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https://www.readbyqxmd.com/read/27907966/getting-rid-of-weakness-in-the-icu-an-updated-approach-to-the-acute-management-of-myasthenia-gravis-and-guillain-barr%C3%A3-syndrome
#1
Alexis A Lizarraga, Karlo J Lizarraga, Michael Benatar
After prompt diagnosis, severe myasthenia gravis and Guillain-Barré syndrome (GBS) usually require management in the intensive care unit. In the myasthenic patient, recognition of precipitating factors is paramount, and frequent monitoring of bulbar, upper airway, and/or respiratory muscle strength is needed to identify impending myasthenic crisis. Noninvasive ventilation can be attempted prior to intubation and mechanical ventilation in the setting of respiratory failure. Cholinesterase inhibitors should be discontinued, but resumed prior to extubation, and steroid dosage could be increased once the airway is secured...
December 2016: Seminars in Neurology
https://www.readbyqxmd.com/read/27891297/exercise-rehabilitation-following-intensive-care-unit-discharge-for-recovery-from-critical-illness-executive-summary-of-a-cochrane-collaboration-systematic-review
#2
REVIEW
Bronwen Connolly, Lisa Salisbury, Brenda O'Neill, Louise Geneen, Abdel Douiri, Michael P W Grocott, Nicholas Hart, Timothy S Walsh, Bronagh Blackwood
Skeletal muscle wasting and weakness are major complications of critical illness and underlie the profound physical and functional impairments experienced by survivors after discharge from the intensive care unit (ICU). Exercise-based rehabilitation has been shown to be beneficial when delivered during ICU admission. This review aimed to determine the effectiveness of exercise rehabilitation initiated after ICU discharge on primary outcomes of functional exercise capacity and health-related quality of life...
December 2016: Journal of Cachexia, Sarcopenia and Muscle
https://www.readbyqxmd.com/read/27832023/rbc-distribution-width-biomarker-for-red-cell-dysfunction-and-critical-illness-outcome
#3
Ahmed S Said, Philip C Spinella, Mary E Hartman, Katherine M Steffen, Ronald Jackups, Richard Holubkov, Mike Wallendorf, Allan Doctor
OBJECTIVES: RBC distribution width is reported to be an independent predictor of outcome in adults with a variety of conditions. We sought to determine if RBC distribution width is associated with morbidity or mortality in critically ill children. DESIGN: Retrospective observational study. SETTING: Tertiary PICU. PATIENTS: All admissions to St. Louis Children's Hospital PICU between January 1, 2005, and December 31, 2012...
November 9, 2016: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/27829717/pseudocholinesterase-as-a-predictor-of-mortality-and-morbidity-in-organophosphorus-poisoning
#4
Pradeepkumar Hiremath, Pradeep Rangappa, Ipe Jacob, Karthik Rao
BACKGROUND: Organophosphorus (OP) pesticide poisoning is a major clinical and public health problem in India. Mortality rate remains high at 15%-30%. AIMS: This prospective, observational study examines the relationship between pseudocholinesterase (PChE) activity and morbidity and mortality in OP poisoning. SETTING AND DESIGN: OP poisoning cases admitted to a tertiary care center Intensive Care Unit (ICU) over 5 years from 2010 to 2014 were studied...
October 2016: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/27825364/mid-regional-pro-adrenomedullin-mr-proadm-a-marker-of-positive-fluid-balance-in-critically-ill-patients-results-of-the-envol-study
#5
Bernard Vigué, Pierre-Etienne Leblanc, Frédérique Moati, Eric Pussard, Hussam Foufa, Aurore Rodrigues, Samy Figueiredo, Anatole Harrois, Jean-Xavier Mazoit, Homa Rafi, Jacques Duranteau
BACKGROUND: The optimal control of blood volume without fluid overload is a main challenge in the daily care of intensive care unit (ICU) patients. Accordingly this study focused on the identification of biomarkers to help characterize fluid overload status. METHODS: Sixty-seven patients were studied from ICU admission to day 7 (D7). Blood and urine samples were taken daily and sodium and water balance strictly calculated resulting in a total cumulative assessment of ∆Na(+) and ∆H2O...
