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Critical care pharmacology

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https://www.readbyqxmd.com/read/28335000/better-than-sham-a-double-blind-placebo-controlled-neurofeedback-study-in-primary-insomnia
#1
Manuel Schabus, Hermann Griessenberger, Maria-Teresa Gnjezda, Dominik P J Heib, Malgorzata Wislowska, Kerstin Hoedlmoser
Neurofeedback training builds upon the simple concept of instrumental conditioning, i.e. behaviour that is rewarded is more likely to reoccur, an effect Thorndike referred to as the 'law of effect'. In the case of neurofeedback, information about specific electroencephalographic activity is fed back to the participant who is rewarded whenever the desired electroencephalography pattern is generated. If some kind of hyperarousal needs to be addressed, the neurofeedback community considers sensorimotor rhythm neurofeedback as the gold standard...
February 23, 2017: Brain: a Journal of Neurology
https://www.readbyqxmd.com/read/28328824/early-use-of-noninvasive-techniques-for-clearing-respiratory-secretions-during-noninvasive-positive-pressure-ventilation-in-patients-with-acute-exacerbation-of-chronic-obstructive-pulmonary-disease-and-hypercapnic-encephalopathy-a-prospective-cohort-study
#2
Jinrong Wang, Zhaobo Cui, Shuhong Liu, Xiuling Gao, Pan Gao, Yi Shi, Shufen Guo, Peipei Li
Noninvasive positive-pressure ventilation (NPPV) might be superior to conventional mechanical ventilation (CMV) in patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPDs). Inefficient clearance of respiratory secretions provokes NPPV failure in patients with hypercapnic encephalopathy (HE). This study compared CMV and NPPV combined with a noninvasive strategy for clearing secretions in HE and AECOPD patients.The present study is a prospective cohort study of AECOPD and HE patients enrolled between October 2013 and August 2015 in a critical care unit of a major university teaching hospital in China...
March 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28328711/management-of-atrial-fibrillation-with-rapid-ventricular-response-in-the-intensive-care-unit-a-secondary-analysis-of-electronic-health-record-data
#3
Ari Moskowitz, Kenneth P Chen, Avraham Z Cooper, Abdullah Chahin, Mohammad M Ghassemi, Leo Anthony Celi
PURPOSE: Atrial fibrillation with rapid ventricular response (RVR) is common during critical illness. In this study, we explore the comparative effectiveness of three commonly used drugs (metoprolol, diltiazem, and amiodarone) in the management of atrial fibrillation with RVR in the intensive care unit (ICU). METHODS: Data pertaining to the first ICU admission were extracted from the Medical Information Mart for Intensive Care (MIMIC) III database. Patients who received one of the above pharmacologic agents while their heart rate was > 110bpm and had atrial fibrillation documented in the clinical chart were included...
March 21, 2017: Shock
https://www.readbyqxmd.com/read/28325182/antimicrobial-pharmacology-for-the-neonatal-foal
#4
REVIEW
K Gary Magdesian
Neonatal foals are at high risk of developing sepsis, which can be life-threatening. Early antimicrobial use is a critical component of the treatment of sepsis. Because the neonatal foal has unique pharmacologic physiology, antimicrobial choice and dosing are often different than in adult horses. Broad-spectrum, bactericidal, and intravenous antimicrobials should be considered first-line therapy for septic foals. A combination of aminoglycoside and beta-lactam antimicrobial or third-generation cephalosporin is an excellent empirical first choice for treating septic foals, until culture and susceptibility results are available...
April 2017: Veterinary Clinics of North America. Equine Practice
https://www.readbyqxmd.com/read/28315063/the-effect-of-regadenoson-on-the-integrity-of-the-human-blood-brain-barrier-a-pilot-study
#5
Sadhana Jackson, Richard T George, Martin A Lodge, Anna Piotrowski, Richard L Wahl, Sachin K Gujar, Stuart A Grossman
Regadenoson is an FDA approved adenosine receptor agonist which increases blood-brain barrier (BBB) permeability in rodents. Regadenoson is used clinically for pharmacologic cardiac stress testing using SPECT or CT imaging agents that do not cross an intact BBB. This study was conducted to determine if standard doses of regadenoson transiently disrupt the human BBB allowing higher concentrations of systemically administered imaging agents to enter the brain. Patients without known intracranial disease undergoing clinically indicated pharmacologic cardiac stress tests were eligible for this study...
