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https://www.readbyqxmd.com/read/28817481/incorporating-dynamic-assessment-of-fluid-responsiveness-into-goal-directed-therapy-a-systematic-review-and-meta-analysis
#1
Joseph M Bednarczyk, Jason A Fridfinnson, Anand Kumar, Laurie Blanchard, Rasheda Rabbani, Dean Bell, Duane Funk, Alexis F Turgeon, Ahmed M Abou-Setta, Ryan Zarychanski
OBJECTIVE: Dynamic tests of fluid responsiveness have been developed and investigated in clinical trials of goal-directed therapy. The impact of this approach on clinically relevant outcomes is unknown. We performed a systematic review and meta-analysis to evaluate whether fluid therapy guided by dynamic assessment of fluid responsiveness compared with standard care improves clinically relevant outcomes in adults admitted to the ICU. DATA SOURCES: Randomized controlled trials from MEDLINE, EMBASE, CENTRAL, clinicaltrials...
September 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28814248/pediatric-abdominal-trauma
#2
Tim Lynch
Abdominal trauma is present in approximately 25% of pediatric patients with major trauma and is the most common cause of unrecognized fatal injury in children. Pediatric abdominal trauma is typically blunt in nature with the spleen being the most common organ injured. Non-operative management is employed in over 95% of patients. Penetrating injuries are less common but often require operative management. Knowledge of specific mechanisms of injury aids the clinician in the diagnosis of specific injuries. Computed tomography (CT) is the gold standard in the identification of intra-abdominal injury...
August 14, 2017: Current Pediatric Reviews
https://www.readbyqxmd.com/read/28811944/successful-resuscitation-of-a-patient-with-life-threatening-metabolic-acidosis-by-hemodialysis-a-case-of-ethylene-glycol-intoxication
#3
Ikuyo Narita, Michiko Shimada, Norio Nakamura, Reiichi Murakami, Takeshi Fujita, Wakako Fukuda, Hirofumi Tomita
BACKGROUND: Ethylene glycol intoxication causes severe metabolic acidosis and acute kidney injury. Fomepizole has become available as its antidote. Nevertheless, a prompt diagnosis is not easy because patients are often unconscious. Here we present a case of ethylene glycol intoxication who successfully recovered with prompt hemodialysis. CASE PRESENTATION: A 52-year-old Japanese male was admitted to a local hospital due to suspected food poisoning. The patient presented with nausea and vomiting, but his condition rapidly deteriorated, with worsening conscious level, respiratory distress requiring mechanical ventilation, hypotension, and severe acute kidney injury...
2017: Case Reports in Nephrology
https://www.readbyqxmd.com/read/28807216/early-resuscitation-with-exendin-4-alleviates-acute-lung-injury-after-hemorrhagic-shock-in-rats
#4
Xiang Song, Gan Chen, Xin Luo, Guoxing You, Yujing Yin, Ying Wang, Lian Zhao, Hong Zhou
BACKGROUND: Oxidative stress induced by hemorrhagic shock (HS) is known to initiate a systemic inflammatory response, which leads to subsequent acute lung injury. This study is aimed to assess the efficacy of exendin-4 (Ex-4) in attenuating lung injury in a rat model of HS and resuscitation (HS/R). METHODS: HS was induced in sodium pentobarbital-anesthetized adult male Wistar rats by withdrawing blood to maintain a mean arterial pressure of 30-35 mm Hg for 50 min...
August 2017: Journal of Surgical Research
https://www.readbyqxmd.com/read/28807037/selepressin-a-novel-selective-vasopressin-v1a-agonist-is-an-effective-substitute-for-norepinephrine-in-a-phase-iia-randomized-placebo-controlled-trial-in-septic-shock-patients
#5
James A Russell, Jean-Louis Vincent, Anne Louise Kjølbye, Håkan Olsson, Allan Blemings, Herbert Spapen, Peder Carl, Pierre-Francois Laterre, Lars Grundemar
BACKGROUND: Vasopressin is widely used for vasopressor support in septic shock patients, but experimental evidence suggests that selective V1A agonists are superior. The initial pharmacodynamic effects, pharmacokinetics, and safety of selepressin, a novel V1A-selective vasopressin analogue, was examined in a phase IIa trial in septic shock patients. METHODS: This was a randomized, double-blind, placebo-controlled multicenter trial in 53 patients in early septic shock (aged ≥18 years, fluid resuscitation, requiring vasopressor support) who received selepressin 1...