November 9, 2016: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/27818334/neuromuscular-blockade-in-the-21-st-century-management-of-the-critically-ill-patient
#6
REVIEW
Julian deBacker, Nicholas Hart, Eddy Fan
Neuromuscular blockings agents (NMBAs) have a controversial role in the ventilatory and medical management of critical illness. The clinical concern surrounding NMBA-induced complications stems from evidence presented in the 2002 clinical practice guidelines, but new evidence from subsequent randomized trials and studies provides a more optimistic outlook about the application of NMBAs in the intensive care unit (ICU). Furthermore, changes in the delivery of critical care such as protocolized care pathways, minimizing or interrupting sedation, increased monitoring techniques, and overall improvements in reducing immobility have created a modern, 21st century ICU environment whereby NMBAs may be administered safely...
November 3, 2016: Chest
https://www.readbyqxmd.com/read/27782830/patient-outcomes-after-critical-illness-a-systematic-review-of-qualitative-studies-following-hospital-discharge
#7
Mohamed D Hashem, Aparna Nallagangula, Swaroopa Nalamalapu, Krishidhar Nunna, Utkarsh Nausran, Karen A Robinson, Victor D Dinglas, Dale M Needham, Michelle N Eakin
BACKGROUND: There is growing interest in patient outcomes following critical illness, with an increasing number and different types of studies conducted, and a need for synthesis of existing findings to help inform the field. For this purpose we conducted a systematic review of qualitative studies evaluating patient outcomes after hospital discharge for survivors of critical illness. METHODS: We searched the PubMed, EMBASE, CINAHL, PsycINFO, and CENTRAL databases from inception to June 2015...
October 26, 2016: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/27778318/oral-hygiene-care-for-critically-ill-patients-to-prevent-ventilator-associated-pneumonia
#8
REVIEW
Fang Hua, Huixu Xie, Helen V Worthington, Susan Furness, Qi Zhang, Chunjie Li
BACKGROUND: Ventilator-associated pneumonia (VAP) is defined as pneumonia developing in people who have received mechanical ventilation for at least 48 hours. VAP is a potentially serious complication in these patients who are already critically ill. Oral hygiene care (OHC), using either a mouthrinse, gel, toothbrush, or combination, together with aspiration of secretions, may reduce the risk of VAP in these patients. OBJECTIVES: To assess the effects of oral hygiene care on incidence of ventilator-associated pneumonia in critically ill patients receiving mechanical ventilation in hospital intensive care units (ICUs)...
October 25, 2016: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/27716370/near-infrared-spectroscopy-for-assessing-tissue-oxygenation-and-microvascular-reactivity-in-critically-ill-patients-a-prospective-observational-study
#9
Abele Donati, Elisa Damiani, Roberta Domizi, Claudia Scorcella, Andrea Carsetti, Stefania Tondi, Valentina Monaldi, Erica Adrario, Rocco Romano, Paolo Pelaia, Mervyn Singer
BACKGROUND: Impaired microcirculatory perfusion and tissue oxygenation during critical illness are associated with adverse outcome. The aim of this study was to detect alterations in tissue oxygenation or microvascular reactivity and their ability to predict outcome in critically ill patients using thenar near-infrared spectroscopy (NIRS) with a vascular occlusion test (VOT). METHODS: Prospective observational study in critically ill adults admitted to a 12-bed intensive care unit (ICU) of a University Hospital...
October 1, 2016: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/27703296/rhabdomyolysis-in-critically-ill-surgical-patients
#10
Biljana Kuzmanovska, Emilija Cvetkovska, Igor Kuzmanovski, Nikola Jankulovski, Mirjana Shosholcheva, Andrijan Kartalov, Tatjana Spirovska
INTRODUCTION: Rhabdomyolysis is a syndrome of injury of skeletal muscles associated with myoglobinuria, muscle weakness, electrolyte imbalance and often, acute kidney injury as severe complication. THE AIM: of this study is to detect the incidence of rhabdomyolysis in critically ill patients in the surgical intensive care unit (ICU), and to raise awareness of this medical condition and its treatment among the clinicians. MATERIAL AND METHODS: A retrospective review of all surgical and trauma patients admitted to surgical ICU of the University Surgical Clinic "Mother Teresa" in Skopje, Macedonia, from January 1(st) till December 31(st) 2015 was performed...
