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ICU -acquired weakness

Rocío Martínez, Carlos Torrente
A 3-month-old intact male Prague ratter was presented to the emergency service for evaluation of progressive lethargy, weakness, coughing and labour breathing after an episode of resistance to oral deworming. The patient exhibited depression, increased respiratory effort and cyanosis at initial presentation. Results of first diagnostic work-up (complete blood cell count, biochemistry panel and thoracic x-rays) were all consistent with aspiration pneumonia. The puppy was initially treated with balanced isotonic crystalloids, broad spectrum antibiotics, nebulization with thoracic coupage and was transferred to an infant incubator with a sustained FiO2 of 40-50%...
December 2017: Topics in Companion Animal Medicine
Hugh Davies, Gavin D Leslie, David Morgan, Geoff J Dobb
BACKGROUND: The risk of fluid overload and mortality is increased in patients with severe acute kidney injury. Charting of daily fluid balance is a key component of fluid assessment but not without problems affecting accuracy. The introduction of electronic bed scales has made routine patient-weighing easier and focused attention on monitoring fluid-related weight changes. OBJECTIVES: This paper investigated the frequency of compliance in weighing patients daily using electronic bed scales and evaluated the relationship between calculated fluid balance and body weight changes in patients receiving continuous renal replacement therapy (CRRT)...
March 1, 2018: Australian Critical Care: Official Journal of the Confederation of Australian Critical Care Nurses
Christiane S Hartog, Konrad Reinhart
PURPOSE OF REVIEW: End-of-life (EOL) care can be stressful for clinicians as well as patients and their relatives. Decisions to withhold or withdraw life-sustaining therapy vary widely depending on culture, beliefs and organizational norms. The following review will describe the current understanding of the problem and give an overview over interventional studies. RECENT FINDINGS: EOL care is a risk factor for clinician burnout; poor work conditions contribute to emotional exhaustion and intent to leave...
April 2018: Current Opinion in Anaesthesiology
Andrius Pranskunas, Tomas Tamosuitis, Neringa Balciuniene, Diana Damanskyte, Edvin Sneider, Astra Vitkauskiene, Edmundas Sirvinskas, Vidas Pilvinis, E Christiaan Boerma
As of now the relationship between glycocalyx degradation and microcirculatory perfusion abnormalities in non-septic critical ill patients is unclear. In addition, conjunctival sidestream dark field-imaging for the purpose of glycocalyx thickness estimation has never been performed. We aimed to investigate whether changes in glycocalyx thickness in non-septic patients are associated with microcirculatory alterations in conjunctival and sublingual mucosa. In this single-centre prospective observational study, using techniques for direct in-vivo observation of the microcirculation, we performed a single measurement of microcirculatory perfusion parameters and visualized glycocalyx thickness in both ocular conjunctiva and sublingual mucosa in mixed cardio surgical (n = 18) and neurocritical patients (n = 27) and compared these data with age-matched healthy controls (n = 20)...
February 17, 2018: Microvascular Research
Tomaz Crochemore, Thiago Domingos Corrêa, Marcus D Lance, Cristina Solomon, Ary Serpa Neto, João Carlos de Campos Guerra, Priscila Scolmeister Lellis, Livia Muller Bernz, Natalia Nunes, Cassio Massashi Mancio, Ana Paula Hitomi Yokoyama, Eliézer Silva
BACKGROUND: Transfusion therapy is associated with increased morbidity, mortality and costs. Conventional coagulation tests (CCT) are weak bleeding predictors, poorly reflecting coagulation in vivo. Thromboelastometry (ROTEM) provides early identification of coagulation disorders and can guide transfusion therapy by goals, reducing blood components transfusion. OBJECTIVE: The aim of this study is to describe coagulation profile of critically ill patients using ROTEM and evaluate the association between CCT and thromboelastometry...
2018: PloS One
A Rodríguez, L F Reyes, J Monclou, B Suberviola, M Bodí, G Sirgo, J Solé-Violán, J Guardiola, D Barahona, E Díaz, I Martín-Loeches, M I Restrepo
INTRODUCTION: Serum procalcitonin (PCT) concentration could be increased in patients with renal dysfunction in the absence of bacterial infection. OBJECTIVE: To determine the interactions among serum renal biomarkers of acute kidney injury (AKI) and serum PCT concentration, in patients admitted to the intensive care unit (ICU) due to lung influenza infection. DESIGN: Secondary analysis of a prospective multicentre observational study. SETTING: 148 Spanish ICUs...