August 15, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/28801484/predicting-outcomes-in-traumatic-out-of-hospital-cardiac-arrest-the-relevance-of-utstein-factors
#6
Ben Beck, Janet E Bray, Peter Cameron, Lahn Straney, Emily Andrew, Stephen Bernard, Karen Smith
BACKGROUND: Given low survival rates in cases of traumatic out-of-hospital cardiac arrest (OHCA), there is a need to identify factors associated with outcomes. We aimed to investigate Utstein factors associated with achieving return of spontaneous circulation (ROSC) and survival to hospital in traumatic OHCA. METHODS: The Victorian Ambulance Cardiac Arrest Registry (VACAR) was used to identify cases of traumatic OHCA that received attempted resuscitation and occurred between July 2008 and June 2014...
August 11, 2017: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/28800036/improved-outcomes-of-cardiopulmonary-resuscitation-in-rats-treated-with-vagus-nerve-stimulation-and-its-potential-mechanism
#7
Peng Sun, Jiangang Wang, Shen Zhao, Zhengfei Yang, Ziren Tang, Navami Ravindra, Jennifer Bradley, Joseph P Ornato, Mary Ann Peberdy, Wanchun Tang
Studies have demonstrated that vagus nerve stimulation (VNS) reduces ischemia/reperfusion (I/R) injury. In this study, we investigated the protective effects of VNS in a rat model of cardiopulmonary resuscitation (CPR). We further investigated whether the beneficial effects of VNS were dependent on the alpha 7 nicotinic acetylcholine receptor (α7nAChR). Forty animals were randomized into 4 groups and all underwent CPR (n = 10 each): (1) CPR alone (control); (2) VNS during CPR; (3) α7nAChR antagonist methyllycaconitine citrate (MLA) with VNS; (4) α7nAChR agonist 3-(2, 4-dimethoxybenzylidene) anabaseine (GTS-21) without VNS...
August 9, 2017: Shock
https://www.readbyqxmd.com/read/28794694/quality-indicators-in-intensive-care-medicine-for-germany-third-edition-2017
#8
REVIEW
Oliver Kumpf, Jan-Peter Braun, Alexander Brinkmann, Hanswerner Bause, Martin Bellgardt, Frank Bloos, Rolf Dubb, Clemens Greim, Arnold Kaltwasser, Gernot Marx, Reimer Riessen, Claudia Spies, Jörg Weimann, Gabriele Wöbker, Elke Muhl, Christian Waydhas
Quality improvement in medicine is depending on measurement of relevant quality indicators. The quality indicators for intensive care medicine of the German Interdisciplinary Society of Intensive Care Medicine (DIVI) from the year 2013 underwent a scheduled evaluation after three years. There were major changes in several indicators but also some indicators were changed only minimally. The focus on treatment processes like ward rounds, management of analgesia and sedation, mechanical ventilation and weaning, as well as the number of 10 indicators were not changed...
2017: German Medical Science: GMS E-journal
https://www.readbyqxmd.com/read/28793138/temporal-changes-in-the-racial-gap-in-survival-after-in-hospital-cardiac-arrest
#9
Lee Joseph, Paul S Chan, Steven M Bradley, Yunshu Zhou, Garth Graham, Philip G Jones, Mary Vaughan-Sarrazin, Saket Girotra
Importance: Previous studies have found marked differences in survival after in-hospital cardiac arrest by race. Whether racial differences in survival have narrowed as overall survival has improved remains unknown. Objectives: To examine whether racial differences in survival after in-hospital cardiac arrest have narrowed over time and if such differences could be explained by acute resuscitation survival, postresuscitation survival, and/or greater temporal improvement in survival at hospitals with higher proportions of black patients...
August 9, 2017: JAMA Cardiology
https://www.readbyqxmd.com/read/28790176/impaired-liver-regeneration-after-hepatectomy-and-bleeding-is-associated-with-a-shift-from-hepatocyte-proliferation-to-hypertrophy
#10
Idit Matot, Nathalie Nachmansson, Omri Duev, Susanne Schulz, Katrin Schroeder-Stein, Stilla Frede, Rinat Abramovitch
Extensive liver resections are common, and bleeding is frequent in these operations. Impaired regeneration after partial hepatectomy (PHx) may contribute to liver failure. We thus assessed the impact of acute bleeding on the liver regeneration progress after PHx and explored possible contributing molecular mechanisms. In rats, the regeneration progress was delayed and attenuated with PHx and bleeding and was not restored with colloid resuscitation. Livers restored their initial volume by postoperative day (POD) 2 after PHx through hepatocyte proliferation vs...