July 27, 2016: Medical Archives
https://www.readbyqxmd.com/read/27660177/subarachnoid-hemorrhage-and-spinal-subdural-hematoma-due-to-acute-csf-hypotension
#11
Christopher S Graffeo, Avital Perry, Eelco F M Wijdicks
BACKGROUND: Intracranial subarachnoid hemorrhage (SAH) and spinal subdural hematoma (SDH) are rare complications of spine surgery, thought to be precipitated by cerebrospinal fluid (CSF) hypotension in the setting of an intraoperative durotomy or postoperative CSF leak. Considerable clinical variability has been reported, requiring a high level of clinical suspicion in patients with a new, unexplained neurologic deficit after spine surgery. METHODS: Case report...
September 22, 2016: Neurocritical Care
https://www.readbyqxmd.com/read/27633969/the-efficacy-of-thymosin-%C3%AE-1-as-immunomodulatory-treatment-for-sepsis-a-systematic-review-of-randomized-controlled-trials
#12
Fang Liu, Hong-Mei Wang, Tiansheng Wang, Ya-Mei Zhang, Xi Zhu
BACKGROUND: Thymosin α1 (Tα1) as immunomodulatory treatment is supposed to be beneficial for the sepsis patients by regulating T cell subsets and inflammatory mediators. However, limited by the small sample size and the poor study design, the persuasive power of the single clinical studies is weak. This meta-analysis aimed to investigate the impact of Tα1 on the sepsis patients. METHODS: We searched for the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CBM, VIP, CNKI, WANFANG, Igaku Chuo Zasshi (ICHUSHI) and Korean literature databases reporting the effects of Tα1 on outcomes in sepsis patients...
2016: BMC Infectious Diseases
https://www.readbyqxmd.com/read/27571047/the-utility-of-clinical-features-for-the-diagnosis-of-seizures-in-the-intensive-care-unit
#13
Sarah E Schmitt
INTRODUCTION: Seizures in the intensive care unit (ICU) are often subtle, and may have little or no clinical correlate. This study attempts to determine what clinical features are most strongly associated with the presence of electrographic seizures on continuous EEG (cEEG) monitoring. METHODS: A retrospective review for all patients who underwent cEEG monitoring between Jan. 2003 and Mar. 2009 for either characterization of clinical events or altered mental status was performed...
August 26, 2016: Journal of Clinical Neurophysiology: Official Publication of the American Electroencephalographic Society
https://www.readbyqxmd.com/read/27555696/the-incidence-of-deep-venous-thrombosis-in-high-risk-indian-neurosurgical-patients-need-for-early-chemoprophylaxis
#14
Ajith John George, Shalini Nair, Jayanthi Chinnaiya Karthic, Mathew Joseph
INTRODUCTION: Deep venous thrombosis (DVT) is thought to be less common in Asians than in Caucasian population. The incidence of DVT in high-risk groups, especially the neurosurgical (NS) patients, has not been well studied. This leaves no firm basis for the start of early prophylactic anticoagulation within first 5 postoperative days in Indian NS patients. This is a prospective observational study to determine the early occurrence of DVT in the NS patients. PATIENTS AND METHODS: We screened 137 consecutive high-risk NS patients based on inclusion and exclusion criteria...
July 2016: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/27512107/spectrum-and-outcome-of-acute-infectious-encephalitis-encephalopathy-in-an-intensive-care-unit-from-india
#15
J Kalita, V E Mani, S K Bhoi, U K Misra
PURPOSE: To evaluate the spectrum of acute infectious encephalitis/encephalopathy syndrome (AIES) in intensive care unit (ICU) and the predictors of mechanical ventilation (MV) and outcome of these patients. METHODS: AIES patients diagnosed on the basis of fever, altered sensorium, seizure and cerebrospinal fluid pleocytosis admitted to the neurology ICU were prospectively included. The demographic and clinical details, hematological, biochemical, MRI and etiological findings of the patients were noted...
