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https://www.readbyqxmd.com/read/28808576/-awake-ecco2r-superseded-intubation-in-a-near-fatal-asthma-attack
#1
Thomas-Michael Schneider, Tibor Bence, Franz Brettner
BACKGROUND: Near-fatal asthma attacks are life threatening events that often require mechanical ventilation. Extracorporeal carbon dioxide removal (ECCO2R) is, beside extracorporeal membrane oxygenation (ECMO), a well-established rescue option whenever ventilation gets to its limits. But there seems to be very rare experience with those techniques in avoiding mechanical ventilation in severe asthma attacks. CASE PRESENTATION: A 67-year-old man with a near-fatal asthma attack deteriorated under non-invasive ventilation conditions...
2017: Journal of Intensive Care
https://www.readbyqxmd.com/read/28807699/communication-challenges-of-oncologists-and-intensivists-caring-for-pediatric-oncology-patients-a-qualitative-study
#2
Folasade Odeniyi, Pamela G Nathanson, Theodore E Schall, Jennifer K Walter
CONTEXT: The families of oncology patients requiring intensive care often face increasing complexity in communication with their providers, particularly when patients are cared for by providers from different disciplines. OBJECTIVE: To describe experiences and challenges faced by pediatric oncologists and intensivists and how the oncologist-intensivist relationship impacts communication and initiation of goals of care discussions (GCDs). METHODS: We conducted semi-structured interviews with a convenience sample of ten physicians, including pediatric oncology and intensive care attendings and fellows...
August 11, 2017: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/28804862/oncological-patients-in-the-intensive-care-unit-prognosis-decision-making-therapies-and-end-of-life-care
#3
Ewelina Biskup, Fengfeng Cai, Marcus Vetter, Stephan Marsch
The effectiveness of intensive care unit (ICU) care for cancer patients remains controversial. Advances in antitumour and supportive care led to major improvements in outcomes of oncological patients in the ICU. Improved cancer therapies and supportive management of organ dysfunctions have contributed to improved survival rates. As a consequence, the number of cancer patients requiring ICU admission is rising. Frequently, cancer patients have a poor performance status and are vulnerable. It is a heterogeneous population, where the nature and curability of the neoplasm and the severity of critical illness cause a plethora of issues about ICU admissions...
August 14, 2017: Swiss Medical Weekly
https://www.readbyqxmd.com/read/28801715/spiritual-care-in-the-icu-perspectives-of-dutch-intensivists-icu-nurses-and-spiritual-caregivers
#4
Suzan Willemse, Wim Smeets, Evert van Leeuwen, Loes Janssen, Norbert Foudraine
Since there are no scientific data available about the role of spiritual care (SC) in Dutch ICUs, the goal of this quantitative study was twofold: first, to map the role of SC as a part of daily adult ICU care in The Netherlands from the perspective of intensivists, ICU nurses, and spiritual caregivers and second, to identify similarities and differences among these three perspectives. This study is the quantitative part of a mixed methods approach. To conduct empirical quantitative cohort research, separate digital questionnaires were sent to three different participant groups in Dutch ICUs, namely intensivists, ICU nurses, and spiritual caregivers working in academic and general hospitals and one specialist oncology hospital...
August 11, 2017: Journal of Religion and Health
https://www.readbyqxmd.com/read/28797896/predictors-of-mortality-in-adults-with-sickle-cell-disease-admitted-to-intensive-care-unit-in-bahrain
#5
Sana Abdulaaziz Al Khawaja, Zainab Mahdi Ateya, Ridha Abdulla Al Hammam
OBJECTIVE: Sickle cell disease (SCD) is one of the most common genetic blood disorders in Bahrain. However, there is a paucity of data regarding the clinical presentation of SCD patients who require ICU admission. This study aimed to describe the epidemiological data of SCD patients admitted to the ICU and to identify predictors of mortality in order to help intensivists identify patients at most risk. METHOD: This study used a retrospective, descriptive, and correlational design...