August 8, 2017: FASEB Journal: Official Publication of the Federation of American Societies for Experimental Biology
https://www.readbyqxmd.com/read/28782702/preferences-for-life-sustaining-treatments-examined-by-hidden-markov-modeling-are-mostly-stable-in-terminally-ill-cancer-patients-last-6-months-of-life
#11
Siew Tzuh Tang, Fur-Hsing Wen, Wen-Cheng Chang, Chia-Hsun Hsieh, Wen-Chi Chou, Jen-Shi Chen, Ming-Mo Hou
BACKGROUND/OBJECTIVE: Stability of life-sustaining treatment (LST) preferences at end of life (EOL) has not been well established for terminally ill cancer patients nor have transition probabilities been explored between different types of preferences. We assessed the stability of cancer patients' LST preferences at EOL by identifying distinct LST-preference states and examining the probability of each state transitioning to other states between consecutive time points. METHODS: Stability of LST preferences (cardio-pulmonary resuscitation, intensive care unit [ICU] care, cardiac massage, intubation with mechanical ventilation, intravenous nutrition support, and nasogastric tube feeding) was examined among 303 cancer patients in their last 6 months by hidden Markov modeling...
August 3, 2017: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/28777139/fluid-bolus-over-15-20-versus-5-10-minutes-each-in-the-first-hour-of-resuscitation-in-children-with-septic-shock-a-randomized-controlled-trial
#12
Jhuma Sankar, Javed Ismail, M Jeeva Sankar, Suresh C P, Rameshwar S Meena
OBJECTIVES: To compare the effect of administration of 40-60 mL/kg of fluids as fluid boluses in aliquots of 20 mL/kg each over 15-20 minutes with that over 5-10 minutes each on the composite outcome of need for mechanical ventilation and/or impaired oxygenation-increase in oxygenation index by 5 from baseline in the initial 6 and 24 hours in children with septic shock. DESIGN: Randomized controlled trial. SETTING: Pediatric emergency and ICU of a tertiary care institute...
August 2, 2017: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/28769583/association-of-code-status-discussion-with-invasive-procedures-among-advanced-stage-cancer-and-noncancer-patients
#13
Akinori Sasaki, Eiji Hiraoka, Yosuke Homma, Osamu Takahashi, Yasuhiro Norisue, Koji Kawai, Shigeki Fujitani
BACKGROUND: Code status discussion is associated with a decrease in invasive procedures among terminally ill cancer patients. We investigated the association between code status discussion on admission and incidence of invasive procedures, cardiopulmonary resuscitation (CPR), and opioid use among inpatients with advanced stages of cancer and noncancer diseases. METHODS: We performed a retrospective cohort study in a single center, Ito Municipal Hospital, Japan. Participants were patients who were admitted to the Department of Internal Medicine between October 1, 2013 and August 30, 2015, with advanced-stage cancer and noncancer...
2017: International Journal of General Medicine
https://www.readbyqxmd.com/read/28767544/compensatory-reserve-index-performance-of-a-novel-monitoring-technology-to-identify-the-bleeding-trauma-patient
#14
Michael Johnson, Abdul Alarhayem, Victor Convertino, Robert Carter, Kevin Chung, Ronald Stewart, John Myers, Daniel Dent, Lilian Liao, Ramon Cestero, Susannah Nicholson, Mark Muir, Martin Schwacha, David Wampler, Mark DeRosa, Brian Eastridge
INTRODUCTION: Hemorrhage is one of the most substantial causes of death after traumatic injury. Standard measures, including systolic blood pressure (SBP), are poor surrogate indicators of physiologic compromise until compensatory mechanisms have been overwhelmed. Compensatory Reserve Index (CRI) is a novel monitoring technology with the ability to assess physiologic reserve. We hypothesized CRI would be a better predictor of physiologic compromise secondary to hemorrhage than traditional vital signs...
August 1, 2017: Shock
https://www.readbyqxmd.com/read/28763433/injury-and-liability-associated-with-spine-surgery
#15
Rachel Kutteruf, Deva Wells, Linda Stephens, Karen L Posner, Lorri A Lee, Karen B Domino
BACKGROUND: Although spine surgery is associated with significant morbidity, the anesthesia liability profile for spine surgery is not known. We examined claims for spine procedures in the Anesthesia Closed Claims Project database to evaluate patterns of injury and liability. MATERIALS AND METHODS: A retrospective cohort study was performed. Inclusion criteria were anesthesia claims provided for surgical procedures in 2000 to 2014. We compared mechanisms of injury for cervical spine to thoracic or lumbar spine procedures using χ and the Fisher exact test...