February 9, 2018: Medicina Intensiva
Paul Carrier, Véronique Loustaud-Ratti
Hepatic encephalopathy (HE) management is a hard and unavoidable clinical challenge in cirrhotic patients [1]. This neuropsychological complex syndrome ranges from weak behavior abnormalities to deep coma. Indeed, the presence of HE is a bad prognostic marker, with a mortality rate higher than 50% in the year following the first symptoms [2,3]. Despite its frequency and numerous dedicated studies, pathophysiology is not totally understood [4]. The main documented physiological factors are impaired ammonia metabolism and specific inflammation linked to liver disease [5,6]...
February 11, 2018: Fundamental & Clinical Pharmacology
Kellie Sosnowski, Marion L Mitchell, Hayden White, Lynette Morrison, Joanne Sutton, Jessica Sharratt, Frances Lin
Background: Early rehabilitation has been found to prevent delirium and weakness that can hamper the recovery of intensive care unit (ICU) survivors. Integrated clinical practice guidelines for managing patient pain, agitation and delirium (PAD) have been developed. The Awakening and Breathing Coordination, Delirium monitoring/management, and Early exercise/mobility (ABCDE) bundle provides a strategy to implement PAD guidelines into everyday clinical practice. However, there is limited evidence on the effectiveness of the ABCDE bundle in the literature...
2018: Pilot and Feasibility Studies
Hee Seon Park, Jung Hoi Koo, Sun Hong Song
Objective: To prospectively assess the association between impoverished sensorimotor integration of the tongue and lips and post-extubation dysphagia (PED). Methods: This cross-sectional study included non-neurologic critically ill adult patients who required endotracheal intubation and underwent videofluoroscopic swallowing study (VFSS) between October and December 2016. Participants underwent evaluation for tongue and lip performance, and oral somatosensory function...
December 2017: Annals of Rehabilitation Medicine
Giuseppe R Gristina, Francesca Baroncelli, Marco Vergano
In the last decades, mortality from severe acute illnesses has considerably declined thanks to the advances in intensive care medicine. Meanwhile, critical care physicians realized that lifesustaining treatments (LST) may not be appropriate for every patient, and end-of-life care in the Intensive Care Unit (ICU) started to receive growing attention. Most deaths occurring in the ICU now follow a decision to forgo life-sustaining treatments (DFLST), which can be implemented either by withdrawing (WDLST) or withholding (WHLST) life-sustaining treatments...
January 17, 2018: Minerva Anestesiologica
Daniel Aragão Machado, Nébia Maria Almeida de Figueiredo, Luciane de Souza Velasques, Cleonice Alves de Melo Bento, Wiliam César Alves Machado, Lúcia Alves Marques Vianna
OBJECTIVE: To measure the levels of stress, anxiety, and depression of nurses working in ICUs, relating them to levels of attention before and after 24 hours. METHOD: An observational, quantitative, analytical study with 18 nurses undergoing an inventory of stress, anxiety, and depression, as well as assessment of attention levels and psychomotor functioning. RESULTS: Sixty-one percent showed positive for stress. Depression was observed in 33%; and anxiety in 99...
January 2018: Revista Brasileira de Enfermagem
Kohei Taniguchi, Syogo Takashima, Ryo Iida, Koshi Ota, Masahiko Nitta, Kazushi Sakane, Tomohiro Fujisaka, Nobukazu Ishizaka, Osamu Umegaki, Kazuhisa Uchiyama, Akira Takasu
RATIONAL: Takotsubo cardiomyopathy (TCM) is a transient systolic dysfunction of the left ventricular apex without stenosis of coronary arteries and is induced by various psychological and physical factors. TCM sometimes causes lethal complications such as arrhythmia, thrombogenesis, and even cardiac rupture, and thus it should be diagnosed appropriately and managed carefully. Intensive care unit (ICU) patients are exposed to overstress during the treatment process and therefore can are at potential risk for TCM...
December 2017: Medicine (Baltimore)
Elise M Cardinale, Abigail A Marsh
In the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, a Limited Prosocial Emotions specifier was added to the conduct disorder diagnostic criteria to designate a subgroup of children who exhibit callous unemotional (CU) traits. The Inventory of Callous Unemotional Traits (ICU) is the only dedicated measure of CU traits and was influential in the development of the Limited Prosocial Emotions specifier. Despite its role in the research and diagnosis of CU traits, some questions have persisted regarding the internal consistency and validity of the ICU and its three subscales: callous, uncaring, and unemotional...
December 1, 2017: Assessment
Chanika Alahakoon, Tharaka Lagath Dassanayake, Indika Bandara Gawarammana, Vajira Senaka Weerasinghe
INTRODUCTION: Ingestion of organophosphorus insecticides (OPI) is a common method of deliberate self harm in the developing world. Deaths mainly follow as a result of the respiratory failure associated with both cholinergic crisis and the intermediate syndrome. Even though death can be prevented by early mechanical ventilation of these patients, limited studies are available regarding the prediction of intermediate syndrome and subsequent respiratory failure. OBJECTIVE: To systematically review articles that are published with regard to possible prediction of intermediate syndrome using clinical, biochemical and electrophysiological parameters...