July 15, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/28794832/perioperative-management-and-monitoring-of-antiplatelet-agents-a-focused-review-on-aspirin-and-p2y12-inhibitors
#6
REVIEW
Michael A Mazzeffi, Khang Lee, Bradley Taylor, Kenichi A Tanaka
Platelets play pivotal roles in hemostasis as well as pathological arterial thrombosis. The combination of aspirin and a P2Y12 inhibitor has become the mainstay therapy in the ageing population with cardiovascular conditions, particularly during and after percutaneous coronary intervention. A number of novel P2Y12 inhibitors has become available in the recent years, and they markedly vary in pharmacokinetic and pharmacodynamic properties. Perioperative physicians today face a challenge of preventing hemorrhage due to platelet inhibitors, while minimizing thrombotic risks...
August 2017: Korean Journal of Anesthesiology
https://www.readbyqxmd.com/read/28792355/factors-related-to-parent-attendance-at-a-follow-up-meeting-with-an-intensivist-after-a-child-s-death-in-the-pediatric-intensive-care-unit
#7
Markita L Suttle, Cynthia A Gerhardt, Marci Z Fults
Parents who experience the death of a child are at high risk for psychopathology. Because a large percentage of pediatric deaths occur in the pediatric intensive care unit each year, a follow-up meeting between bereaved parents and intensivists could provide essential emotional support, although some parents may not attend. The aim of this study was to explore demographic and medical factors that may distinguish between bereaved parents who attend a follow-up meeting with their child's pediatric intensivist and those who do not...
January 1, 2017: Omega
https://www.readbyqxmd.com/read/28790275/-management-of-acute-type-a-dissection-complicated-with-acute-mesenteric-ischemia
#8
Tomonobu Abe, Akihiko Usui
Acute mesenteric ischemia as malperfusion syndrome associated with acute aortic dissection is a difficult situation. The incidence is approximately 3~4% in acute type A dissection. Traditionally, most of these patients underwent immediate simple central aortic repair expecting that mesenteric artery obstruction and intestinal ischemia would be resolved by simple central aortic repair. However, short term mortality has been reported very high in this strategy. With the aid of rapidly progressing imaging techniques and newer endovascular repair techniques, results seem to be improving in recent years...
July 2017: Kyobu Geka. the Japanese Journal of Thoracic Surgery
https://www.readbyqxmd.com/read/28779834/inhaled-antibiotics-for-ventilator-associated-infections
#9
REVIEW
Lucy B Palmer
Multidrug-resistant organisms are creating a challenge for physicians treating the critically ill. As new antibiotics lag behind the emergence of worsening resistance, intensivists in countries with high rates of extensively drug-resistant bacteria are turning to inhaled antibiotics as adjunctive therapy. These drugs can provide high concentrations of drug in the lung that could not be achieved with intravenous antibiotics without significant systemic toxicity. This article summarizes current evidence describing the use of inhaled antibiotics for the treatment of bacterial ventilator-associated pneumonia and ventilator-associated tracheobronchitis...
September 2017: Infectious Disease Clinics of North America
https://www.readbyqxmd.com/read/28766156/a-primer-on-nerve-agents-what-the-emergency-responder-anesthesiologist-and-intensivist-needs-to-know
#10
Keith Candiotti
PURPOSE: The purpose of this review article is to familiarize first responders, anesthesiologists, and intensivists with the medical management of patients exposed to nerve agents. SOURCE: This review is based on the current medical literature available to the general medical community. PRINCIPAL FINDINGS: Nerve agents are some of the deadliest substances known to humanity. Though they kill primarily via muscle paralysis, which leads to respiratory arrest, these agents affect virtually every organ system in the body...