July 31, 2017: Journal of Neurosurgical Anesthesiology
https://www.readbyqxmd.com/read/28755278/endothelial-bmp4-regulates-leukocyte-diapedesis-and-promotes-inflammation
#16
Thomas Helbing, Linus Arnold, Gwendoline Wiltgen, Eva Hirschbihl, Valentin Gabelmann, Alexandra Hornstein, Jennifer S Esser, Philipp Diehl, Sebastian Grundmann, Hans-Jörg Busch, Katrin Fink, Christoph Bode, Martin Moser
Leukocyte recruitment is a fundamental event in the response of the innate immune system to injury. This process is promoted in part by the opening of endothelial cell adherens junctions that allows leukocyte extravasation through gaps between adjacent endothelial cells. VE-cadherin is a key component of endothelial cell adherens junctions and a negative regulator of leukocyte emigration. Accumulating evidence implicates bone morphogenetic protein (BMP) 4 as a critical regulator in vascular biology, but its role in leukocyte extravasation in vitro and in vivo has not been investigated so far...
July 28, 2017: Inflammation
https://www.readbyqxmd.com/read/28754760/accidental-hypothermic-cardiac-arrest-and-rapid-mediastinal-warming-with-pleural-lavage-a-survivor-after-3-5-hours-of-manual-cpr
#17
George Little
A 30-year-old man suffered post-traumatic hypothermic cardiac arrest. On arrival in the emergency department, rectal core temperature was 23°C. Manual cardiopulmonary resuscitation (CPR) was continued as no mechanical chest compression device was available, and active and passive rewarming was undertaken. Bilateral thoracostomies confirmed good lung inflation. Defibrillation and intravenous epinephrine were discontinued until core temperature was elevated above 30°C. Extracorporeal rewarming was unavailable...
July 27, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28749962/severe-imported-malaria-in-children-in-france-a-national-retrospective-study-from-1996-to-2005
#18
Pierre Mornand, Catherine Verret, Philippe Minodier, Albert Faye, Marc Thellier, Patrick Imbert
BACKGROUNDS: Malaria is a leading cause of imported febrile illnesses in pediatric travelers, but few studies have addressed severe imported pediatric malaria. We aimed to determine the risk factors and the features of imported pediatric severe malaria. METHODS: We conducted a retrospective, descriptive study using the French National Reference Center for Imported Malaria database, in children aged 0-15 years who were hospitalized with a falciparum malaria from January 1st 1996 to December 31th 2005...
2017: PloS One
https://www.readbyqxmd.com/read/28744986/complete-recovery-of-fulminant-peripartum-cardiomyopathy-on-mechanical-circulatory-support-combined-with-high-dose-bromocriptine-therapy
#19
Patrick Horn, Diyar Saeed, Payam Akhyari, Denise Hilfiker-Kleiner, Malte Kelm, Ralf Westenfeld
Peripartum cardiomyopathy (PPCM) is an idiopathic cardiomyopathy presenting with heart failure due to left ventricular systolic dysfunction towards the end of pregnancy or in the months following delivery, where no other cause of heart failure is found. We report a case of a woman with PPCM who developed a critical cardiogenic shock with repeated cardiopulmonary resuscitation. We show for the first time that mechanical circulatory support combined with high-dose bromocriptine therapy to suppress systemic prolactin levels may serve as an effective therapeutic option in patients with fulminant PPCM and cardiogenic shock...
July 25, 2017: ESC Heart Failure
https://www.readbyqxmd.com/read/28741013/prompt-use-of-mechanical-cardiopulmonary-resuscitation-in-out-of-hospital-cardiac-arrest-the-mecca-study-report
#20
Venkataraman Anantharaman, Boon Lui Benjamin Ng, Shiang Hu Ang, Chun Yue Francis Lee, Siew Hon Benjamin Leong, Marcus Eng Hock Ong, Siang Jin Terrance Chua, Antony Charles Rabind, Nagaraj Baglody Anjali, Ying Hao
INTRODUCTION: Early use of mechanical cardiopulmonary resuscitation (CPR) for out-of-hospital cardiac arrest (OHCA) may improve survival outcomes. Current evidence for such devices uses outcomes from an intention-to-treat (ITT) perspective. We aimed to determine whether early use of mechanical CPR using a LUCAS 2 device results in better outcomes. METHODS: A prospective, randomised, multicentre study was conducted over one year with LUCAS 2 devices in 14 ambulances and manual CPR in 32 ambulances to manage OHCA...
July 2017: Singapore Medical Journal
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