December 5, 2017: Neurotoxicology
Audrey R Roberson, Angela Starkweather, Catherine Grossman, Edmund Acevedo, Jeanne Salyer
BACKGROUND: Muscle strength may be one indicator of readiness to mobilize that can be used to guide decisions regarding early mobility efforts and to progressively advance mobilization. OBJECTIVES: To provide a synthesis of current measures of muscle strength in the assessment of early mobilization in critically ill adult patients who are receiving MV therapy. METHODS: Research studies conducted between 2000-2015 were identified using PubMed, CINHAL, MEDLINE, and the Cochrane Database of Systematic Reviews databases using the search terms "muscle strength", "intensive care", "mechanical ventilation" and "muscle weakness"...
January 2018: Heart & Lung: the Journal of Critical Care
Veronika Krautheim, Andrea Schmitz, Gesine Benze, Thomas Standl, Christine Schiessl, Wolfgang Waldeyer, Alexander Hapfelmeier, Eberhard F Kochs, Gerhard Schneider, Klaus J Wagner, Christian M Schulz
BACKGROUND: Little is known about ICU physicians' self-confidence and knowledge related to palliative care. Our objective was to investigate self-confidence and knowledge of German ICU physicians related to palliative care, and to assess the impact of work experience, gender, specialty and additional certifications in pain or palliative medicine. METHODS: In a multicentre prospective observational study ICU physicians of ten hospitals were asked to rate their self-confidence and to complete a multiple choice questionnaire for the assessment of knowledge...
November 22, 2017: BMC Palliative Care
Flavia A De Orange, Rebeca Gac Andrade, Andrea Lemos, Paulo Sgn Borges, José N Figueiroa, Pete G Kovatsis
BACKGROUND: Since the introduction of endotracheal intubation in paediatrics, uncuffed endotracheal tubes (ETTs) have been the standard of care for children under eight years old, based on the presumption that complications, particularly postoperative stridor, are higher with cuffed ETTs. The major disadvantages of uncuffed ETTs cited for this shift in procedure include the difficulty in achieving tidal volumes due to leakage around an uncuffed ETT. To seal the airway adequately, uncuffed tubes may need to be exchanged for another tube with a larger diameter, which sometimes requires several attempts before the appropriate size is found...
November 17, 2017: Cochrane Database of Systematic Reviews
Saurabh Saigal, Jai Prakash Sharma, Abhijit Pakhare, Santosh Bhaskar, Sanjay Dhanuka, Sanjay Kumar, Yogesh Sabde, Pradip Bhattacharya, Rajnish Joshi
Background: In low- and middle-income countries such as India, where health systems are weak, the number of available Critical Care Unit (Intensive Care Unit [ICU]) beds is expected to be low. There is no study from the Indian subcontinent that has reported the characteristics and distribution of existing ICUs. We performed this study to understand the characteristics and distribution of ICUs in Madhya Pradesh (MP) state of Central India. We also aimed to develop a consensus scoring system and internally validate it to define levels of care and to improve health system planning and to strengthen referral networks in the state...
October 2017: Indian Journal of Critical Care Medicine
Tilde Skovkær Withen Olesen, Mary Kruse, Malgorzata Pawlowicz-Dworzanska, Kirsten Klostergaard, Peter Derek Christian Leutscher
Patients surviving severe critical illness commonly develop post intensive care syndrome (PICS). The syndrome consists of a constellation of cognitive dysfunction, depression, anxiety and post-traumatic stress disorder combined with physical weakness. Different contributing risk factors for development of PICS have been identified. Furthermore, close family members of the patient are at risk of developing similar psychiatric manifestations. Focus should be on early preventive measures during hospitalization and post-ICU follow-up with a multidisciplinary approach...
November 6, 2017: Ugeskrift for Laeger
Ajitesh Ojha, Sasha A Zivkovic, David Lacomis
INTRODUCTION: Since the late 1980s, critical illness myopathy (CIM) and polyneuropathy (CIP) have been increasingly recognized in the intensive care unit (ICU). We explored whether these causes of ICU weakness were now more likely to lead to electrodiagnostic studies (EDX) at our institution than they were 19-20 years earlier. METHODS: We reviewed 100 consecutive ICU patients who underwent EDX from 2009-2015 and compared them to a previously reported study population from 1990-1995...
October 20, 2017: Muscle & Nerve
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