August 1, 2017: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
https://www.readbyqxmd.com/read/28765736/factors-influencing-the-quality-of-standardized-treatment-for-patients-with-post-cardiac-arrest-syndrome
#11
Jing Lu, Lijun Liu, Jianliang Zhu, Xinying Guo
BACKGROUND AND OBJECTIVES: For the present study, we investigated the factors that influence the quality of standardized treatment for patients with post-cardiac arrest syndrome (PCAS) to improve the quality of PCAS treatment. SUBJECTS AND METHODS: We collected data on patients with cardiac arrest (CA) who were admitted to the intensive care units (ICUs) of 11 hospitals-Class II Grade A or above-in Suzhou from January to October 2013. Indexes of standardized treatment were observed within 72 hrs of CA...
July 2017: Korean Circulation Journal
https://www.readbyqxmd.com/read/28765018/takotsubo-cardiomyopathy-triggered-by-venous-air-embolism-during-craniotomy-in-sitting-position-a-case-report
#12
Florian Raimann, Christian Senft, Jörg Honold, Kai Zacharowski, Volker Seifert, Jan Mersmann
BACKGROUND: Here we present a case of a stress induced cardiomyopathy (TakoTsubo cardiomyopathy) caused by a venous air embolism during a craniotomy in sitting position. CASE DESCRIPTION: A 69-year old female patient was admitted to the neurosurgical department and scheduled for elective resection of a cerebellar metastasis in sitting position. After craniotomy and opening of the posterior fossa a venous air embolism was detected via transesophageal echocardiography...
July 29, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28758559/small-for-size-syndrome-bridging-the-gap-between-liver-transplantation-and-graft-recovery
#13
Akila Rajakumar, Ilankumaran Kaliamoorthy, Mohamed Rela, M Susan Mandell
In living donor liver transplantation, optimal graft size is estimated from values like graft volume/standard liver volume and graft/recipient body weight ratio but the final functional hepatic mass is influenced by other donor and recipient factors. Grafts with insufficient functional hepatic mass can produce a life-threatening condition with rapidly progressive liver failure called small-for-size syndrome (SFSS). Diagnosis of SFSS requires careful surveillance for signs of inadequate hepatocellular function, residual portal hypertension, and systemic inflammation that suggest rapidly progressive liver failure...
September 2017: Seminars in Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/28756405/the-recognition-and-management-of-sepsis-and-septic-shock-a-guide-for-non-intensivists
#14
REVIEW
Alexander Keeley, Paul Hine, Emmanuel Nsutebu
Sepsis is common, often fatal and requires rapid interventions to improve outcomes. While the optimal management of sepsis in the intensive care setting is the focus of extensive research interest, the mainstay of the recognition and initial management of sepsis will occur outside the intensive care setting. Therefore, it is key that institutions and clinicians remain well informed of the current updates in sepsis management and continue to use them to deliver appropriate and timely interventions to enhance patient survival...
July 29, 2017: Postgraduate Medical Journal
https://www.readbyqxmd.com/read/28748278/-therapy-escalation-for-the-potential-organ-donor-are-all-intensive-care-measures-also-ethically-justifiable
#15
REVIEW
S-O Kuhn, K Hahnenkamp
The gap between the number of organs needed and the number available has dramatically increased in Germany in the last decade-for intensivists and transplantation specialists, it is challenging to cover the demand responsibly. It is therefore increasingly important to identify potential organ donors in order to realize organ donation. An escalation of intensive care measures is often required, which raises critical ethical questions. In Germany, organ donation is only allowed after brain death with prior informed consent from the deceased or his/her relatives...
July 26, 2017: Medizinische Klinik, Intensivmedizin und Notfallmedizin
https://www.readbyqxmd.com/read/28737600/an-interprofessional-quality-improvement-initiative-to-standardize-pediatric-extubation-readiness-assessment
#16
Samer Abu-Sultaneh, Acrista J Hole, Alvaro J Tori, Brain D Benneyworth, Riad Lutfi, Christopher W Mastropietro
OBJECTIVES: Establishing protocols to wean mechanical ventilation and assess readiness for extubation, with the goal of minimizing morbidity associated with extubation failure and prolonged mechanical ventilation, have become increasingly important in contemporary PICUs. The aim of this quality improvement initiative is to establish a respiratory therapist-led daily spontaneous breathing trial protocol to standardize extubation readiness assessment and documentation in our PICU. DESIGN: A quality improvement project...
