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https://www.readbyqxmd.com/read/28716593/the-critical-care-literature-2016
#1
REVIEW
Michael E Winters, Joseph P Martinez, Haney Mallemat, William J Brady
An emergency physician (EP) is often the first health care provider to evaluate, resuscitate, and manage a critically ill patient. Between 2001 and 2009, the annual hours of critical care delivered in emergency departments (EDs) across the United States increased >200%! (Herring et al., 2013). This trend has persisted since then. In addition to seeing more critically ill patients, EPs are often tasked with providing critical care long beyond the initial resuscitation period. In fact, >33% of critically ill patients who are brought to an ED remain there for >6h (Herring et al...
July 13, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28708664/esmolol-administration-to-control-tachycardia-in-an-ovine-model-of-peritonitis
#2
Koji Hosokawa, Fuhong Su, Fabio Silvio Taccone, Emiel Hendrik Post, Adriano José Pereira, Antoine Herpain, Jacques Creteur, Jean-Louis Vincent
BACKGROUND: Excessive adrenergic signaling may be harmful in sepsis. Using β-blockers to reduce sympathetic overactivity may modulate sepsis-induced cardiovascular, metabolic, immunologic, and coagulation alterations. Using a randomized ovine fecal peritonitis model, we investigated whether administration of a short-acting β-blocker, esmolol, could control tachycardia without deleterious effects on hemodynamics, renal perfusion, cerebral perfusion, cerebral metabolism, or outcome. METHODS: After induction of fecal peritonitis, 14 anesthetized, mechanically ventilated, and hemodynamically monitored adult female sheep were randomly assigned to receive a continuous intravenous infusion of esmolol to control heart rate between 80 and 100 bpm (n = 7) or a saline infusion (control group, n = 7)...
July 13, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28707404/sustained-versus-standard-inflations-during-neonatal-resuscitation-to-prevent-mortality-and-improve-respiratory-outcomes
#3
REVIEW
Matteo Bruschettini, Colm Pf O'Donnell, Peter G Davis, Colin J Morley, Lorenzo Moja, Simona Zappettini, Maria Grazia Calevo
BACKGROUND: At birth, infants' lungs are fluid-filled. For newborns to have a successful transition, this fluid must be replaced by air to enable effective breathing. Some infants are judged to have inadequate breathing at birth and are resuscitated with positive pressure ventilation (PPV). Giving prolonged (sustained) inflations at the start of PPV may help clear lung fluid and establish gas volume within the lungs. OBJECTIVES: To assess the efficacy of an initial sustained (> 1 second duration) lung inflation versus standard inflations (≤ 1 second) in newly born infants receiving resuscitation with intermittent PPV...
July 14, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28704248/low-end-tidal-carbon-dioxide-at-the-onset-of-emergent-trauma-surgery-is-associated-with-nonsurvival-a-case-series
#4
Roman Dudaryk, Danielle K Bodzin, Juliet J Ray, Craig S Jabaley, Richard R McNeer, Richard H Epstein
BACKGROUND: End-tidal carbon dioxide (EtCO2) is a valuable marker of the return of adequate circulation following cardiac arrest due to medical causes. Previously, the prognostic value of capnography in trauma has been studied among limited populations in prehospital and emergency department settings. We aimed to investigate the relationship between early intraoperative EtCO2 and nonsurvival of patients undergoing emergency surgery at a level 1 academic trauma center as a case series...
July 10, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28697023/clot-dynamics-and-mortality-the-ma-r-ratio
#5
Stephanie A Savage, Ben L Zarzaur, Timothy H Pohlman, Brian L Brewer, Louis J Magnotti, Martin A Croce, Garrett H Lim, Ali C Martin
INTRODUCTION: The coagulopathy of trauma, illustrated by a short R-time, is common and well understood. The physiology behind this may be early thrombin burst with rapid clot formation. Rapid consumption of fibrinogen, however, may result in weak clot and substrate depletion, resulting in low MA. While these characteristics are interesting, utilizing TEG to identify those at risk for subsequent bleeding diathesis, especially in those who do not demonstrate early signs of physiologic derangement, is challenging...