March 17, 2017: Journal of Neuro-oncology
https://www.readbyqxmd.com/read/28302279/venous-thromboembolism-prophylaxis-in-the-pediatric-trauma-patient
#6
John K Petty
Although venous thromboembolism (VTE) occurs in less than 1% of hospitalized pediatric trauma patients, care providers must make decisions about VTE prophylaxis on a daily basis. The consequences of VTE are significant; the risks of developing VTE are variable; and the effectiveness of prophylaxis against VTE is not conclusive in children. While the value of VTE prophylaxis is well defined in adult trauma care, it is unclear how this translates to the care of injured children. This review evaluates the incidence and risks of VTE in pediatric trauma and assesses the merits of prophylaxis in children...
February 2017: Seminars in Pediatric Surgery
https://www.readbyqxmd.com/read/28291095/angioedema
#7
Daniel LoVerde, Daniel Clark Files, Guha Krishnaswamy
OBJECTIVES: Angioedema is a potentially life-threatening occurrence that is encountered by critical care providers. The mechanistic understanding of angioedema syndromes has improved in recent years, and novel medications are available that improve outcomes from these syndromes. This clinically focused review will describe the underlying genetics, pathophysiology, classification and treatment of angioedema syndromes, with an emphasis on the novel pharmacologic agents that have recently become available for acute treatment...
April 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28236991/-how-to-assess-curative-and-or-preventive-effects-of-psychotropic-drugs
#8
T Bottai, D Pringuey, R Belzeaux, M Adida, J-M Azorin
Proving the efficacy of a psychotropic drug is a medical, scientific and ethical need. Psychotropic drug development is now a highly complex process, which takes several years and which is very expensive. It involves multiple steps of preclinical and clinical pharmacological refinement and testing. Methodology of studies to prove curative or preventive effect of psychotropic drugs is well codified. Preclinical studies include pharmacokinetic data, toxicology and performance in various animal models of pathology...
December 2016: L'Encéphale
https://www.readbyqxmd.com/read/28236390/optimizing-oxygenation-in-the-mechanically-ventilated-patient-nursing-practice-implications
#9
REVIEW
Glenn Barton, Brandi Vanderspank-Wright, Jacqueline Shea
Critical care nurses constitute front-line care provision for patients in the intensive care unit (ICU). Hypoxemic respiratory compromise/failure is a primary reason that patients require ICU admission and mechanical ventilation. Critical care nurses must possess advanced knowledge, skill, and judgment when caring for these patients to ensure that interventions aimed at optimizing oxygenation are both effective and safe. This article discusses fundamental aspects of respiratory physiology and clinical indices used to describe oxygenation status...
December 2016: Critical Care Nursing Clinics of North America
https://www.readbyqxmd.com/read/28190445/management-of-neurologic-complications-of-coagulopathies
#10
J D Vanderwerf, M A Kumar
Coagulopathy is common in intensive care units (ICUs). Many physiologic derangements lead to dysfunctional hemostasis; these may be either congenital or acquired. The most devastating outcome of coagulopathy in the critically ill is major bleeding, defined by transfusion requirement, hemodynamic instability, or intracranial hemorrhage. ICU coagulopathy often poses complex management dilemmas, as bleeding risk must be tempered with thrombotic potential. Coagulopathy associated with intracranial hemorrhage bears directly on prognosis and outcome...
2017: Handbook of Clinical Neurology
https://www.readbyqxmd.com/read/28173638/valproate-protein-binding-is-highly-variable-in-icu-patients-and-not-predicted-by-total-serum-concentrations-a-case-series-and-literature-review
#11
Richard R Riker, David J Gagnon, Colman Hatton, Teresa May, David B Seder, Katie Stokem, Gilles L Fraser
STUDY OBJECTIVE: The free fraction of valproate (the pharmacologically active moiety, normally 5-10%) may vary significantly in critically ill patients, but this topic is understudied, with only 4 prior ICU case reports. The objective of this study was to evaluate the range of valproate plasma protein binding in ICU patients. DESIGN: Observational study of consecutive ICU patients. SETTING: Neurocritical and medical critical care services in a non-university academic medical center...
February 7, 2017: Pharmacotherapy
https://www.readbyqxmd.com/read/28167634/management-of-patients-on-non-vitamin-k-antagonist-oral-anticoagulants-in-the-acute-care-and-periprocedural-setting-a-scientific-statement-from-the-american-heart-association
#12
Amish N Raval, Joaquin E Cigarroa, Mina K Chung, Larry J Diaz-Sandoval, Deborah Diercks, Jonathan P Piccini, Hee Soo Jung, Jeffrey B Washam, Babu G Welch, Allyson R Zazulia, Sean P Collins
Non-vitamin K oral anticoagulants (NOACs) are now widely used as alternatives to warfarin for stroke prevention in atrial fibrillation and management of venous thromboembolism. In clinical practice, there is still widespread uncertainty on how to manage patients on NOACs who bleed or who are at risk for bleeding. Clinical trial data related to NOAC reversal for bleeding and perioperative management are sparse, and recommendations are largely derived from expert opinion. Knowledge of time of last ingestion of the NOAC and renal function is critical to managing these patients given that laboratory measurement is challenging because of the lack of commercially available assays in the United States...
February 6, 2017: Circulation
https://www.readbyqxmd.com/read/28096485/murine-cytomegalovirus-deubiquitinase-regulates-viral-chemokine-levels-to-control-inflammation-and-pathogenesis
#13
Adam T Hilterbrand, Daniel R Boutz, Edward M Marcotte, Jason W Upton
Maintaining control over inflammatory processes represents a paradox for viral pathogens. Although many viruses induce host inflammatory responses to facilitate infection, control is necessary to avoid overactivation. One way is through the manipulation of proinflammatory chemokine levels, both host and viral. Murine cytomegalovirus (MCMV), a model betaherpesvirus, encodes a viral C-C chemokine, MCK2, which promotes host inflammatory responses and incorporates into virions to facilitate viral dissemination...
January 17, 2017: MBio
https://www.readbyqxmd.com/read/28093813/nerolidol-protects-against-lps-induced-acute-kidney-injury-via-inhibiting-tlr4-nf-%C3%AE%C2%BAb-signaling
#14
Lu Zhang, Dandan Sun, Yan Bao, Yan Shi, Yan Cui, Minghao Guo
Acute kidney injury (AKI) is a critical care syndrome, resulting in acute reduction of renal function and up to 22% mortality of hospitalized patients. Nerolidol is a major component in several essential oils that possesses various pharmacological properties. The present study aimed to investigate the potential effect of nerolidol on lipopolysaccharide (LPS)-induced AKI. Nerolidol dose-dependently reduced the pathological injuries of kidney induced by LPS in rats. Nerolidol significantly decreased the levels of blood urea nitrogen and creatinine in LPS-treated rats in a dose-dependent manner...
January 17, 2017: Phytotherapy Research: PTR
https://www.readbyqxmd.com/read/28074823/pharmacological-update-new-drugs-in-cardiac-practice-a-critical-appraisal
#15
REVIEW
Rohan Magoon, Arindam Choudhury, Vishwas Malik, Ridhima Sharma, Poonam Malhotra Kapoor
Cardiac practice involves the application of a range of pharmacological therapies. An anesthesiologist needs to keep pace with the rampant drug developments in the field of cardiovascular medicine for appropriate management in both perioperative and intensive care set-up, to strengthen his/her role as a perioperative physician in practice. The article reviews the changing trends and the future perspectives in major classes of cardiovascular medicine.
January 2017: Annals of Cardiac Anaesthesia
https://www.readbyqxmd.com/read/28068863/an-exploratory-study-investigating-the-multidimensional-factors-impacting-the-health-and-well-being-of-young-adults-with-cerebral-palsy
#16
Susan E Sienko
BACKGROUND: For young adults with cerebral palsy, changes in psychological and social development, in conjunction with the progression of musculoskeletal deformities and the onset of secondary conditions, make the transition to adulthood a difficult developmental phase. Preliminary evidence shows that many of the physical impairments reported in adults with cerebral palsy begin during late adolescence; however, there is little information about prevalence of impairments and the combined role impairments, psychological and social factors have on the health and well-being of young adults with cerebral palsy...
January 9, 2017: Disability and Rehabilitation
https://www.readbyqxmd.com/read/28051841/a-review-of-a-national-training-initiative-to-increase-provider-use-of-mat-to-address-the-opioid-epidemic
#17
REVIEW
Frances R Levin, Adam Bisaga, Maria A Sullivan, Arthur Robin Williams, Kathryn Cates-Wessel
BACKGROUND AND OBJECTIVES: The Providers' Clinical Support System for Medication Assisted Treatment (PCSS-MAT) initiative focuses on training and mentoring health professionals in the treatment of opioid use disorders (OUD) using pharmacological strategies. Led by the American Academy of Addiction Psychiatry (AAAP), PCSS-MAT is a consortium representing four of the five national professional organizations authorized by DATA 2,000-AAAP, American Osteopathic Academy of Addiction Medicine, American Psychiatric Association, and American Society of Addiction Medicine...
December 2016: American Journal on Addictions
https://www.readbyqxmd.com/read/28028552/venous-thromboembolic-events-in-critically-ill-traumatic-brain-injury-patients
#18
Markus B Skrifvars, Michael Bailey, Jeffrey Presneill, Craig French, Alistair Nichol, Lorraine Little, Jacques Duranteau, Olivier Huet, Samir Haddad, Yaseen Arabi, Colin McArthur, D James Cooper, Rinaldo Bellomo
PURPOSE: To estimate the prevalence, risk factors, prophylactic treatment and impact on mortality for venous thromboembolism (VTE) in patients with moderate to severe traumatic brain injury (TBI) treated in the intensive care unit. METHODS: A post hoc analysis of the erythropoietin in traumatic brain injury (EPO-TBI) trial that included twice-weekly lower limb ultrasound screening. Venous thrombotic events were defined as ultrasound-proven proximal deep venous thrombosis (DVT) or clinically detected pulmonary embolism (PE)...
March 2017: Intensive Care Medicine
https://www.readbyqxmd.com/read/28024557/acute-right-ventricle-failure-in-the-intensive-care-unit-assessment-and-management
#19
REVIEW
Carmen Hrymak, Johann Strumpher, Eric Jacobsohn
Caring for the critically ill patient with acute right ventricle (RV) failure is a diagnostic and management challenge. A thorough understanding of normal RV anatomy and physiology is essential to manage RV failure. Despite the fact that the RV is essentially a volume chamber that ejects into a low-pressure system, the left ventricle contributes significantly to RV function through maintenance of the transseptal gradient (TSG). Preserving systemic mean arterial pressure maintains the TSG and RV perfusion. Various pathological states cause acute RV failure by decreasing the TSG and RV perfusion and/or increasing pulmonary vascular resistance...
January 2017: Canadian Journal of Cardiology
https://www.readbyqxmd.com/read/28002134/neuroplasticity-and-amblyopia-vision-at-the-balance-point
#20
Vijay K Tailor, D Samuel Schwarzkopf, Annegret H Dahlmann-Noor
PURPOSE OF REVIEW: New insights into triggers and brakes of plasticity in the visual system are being translated into new treatment approaches which may improve outcomes not only in children, but also in adults. RECENT FINDINGS: Visual experience-driven plasticity is greatest in early childhood, triggered by maturation of inhibitory interneurons which facilitate strengthening of synchronous synaptic connections, and inactivation of others. Normal binocular development leads to progressive refinement of monocular visual acuity, stereoacuity and fusion of images from both eyes...
December 20, 2016: Current Opinion in Neurology
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