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https://www.readbyqxmd.com/read/27923227/optimal-role-of-the-nephrologist-in-the-intensive-care-unit
#1
D J Askenazi, Michael Heung, Michael J Connor, Rajit K Basu, Jorge Cerdá, Kent Doi, Jay L Koyner, Azra Bihorac, Ladan Golestaneh, Anitha Vijayan, Mark D Okusa, Sarah Faubel
As advances in Critical Care Medicine continue, critically ill patients are surviving despite the severity of their illness. The incidence of acute kidney injury (AKI) has increased, and its impact on clinical outcomes as well as medical expenditures has been established. The role, indications and technological advancements of renal replacement therapy (RRT) have evolved, allowing more effective therapies with less complications. With these changes, Critical Care Nephrology has become an established specialty, and ongoing collaborations between critical care physicians and nephrologist have improved education of multi-disciplinary team members and patient care in the ICU...
December 3, 2016: Blood Purification
https://www.readbyqxmd.com/read/27922841/stress-resiliency-practices-in-neonatal-nurses
#2
Lisa M Pannell, Lynn Rowe, Salena Tully
BACKGROUND: Multiple environmental changes were experienced in a large level III neonatal intensive care unit (NICU) causing a perception of work-related stress leading to high nurse turnover, decreased engagement, and decreased satisfaction. PURPOSE: To identify a preintervention measure of perceived stress resiliency and ranking of interpretive styles in a population of neonatal, bedside registered nurses faced with a change in the physical practice environment...
December 5, 2016: Advances in Neonatal Care: Official Journal of the National Association of Neonatal Nurses
https://www.readbyqxmd.com/read/27922495/toxic-and-endocrine-myopathies
#3
Hans D Katzberg, Charles D Kassardjian
PURPOSE OF REVIEW: This article discusses the clinical features, pathophysiology, and management of toxic and endocrine myopathies. RECENT FINDINGS: Early detection and expeditious correction of metabolic disturbances in endocrinopathies such as Cushing syndrome, thyroid and parathyroid diseases, and acromegaly can minimize and prevent neurologic complications including myopathy. Recently proposed mechanisms of injury in patients with critical illness myopathy include inhibition of protein synthesis, mitochondrial dysfunction, disruption of the ubiquitin-proteasome system, oxidative stress, and disruption of intramuscular calcium homeostasis, which can cause a myosin-loss myopathy...
December 2016: Continuum: Lifelong Learning in Neurology
https://www.readbyqxmd.com/read/27922344/predictors-of-mortality-in-a-paediatric-intensive-care-unit-in-kigali-rwanda
#4
Rosine Nyirasafari, Mark H Corden, Angélique Charlie Karambizi, Jean Claude Kabayiza, Jean Damascene Makuza, Rex Wong, Michael F Canarie
BACKGROUND: The enormous burden of critical illness in resource-limited settings has led to a growing interest in paediatric critical care in these regions. However, published data on the practice of critical care and patient outcomes in these settings are scant. OBJECTIVE: This study sought to identify risk factors associated with mortality in the newly established Paediatric Intensive Care Unit (PICU) at Kigali University Teaching Hospital (KUTH) in Rwanda and test the predictive ability of a newly devised mortality risk score, the modified PRISM (MP) score...
December 6, 2016: Paediatrics and International Child Health
https://www.readbyqxmd.com/read/27922256/statins-in-critical-care-to-give-or-not-to-give
#5
Amr S Omar, Samy Hanoura, Haifa M Aljanubi, Ahmed Mahfouz
Owing to statin's immune modulatory, anti-inflammatory, antioxidant, antithrombotic and endothelial function actions, they are widely used in the critical care settings in diverse disease scenarios. We aim to explore the evidence to globalize the utilization of statins in the intensive care practice for different indications. We carried out a search of the PubMed, Cochrane and EMBASE databases up to January 2016. We included review articles, meta-analyses, and original trials on the effects of statin therapy in the intensive care unit (ICU) combining the following MESH terms: 'satins', 'intensive care, 'cardiac surgery', 'sepsis', 'acute respiratory distress syndrome' 'pneumonia', subarachnoid hemorrhage', traumatic brain injury and 'critical illness'...
December 6, 2016: Minerva Anestesiologica
https://www.readbyqxmd.com/read/27920421/a-missing-guide-wire-after-placement-of-peripherally-inserted-central-venous-catheter
#6
Muhammad Kashif, Hafiz Hashmi, Preeti Jadhav, Misbahuddin Khaja
BACKGROUND Central venous catheterization is a common tool used in critically ill patients to monitor central venous pressure and administer fluids and medications such as vasopressors. Here we present a case of a missing guide wire after placement of peripherally inserted central catheter (PICC), which was incidentally picked up by bedside ultrasound in the intensive care unit.  CASE REPORT A 50-year-old Hispanic male was admitted to the intensive care unit for alcohol intoxication. He was managed for septic shock and required placement of a peripherally inserted central line in his left upper extremity for antibiotics and vasopressor administration...
December 6, 2016: American Journal of Case Reports
https://www.readbyqxmd.com/read/27920416/re-evaluating-the-inhibition-of-stress-erosions-revise-a-protocol-for-pilot-randomized-controlled-trial
#7
Waleed Alhazzani, Gordon Guyatt, John C Marshall, Richard Hall, John Muscedere, Francois Lauzier, Lehana Thabane, Mohammed Alshahrani, Shane W English, Yaseen M Arabi, Adam M Deane, Tim Karachi, Bram Rochwerg, Simon Finfer, Nick Daneman, Nicole Zytaruk, Diane Heel-Ansdell, Deborah Cook, On Behalf Of
INTRODUCTION: Clinicians routinely administer stress ulcer prophylaxis to mechanically ventilated patients in the intensive care unit (ICU), most commonly prescribing proton pump inhibitors (PPIs). However, the incidence of gastrointestinal (GI) bleeding from stress ulceration is low and recent observational studies suggest these agents may increase infections. Therefore, a large randomized clinical trial (RCT) is needed to inform modern practice. The aim of this multicenter pilot trial is to determine the feasibility of performing a large RCT to investigate the efficacy and safety of withholding intravenous pantoprazole...
November 2016: Annals of Saudi Medicine
https://www.readbyqxmd.com/read/27918902/development-of-an-intensive-care-unit-resource-assessment-survey-for-the-care-of-critically-ill-patients-in-resource-limited-settings
#8
Aleksandra Leligdowicz, Satish Bhagwanjee, Janet V Diaz, Wei Xiong, John C Marshall, Robert A Fowler, Neill Kj Adhikari
PURPOSE: Capacity to provide critical care in resource-limited settings is poorly understood because of lack of data about resources available to manage critically ill patients. Our objective was to develop a survey to address this issue. METHODS: We developed and piloted a cross-sectional self-administered survey in 9 resource-limited countries. The survey consisted of 8 domains; specific items within domains were modified from previously developed survey tools...
November 5, 2016: Journal of Critical Care
https://www.readbyqxmd.com/read/27918901/clinical-utility-of-methicillin-resistant-staphylococcus-aureus-nasal-polymerase-chain-reaction-assay-in-critically-ill-patients-with-nosocomial-pneumonia
#9
Melanie N Smith, Michael J Erdman, Jason A Ferreira, Petra Aldridge, Christopher A Jankowski
PURPOSE: This study investigated the diagnostic performance characteristics of a methicillin-resistant Staphylococcus aureus (MRSA) nasal polymerase chain reaction (PCR) assay in critically ill patients with nosocomial pneumonia. MATERIALS AND METHODS: This retrospective, single-center study included adult patients admitted to an intensive care unit with suspected nosocomial pneumonia. Patients must have received an MRSA nasal PCR assay and respiratory culture within predetermined time intervals...
November 15, 2016: Journal of Critical Care
https://www.readbyqxmd.com/read/27918253/placental-growth-factor-alone-or-in-combination-with-soluble-fms-like-tyrosine-kinase-1-as-an-aid-to-the-assessment-of-women-with-suspected-pre-eclampsia-systematic-review-and-economic-analysis
#10
Geoff K Frampton, Jeremy Jones, Micah Rose, Liz Payne
BACKGROUND: Pre-eclampsia (PE) prediction based on blood pressure, presence of protein in the urine, symptoms and laboratory test abnormalities can result in false-positive diagnoses. This may lead to unnecessary antenatal admissions and preterm delivery. Blood tests that measure placental growth factor (PlGF) or the ratio of soluble fms-like tyrosine kinase 1 (sFlt-1) to PlGF could aid prediction of PE if either were added to routine clinical assessment or used as a replacement for proteinuria testing...
November 2016: Health Technology Assessment: HTA
https://www.readbyqxmd.com/read/27918157/necrotic-fasciitis-of-the-lateral-muscle-group-of-the-thigh-following-outside-in-transobturatory-tape-procedure
#11
O Dvořák, D Leško, J Kestřánek
OBJECTIVE: Sling procedures are the preferred surgical treatment of stress urinary incontinence (SUI) due to their high success rate and low risk of complications. DESIGN: Case report. SETTING: Department of Obstetrics and Gynecology, Medical Faculty of Charles University and Faculty Hospital Hradec Kralove. CASE REPORT: Necrotic fasciitis is a rare infectious complication, the mortality of which varies by age and can reach 73% if untreated...
2016: Ceská Gynekologie
https://www.readbyqxmd.com/read/27917707/management-of-pneumonia-in-the-pediatric-critical-care-unit-an-area-for-antimicrobial-stewardship
#12
Aimee M Dassner, David P Nicolau, Jennifer E Girotto
Pediatric pneumonia is one of the most common causes of childhood infection requiring hospitalization and is a substantial driver of antimicrobial use among hospitalized children. About 12-20% of pediatric patients hospitalized with community-acquired pneumonia (CAP) require critical care. Additionally, nosocomial pneumonias (i.e. hospital-acquired and ventilator-associated pneumonias) are responsible for 15-53% of hospital-associated infections and are the most common indication for empiric antibiotics in the pediatric intensive care unit...
December 4, 2016: Current Pediatric Reviews
https://www.readbyqxmd.com/read/27916368/prognostic-indicators-for-early-mortality-after-tracheostomy-in-the-intensive-care-unit
#13
Afshin Parsikia, Matthew Goodwin, Zachary Wells, Zoe Gauthier, Molli Bascom, Moon Suh, Beth Meloro, Jorge Ortiz, Amit R T Joshi
BACKGROUND: Tracheostomy is indicated for patients requiring prolonged mechanical ventilation. The aim of this study is to identify prognostic indicators for early mortality after tracheostomy to potentially avoid futility in the intensive care unit. METHODS: Patients who underwent tracheostomy and died within 30 d of admission (futile group) were compared with patients who underwent tracheostomy and survived more than 30 d after admission (nonfutile group). Categorical data were analyzed using chi-square and Fisher's exact tests...
November 2016: Journal of Surgical Research
https://www.readbyqxmd.com/read/27915963/kidney-transplant-recipients-requiring-critical-care-admission-within-one-year-of-transplant
#14
Okechukwu O Okidi, David Van Dellen, Cassandra Sobajo, Angela Summers, John R Greer, Titus Augustine
OBJECTIVES: Kidney transplant is the gold standard for treatment of renal failure. With the increasing age of the recipient population, which carries significant comorbidities, and the use of more marginal organs, there is potential for increased critical care admissions. In this study, we investigated the incidence, indications, and outcomes of patients admitted to critical care within 1 year of transplant. We also aimed to identify any precipitating factors or events that may trigger these admissions, as well as establish variables that could affect mortality...
December 2, 2016: Experimental and Clinical Transplantation
https://www.readbyqxmd.com/read/27915328/critical-care-nephrology-a-multidisciplinary-approach
#15
Lilia Rizo-Topete, Claudio Ronco
Acute kidney injury (AKI) is a serious medical condition affecting millions of people. Patients in intensive care unit (ICU) who develop AKI have increased morbidity and mortality, prolonged length of stay in ICU and hospital and increased costs, especially when they require renal replacement therapy. In the latter case, morbidity and mortality increase further. In order to meet the needs of the critically ill patients, a multidisciplinary care team is required, combining the efforts of physicians and nurses from different disciplines as well as nephrologists and intensivists...
December 3, 2016: Blood Purification
https://www.readbyqxmd.com/read/27914671/current-practice-in-continuous-renal-replacement-therapy-an-epidemiological-multicenter-study
#16
T M Tomasa Irriguible, J Sabater Riera, E Poch López de Briñas, J Fort Ros, M J Lloret Cora, J Roca Antònio, A Navas Pérez, P Ortiz Ballujera, L Servià Goixart, F J González de Molina Ortiz, C Rovira Anglès, A Roglan Piqueras, M Rodríguez López
OBJECTIVE: The aim of the study is to ascertain the most relevant aspects of the current management of renal replacement therapy (RRT) in critically ill patients, and to analyze renal function recovery and mortality in patients undergoing RRT. METHODS: A non-interventional three-month observational study was made in 2012, with a follow-up period of 90 days, in 21 centers in Catalonia (Spain). Demographic information, severity scores and clinical data were obtained, as well as RRT parameters...