August 10, 2016: QJM: Monthly Journal of the Association of Physicians
https://www.readbyqxmd.com/read/27475524/respiratory-weakness-after-mechanical-ventilation-is-associated-with-one-year-mortality-a-prospective-study
#16
Clément Medrinal, Guillaume Prieur, Éric Frenoy, Aurora Robledo Quesada, Antoine Poncet, Tristan Bonnevie, Francis-Edouard Gravier, Bouchra Lamia, Olivier Contal
BACKGROUND: Diaphragm dysfunction in mechanically ventilated patients is associated with poor outcome. Maximal inspiratory pressure (MIP) can be used to evaluate inspiratory muscle function. However, it is unclear whether respiratory weakness is independently associated with long-term mortality. The aim of this study was to determine if low MIP is independently associated with one-year mortality. METHODS: We conducted a prospective observational cohort study in an 18-bed ICU...
July 31, 2016: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/27440632/microcirculatory-changes-in-children-undergoing-cardiac-surgery-a-prospective-observational-study
#17
S Scolletta, D Marianello, G Isgrò, A Dapoto, V Terranova, F Franchi, E Baryshnikova, C Carlucci, M Ranucci
BACKGROUND: The effects of cardiac surgery on the microcirculation of children are unknown. The aim of this study was to assess the microcirculatory changes in children undergoing surgery for correction of congenital heart disease. METHODS: We used a videomicroscope (Sidestream Dark Field, SDF) in a convenience sample of 24 children <five yr old. Total vascular density (TVD, vessels mm(-2)), microvascular flow index (MFI, arbitrary units), proportion of perfused small vessels (PPV, percentage), and perfused vessel density (PVD) were obtained after induction of anaesthesia (T1), at the end of the surgical procedure (T2), after intensive care unit (ICU) admission (T3), and at six h (T4) and 12h (T5) after ICU admission...
August 2016: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/27350299/non-missile-penetrating-injury-to-head-an-experience-of-17-cases
#18
Forhad H Chowdhury, Mohammod Raziul Haque, Zahed Hossain, Noman Khaled Chowdhury, Sarwar Murshed Alam, Mainul Haque Sarker
OBJECT: Penetrating non-missile injury to head is far less common in comparison to missile penetrating injury. Here we describe our experiences of management of 17 cases of non-missile injury to head, which is probably the largest series in the literature. We also highlight on simple surgical steps and techniques of removal of in situ objects (weapon) in the penetrating wound that were not previously described. METHOD: We retrogradely studied the non-missile, low velocity penetrating injury of head cases that were admitted and managed in our department...
June 24, 2016: World Neurosurgery
https://www.readbyqxmd.com/read/27341052/lateral-interbody-fusion-combined-with-open-posterior-surgery-for-adult-spinal-deformity
#19
Russell G Strom, Junseok Bae, Jun Mizutani, Frank Valone, Christopher P Ames, Vedat Deviren
OBJECTIVE Lateral interbody fusion (LIF) with percutaneous screw fixation can treat adult spinal deformity (ASD) in the coronal plane, but sagittal correction is limited. The authors combined LIF with open posterior (OP) surgery using facet osteotomies and a rod-cantilever technique to enhance lumbar lordosis (LL). It is unclear how this hybrid strategy compares to OP surgery alone. The goal of this study was to evaluate the combination of LIF and OP surgery (LIF+OP) for ASD. METHODS All thoracolumbar ASD cases from 2009 to 2014 were reviewed...
December 2016: Journal of Neurosurgery. Spine
https://www.readbyqxmd.com/read/27309787/critical-care-follow-up-clinics-a-scoping-review-of-interventions-and-outcomes
#20
Sue Lasiter, Sylwia K Oles, James Mundell, Susan London, Babar Khan
OBJECTIVE: The purpose of this scoping review is to identify evidence describing benefits of interventions provided in intensive care unit (ICU) survivor follow-up clinics. BACKGROUND: Advances in ICU treatments have increased the number of survivors who require specialized care for ICU-related sequelae. Intensive care unit survivor follow-up clinics exist, yet little is known about the nature and impact of interventions provided in such clinics. A scoping review of publications about in-person post-ICU follow-up care was undertaken...
July 2016: Clinical Nurse Specialist CNS
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