July 8, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28697015/the-p50-research-center-in-perioperative-sciences-how-the-investment-by-the-national-institute-of-general-medical-sciences-in-team-science-has-reduced-post-burn-mortality
#6
Celeste C Finnerty, Karel Capek, Charles Voigt, Gabriel Hundeshagen, Janos Cambiaso-Daniel, Craig Porter, Linda E Sousse, Amina El Ayadi, Ramon Zapata-Sirvent, Ashley Guillory, Oscar E Suman, David N Herndon
Since the inception of the P50 Research Center in Peri-Operative Sciences (RCIPS) funding mechanism, the National Institute for General Medical Sciences has supported a team approach to science. Many advances in critical care, particularly burns, have been driven by RCIPS teams. In fact, burns that were fatal in the early 1970s, prior to the inception of the P50 RCIPS program, are now routinely survived as a result of the P50-funded research. The advances in clinical care that led to the reduction in post-burn death were made by optimizing resuscitation, incorporating early excision and grafting, bolstering acute care including support for inhalation injury, modulating the hypermetabolic response, augmenting the immune response, incorporating aerobic exercise, and developing anti-scarring strategies...
July 8, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28692439/lipid-emulsion-in-local-anesthetic-toxicity
#7
Martyn Harvey, Grant Cave
PURPOSE OF REVIEW: Enthusiasm for regional anesthesia has been driven by multimodal benefits to patient outcomes. Despite widespread awareness and improved techniques (including the increasing use of ultrasound guidance for block placement), intravascular sequestration and the attendant risk of local anesthetic systemic toxicity (LAST) remains. Intravenous lipid emulsion (ILE) for the treatment of LAST has been endorsed by anesthetic regulatory societies on the basis of animal study and human case report data...
July 7, 2017: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/28691504/takotsubo-cardiomyopathy-another-form-of-cardiorenal-syndrome
#8
Verena Bill, Ibrahim El-Battrawy, Ursula Hoffmann, Darius Haghi, Jürgen Kuschyk, Martin Borggrefe, Ibrahim Akin
Takotsubo cardiomyopathy (TC) is a life-threatening syndrome with ambiguous pathophysiology. The interdependency between heart failure and kidney failure (KF) is well established, but the influence of KF on TC outcome is not known. This single-center cohort from January 2003 to September 2015 consisted of 114 consecutive patients with TC. They were divided into 2 groups according to the presence (n = 32, 29.6%) or absence (n = 76, 70.3%) of KF. The end point of this retrospective study was a composite of in-hospital events, all-cause mortality, rehospitalization due to heart failure, stroke, and recurrence of TC (mean follow-up: 5 years)...
January 1, 2017: Angiology
https://www.readbyqxmd.com/read/28687052/borneol-a-novel-agent-that-improves-central-nervous-system-drug-delivery-by-enhancing-blood-brain-barrier-permeability
#9
Qun-Lin Zhang, Bingmei M Fu, Zhang-Jin Zhang
The clinical application of central nervous system (CNS) drugs is limited by their poor bioavailability due to the blood-brain barrier (BBB). Borneol is a naturally occurring compound in a class of 'orifice-opening' agents often used for resuscitative purposes in traditional Chinese medicine. A growing body of evidence confirms that the 'orifice-opening' effect of borneol is principally derived from opening the BBB. Borneol is therefore believed to be an effective adjuvant that can improve drug delivery to the brain...
November 2017: Drug Delivery
https://www.readbyqxmd.com/read/28685447/diet-induced-ketosis-protects-against-focal-cerebral-ischemia-in-mouse
#10
Kui Xu, Lena Ye, Katyayini Sharma, Yongming Jin, Matthew M Harrison, Tylor Caldwell, Jessica M Berthiaume, Yu Luo, Joseph C LaManna, