIASHF) etiology...
April 18, 2017: Polish Archives of Internal Medicine
Jeremy R Beitler, Tiffany Bita Ghafouri, Sayuri P Jinadasa, Ariel Mueller, Leeyen Hsu, Ryan J Anderson, Jisha Joshua, Sanjeev Tyagi, Atul Malhotra, Rebecca E Sell, Daniel Talmor
RATIONALE: Neurocognitive outcome after out-of-hospital cardiac arrest (OHCA) often is poor even when initial resuscitation succeeds. Lower tidal volumes (VT) attenuate extrapulmonary organ injury in other disease states and are neuro-protective in preclinical models of critical illness. OBJECTIVE: To evaluate the association between VT and neurocognitive outcome following OHCA. METHODS: Propensity-adjusted analysis of two-center retrospective cohort of OHCA patients who received mechanical ventilation for at least the first 48 hours of hospitalization...
March 7, 2017: American Journal of Respiratory and Critical Care Medicine
L C Napp, C Kühn, J Bauersachs
Cardiogenic shock is an acute emergency, which is classically managed by medical support with inotropes or vasopressors and frequently requires invasive ventilation. However, both catecholamines and ventilation are associated with a worse prognosis, and many patients deteriorate despite all efforts. Mechanical circulatory support is increasingly considered to allow for recovery or to bridge until making a decision or definite treatment. Of all devices, extracorporeal membrane oxygenation (ECMO) is the most widely used...
February 2017: Herz
Allan J Walkey, Janice Weinberg, Renda Soylemez Wiener, Colin R Cooke, Peter K Lindenauer
OBJECTIVE: To determine between-hospital variation in interventions provided to patients with do not resuscitate (DNR) orders. DATA SOURCES/SETTING: United States Agency of Healthcare Research and Quality, Healthcare Cost and Utilization Project, California State Inpatient Database. STUDY DESIGN: Retrospective cohort study including hospitalized patients aged 40 and older with potential indications for invasive treatments: in-hospital cardiac arrest (indication for CPR), acute respiratory failure (mechanical ventilation), acute renal failure (hemodialysis), septic shock (central venous catheterization), and palliative care...
January 18, 2017: Health Services Research
Jiri Parenica, Jiri Jarkovsky, Jan Malaska, Alexandre Mebazaa, Jana Gottwaldova, Katerina Helanova, Jiri Litzman, Milan Dastych, Josef Tomandl, Jindrich Spinar, Ludmila Dostalova, Petr Lokaj, Marie Tomandlova, Monika Goldergova Pavkova, Pavel Sevcik, Matthieu Legrand
INTRODUCTION: Patients with cardiogenic shock (CS) are at a high risk of developing infectious complications; however, their early detection is difficult, mainly due to a frequently occurring noninfectious inflammatory response, which accompanies an extensive myocardial infarction (MI) or a postcardiac arrest syndrome. The goal of our prospective study was to describe infectious complications in CS and the immune/inflammatory response based on a serial measurement of several blood-based inflammatory biomarkers...
February 2017: Shock
Jorrit S Lemkes, Gladys N Janssens, Heleen M Oudemans-van Straaten, Paul W Elbers, Nina W van der Hoeven, Jan G P Tijssen, Luuk C Otterspoor, Michiel Voskuil, Joris J van der Heijden, Martijn Meuwissen, Tom A Rijpstra, Georgios J Vlachojannis, Raoul M van der Vleugel, Koen Nieman, Lucia S D Jewbali, Gabe B Bleeker, Rémon Baak, Bert Beishuizen, Martin G Stoel, Pim van der Harst, Cyril Camaro, José P S Henriques, Maarten A Vink, Marcel T M Gosselink, Hans A Bosker, Harry J G M Crijns, Niels van Royen
BACKGROUND: Ischemic heart disease is a major cause of out-of-hospital cardiac arrest. The role of immediate coronary angiography (CAG) and percutaneous coronary intervention (PCI) after restoration of spontaneous circulation following cardiac arrest in the absence of ST-segment elevation myocardial infarction (STEMI) remains debated. HYPOTHESIS: We hypothesize that immediate CAG and PCI, if indicated, will improve 90-day survival in post-cardiac arrest patients without signs of STEMI...
October 2016: American Heart Journal
Christine M Murphy, Cliff Williams, Michael E Quinn, Brian Nicholson, Thomas Shoe, Michael C Beuhler, William P Kerns
Animal studies and human case reports show promise in using lipid rescue to treat refractory calcium channel antagonist toxicity. However, the majority of research and clinical experience has focused on non-dihydropyridine agents. Thus, we sought to investigate the value of lipid emulsion (ILE) therapy for dihydropyridine-induced shock. This IACUC-approved study utilized seven swine that were sedated with alpha-chloralose, mechanically ventilated, and instrumented for drug delivery and hemodynamic measures...