November 30, 2016: Medicina Intensiva
https://www.readbyqxmd.com/read/27912981/examining-the-association-between-surface-bioburden-and-frequently-touched-sites-in-intensive-care
#17
C E Adams, J Smith, V Watson, C Robertson, S J Dancer
BACKGROUND: Critical care patients are at increased risk of infection. Near-patient surfaces act as reservoirs of microbial soil, which may contain pathogens. AIM: To correlate soil levels with hand-touch frequency of near-patient sites in an intensive care unit (ICU). METHODS: Five sites around each bed in a 10-bed ICU were screened for total microbial soil (cfu/cm(2)) and Staphylococcus aureus every month for 10 months. Selected sites were infusion pump and cardiac monitor, left and right bedrails, and bed table...
November 13, 2016: Journal of Hospital Infection
https://www.readbyqxmd.com/read/27912161/a-prospective-randomized-trial-of-tapered-cuff-endotracheal-tubes-with-intermittent-subglottic-suctioning-in-preventing-ventilator-associated-pneumonia-in-critically-ill-patients
#18
Ata Mahmoodpoor, Hadi Hamishehkar, Masoud Hamidi, Kamran Shadvar, Sarvin Sanaie, Samad Ej Golzari, Zahid Hussain Khan, Nader D Nader
BACKGROUND: Endotracheal tube placement is necessary for the control of the airway in patients who are mechanically ventilated. However, prolonged duration of endotracheal tube placement contributes to the development of ventilator-associated pneumonias (VAPs). The aim of this study was to evaluate whether subglottic suctioning using TaperGuard EVAC tubes was effective in decreasing the frequency of VAP. METHODS: A total of 276 mechanically ventilated patients for more than 72 hours were randomly assigned to group E (EVAC tube) and group C (conventional tube)...
November 14, 2016: Journal of Critical Care
https://www.readbyqxmd.com/read/27912070/cardiac-complications-associated-with-the-influenza-viruses-a-subtype-h7n9-or-pandemic-h1n1-in-critically-ill-patients-under-intensive-care
#19
Jiajia Wang, Hua Xu, Xinjing Yang, Daguo Zhao, Shenlang Liu, Xue Sun, Jian-An Huang, Qiang Guo
BACKGROUND AND OBJECTIVE: The clinical presentations and disease courses of patients hospitalized with either influenza A virus subtype H7N9 (H7N9) or 2009 pandemic H1N1 influenza virus (pH1N1) were compared in a recent report, but associated cardiac complications remain unclear. The present retrospective study investigated whether cardiac complications in critically ill patients with H7N9 infections differed from those infected with the pH1N1 strain. METHODS: Suspect cases were confirmed by reverse transcription polymerase chain reaction assays with specific confirmation of the pandemic H1N1 strain at the Centers for Disease Control and Prevention...
November 29, 2016: Brazilian Journal of Infectious Diseases
https://www.readbyqxmd.com/read/27911590/proteomic-profiling-identifies-n-acetylmuramoyl-l-alanine-amidase-as-a-novel-biomarker-of-sepsis
#20
Fabiano Pinheiro da Silva, Thais Regiani Cataldi, Thais Martins de Lima, Paulo Nogueira Starzynski, Hermes Vieira Barbeiro, Monica Teresa Veneziano Labate, Marcel Cerqueira Cesar CéMachado, Heraldo Possolo de Souza, Carlos Alberto Labate
AIM: Sepsis is a critical condition that leads to high mortality and is the most common cause of death in intensive care units. Despite exhaustive efforts by the scientific community, a reliable biomarker for diagnosis, evolution and prognosis of sepsis is still lacking. Results/methodology: Here, using high-throughput proteomics, we describe N-acetylmuramoyl-l-alanine amidase as a novel candidate for differentiating infectious and noninfectious inflammatory syndromes. DISCUSSION/CONCLUSION: This is the first description of N-acetylmuramoyl-l-alanine amidase as a biomarker that can be used alone or in conjunction with other biomarkers to facilitate the diagnosis of sepsis in the critically ill...
December 2, 2016: Biomarkers in Medicine
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