July 21, 2017: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/28726590/a-method-of-managing-severe-traumatic-brain-injury-in-the-absence-of-intracranial-pressure-monitoring-the-ice-protocol
#17
Randall Chesnut, Nancy Temkin, Sureyya Dikmen, Carlos Rondina, Walter Videtta, Gustavo Petroni, Silvia Lujan, Victor Alanis, Antonio Luis Eiras Falcao, Gustavo La Fuente, Luis Gonzalez, Manuel Jibaja, Arturo Lavendez, Freddy Sandi Lora, Roberto Merida, Ricardo Romero, James Pridgeon, Jason Barber, Joan Machamer, Kelley Chaddock
Purpose - The imaging- and clinical-examination (ICE) algorithm used in the BEST TRIP ICP randomized controlled trial is the only prospectively investigated clinical protocol for TBI management without ICP monitoring. As the default literature standard, it warrants careful evaluation. Methods - We present the ICE protocol in detail and analyse the demographics, outcome, treatment intensity, frequency of intervention usage, and related adverse events in the ICE-protocol cohort. Results - The 167 ICE protocol patients were young (median 29 years) with a median Glasgow Coma Scale motor score of 4 but with anisocoria or abnormal pupillary reactivity in 40%...
July 20, 2017: Journal of Neurotrauma
https://www.readbyqxmd.com/read/28724143/potentially-avoidable-surgical-intensive-care-unit-admissions-and-disposition-delays
#18
Navpreet K Dhillon, Ara Ko, Eric J T Smith, Mayumi Kharabi, Joseph Castongia, Michael Nurok, Bruce L Gewertz, Eric J Ley
Importance: High health care costs encourage initiatives that avoid overuse of resources and identify opportunities to promote appropriate care. Objective: To investigate the causes of potentially avoidable surgical intensive care unit (SICU) admissions and disposition delays to determine whether targeted interventions could decrease these stays. Design, Setting, and Participants: This prospective, observational study focused on potentially avoidable SICU days, as determined by observers with input from the rounding intensivists at a 24-bed open SICU at an urban, academic hospital...
July 19, 2017: JAMA Surgery
https://www.readbyqxmd.com/read/28707845/clinical-ethics-what-the-anaesthesiologist-and-the-intensivist-need-to-know
#19
Marco Vergano, Emma Magavern, Nereo Zamperetti
Clinical ethics if often perceived as an intuitive understanding of what is right versus wrong. This is insufficient for healthcare workers in general, but particularly for anesthesiologists and intensivists, who often must weigh up complex and emergent life or death decisions and subsequently justify these decisions to their team and patients, as well as patient's families. Articulating the rationale for such decisions is an arduous task. Thus, a brief introduction to the basic conceptual framework and vocabulary of clinical ethics may be useful to this population of physicians...
July 12, 2017: Minerva Anestesiologica
https://www.readbyqxmd.com/read/28705304/clinical-practice-of-acute-respiratory-distress-syndrome-in-japan-a-nationwide-survey-and-scientific-evidences
#20
Sadatomo Tasaka, Koichiro Tatsumi
BACKGROUND: There has been limited information about epidemiology and clinical practice of acute respiratory distress syndrome (ARDS) in Japan. METHODS: An invitation letter to the web-based survey was mailed to all 871 board certified hospitals of the Japanese Respiratory Society. The questionnaires were designed to collect data on epidemiology and clinical practice of ARDS, including diagnostic measures and therapeutics. RESULTS: Within 4 months of the survey period, valid responses were obtained from 296 (34%) hospitals...
July 2017: Respiratory Investigation
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