December 2016: Journal of Medical Toxicology: Official Journal of the American College of Medical Toxicology
Alexandra-Maria Warenits, Fritz Sterz, Andreas Schober, Florian Ettl, Ingrid Anna Maria Magnet, Sandra Högler, Ursula Teubenbacher, Daniel Grassmann, Michael Wagner, Andreas Janata, Wolfgang Weihs
Extracorporeal life support is a promising concept for selected patients in refractory cardiogenic shock and for advanced life support of persistent ventricular fibrillation cardiac arrest. Animal models of ventricular fibrillation cardiac arrest could help to investigate new treatment strategies for successful resuscitation. Associated procedural pitfalls in establishing a rat model of extracorporeal life support resuscitation need to be replaced, refined, reduced and reported.Anesthetized male Sprague-Dawley rats (350-600 g), (n = 126), underwent cardiac arrest induced with a pacing catheter placed into the right ventricle via a jugular cannula...
July 7, 2016: Shock
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No abstract text is available yet for this article.
June 2016: Annals of Intensive Care
Alexander Levitov, Heidi L Frankel, Michael Blaivas, Andrew W Kirkpatrick, Erik Su, David Evans, Douglas T Summerfield, Anthony Slonim, Raoul Breitkreutz, Susanna Price, Matthew McLaughlin, Paul E Marik, Mahmoud Elbarbary
OBJECTIVE: To establish evidence-based guidelines for the use of bedside cardiac ultrasound, echocardiography, in the ICU and equivalent care sites. METHODS: Grading of Recommendations, Assessment, Development and Evaluation system was used to rank the "levels" of quality of evidence into high (A), moderate (B), or low (C) and to determine the "strength" of recommendations as either strong (strength class 1) or conditional/weak (strength class 2), thus generating six "grades" of recommendations (1A-1B-1C-2A-2B-2C)...
June 2016: Critical Care Medicine
Meng-Han Chou, Hsin-Hui Huang, Yu-Ju Lai, Kwei-Shuai Hwang, Yu-Chi Wang, Her-Young Su
OBJECTIVE: To present the correlation between severe pre-eclampsia and peripartum cardiomyopathy in pregnancy. CASE REPORT: A 41-year-old parturient, gravida 3, para 1, at 34 4/7 weeks' gestation, was diagnosed with severe pre-eclampsia. At the time of admission, a plain chest film disclosed bilateral pleural effusions. An emergent cesarean section was planned because of decreased fetal movement, heavy daily protein loss, and bilateral pleural effusions. During the cesarean section, she developed shock with acute respiratory failure...
February 2016: Taiwanese Journal of Obstetrics & Gynecology
Vincent Auffret, Aurélie Loirat, Guillaume Leurent, Raphael P Martins, Emmanuelle Filippi, Isabelle Coudert, Jean Philippe Hacot, Martine Gilard, Philippe Castellant, Antoine Rialan, Régis Delaunay, Gilles Rouault, Philippe Druelles, Bertrand Boulanger, Josiane Treuil, Bertrand Avez, Marc Bedossa, Dominique Boulmier, Marielle Le Guellec, Jean-Claude Daubert, Hervé Le Breton
BACKGROUND: High-degree atrioventricular block (HAVB) is a common complication of ST segment elevation myocardial infarction (STEMI). HAVB in STEMI is historically considered as a marker of worse outcome but overall data about HAVB in the contemporary era of mechanical reperfusion and potent antiplatelet therapies are scarce. AIM: Analysing incidence, clinical correlates and impact on inhospital outcomes of HAVB in a large prospective registry (Observatoire Régional Breton sur l'Infarctus, ORBI) of modern management of STEMI with a special focus on potential differences between patients with HAVB on admission and those who developed HAVB during hospitalisation...
January 2016: Heart: Official Journal of the British Cardiac Society
Laura Doyon, Alejandro Moreno-Koehler, Rocco Ricciardi, Dmitry Nepomnayshy
BACKGROUND: As clinical outcome data are increasingly tied to hospital reimbursement, balancing quality care with training of surgical residents has become critical. We used the ACS-NSQIP database to determine impact of resident participation in laparoscopic gastric bypass on 30-day morbidity and mortality. METHODS: We queried the ACS-NSQIP database from 1/2005 to 12/2012 for laparoscopic gastric bypass, dividing cases between those with or without resident involvement...
August 2016: Surgical Endoscopy
Jill Cox, Sharon Roche
BACKGROUND: Vasopressors are lifesaving agents used to raise mean arterial pressure in critically ill patients in shock states. The pharmacodynamics of these agents suggest vasopressors may play a role in development of pressure ulcers; however, this aspect has been understudied. OBJECTIVE: To examine associations between type, dose, and duration of vasopressors (norepinephrine, epinephrine, vasopressin, phenylephrine, dopamine) and development of pressure ulcers in medical-surgical and cardiothoracic intensive care unit patients and to examine predictors of the development of pressure ulcers in these patients...
November 2015: American Journal of Critical Care: An Official Publication, American Association of Critical-Care Nurses
Boulos S Nassar, Gregory A Schmidt
Capnography has made steady inroads in the ICU and is increasingly used for all patients who are mechanically ventilated. There is growing recognition that capnography is rich in information about lung and circulatory physiology and provides insight into many diseases and treatments. These include conditions of impaired matching of ventilation and perfusion, such as pulmonary embolism and obstructive lung diseases; circulatory questions, such as the adequacy of chest compressions during cardiac arrest or fluid responsiveness in patients in shock; and the safety of procedural sedation...
February 2016: Chest
Vincent Roule, Adrien Lemaitre, Rémi Sabatier, Thérèse Lognoné, Ziad Dahdouh, Ludovic Berger, Paul Milliez, Gilles Grollier, Gilles Montalescot, Farzin Beygui
BACKGROUND: The transradial approach for percutaneous coronary intervention (PCI) is associated with a better outcome in myocardial infarction (MI), but patients with cardiogenic shock (CS) were excluded from most trials. AIMS: To compare outcomes of PCI for MI-related CS via the transradial versus transfemoral approach. METHODS: A prospective cohort of 101 consecutive patients admitted for PCI for MI-related CS were treated via the transradial (n=74) or transfemoral (n=27) approach...
November 2015: Archives of Cardiovascular Diseases
Matthieu Schmidt, Aidan Burrell, Lloyd Roberts, Michael Bailey, Jayne Sheldrake, Peter T Rycus, Carol Hodgson, Carlos Scheinkestel, D Jamie Cooper, Ravi R Thiagarajan, Daniel Brodie, Vincent Pellegrino, David Pilcher
RATIONALE: Extracorporeal membrane oxygenation (ECMO) may provide mechanical pulmonary and circulatory support for patients with cardiogenic shock refractory to conventional medical therapy. Prediction of survival in these patients may assist in management of these patients and comparison of results from different centers. AIMS: To identify pre-ECMO factors which predict survival from refractory cardiogenic shock requiring ECMO and create the survival after veno-arterial-ECMO (SAVE)-score...
September 1, 2015: European Heart Journal
Romain Gallet, Guy Meyer, Julien Ternacle, Caroline Biendel, Anne Brunet, Nicolas Meneveau, Roger Rosario, Francis Couturaud, Mustapha Sebbane, Nicolas Lamblin, Helene Bouvaist, Pierre Coste, Bernard Maitre, Sylvie Bastuji-Garin, Jean-Luc Dubois-Rande, Pascal Lim
INTRODUCTION: In acute pulmonary embolism (PE), poor outcome is usually related to right ventricular (RV) failure due to the increase in RV afterload. Treatment of PE with RV failure without shock is controversial and usually relies on fluid expansion to increase RV preload. However, several studies suggest that fluid expansion may worsen acute RV failure by increasing RV dilation and ischaemia, and increase left ventricular compression by RV dilation. By reducing RV enlargement, diuretic treatment may break this vicious circle and provide early improvement in normotensive patients referred for acute PE with RV failure...
May 22, 2015: BMJ Open
Lorissa Lamoureux, Jeejabai Radhakrishnan, Raúl J Gazmuri
A rat model of electrically-induced ventricular fibrillation followed by cardiac resuscitation using a closed chest technique that incorporates the basic components of cardiopulmonary resuscitation in humans is herein described. The model was developed in 1988 and has been used in approximately 70 peer-reviewed publications examining a myriad of resuscitation aspects including its physiology and pathophysiology, determinants of resuscitability, pharmacologic interventions, and even the effects of cell therapies...
April 26, 2015: Journal of Visualized Experiments: JoVE
Hendrik J F Helmerhorst, Marie-José Roos-Blom, David J van Westerloo, Evert de Jonge
OBJECTIVE: Oxygen is vital during critical illness, but hyperoxia may harm patients. Our aim was to systematically evaluate the methodology and findings of cohort studies investigating the effects of hyperoxia in critically ill adults. DATA SOURCE: A meta-analysis and meta-regression analysis of cohort studies published between 2008 and 2015 was conducted. Electronic databases of MEDLINE, EMBASE, and Web of Science were systematically searched for the keywords hyperoxia and mortality or outcome...
July 2015: Critical Care Medicine
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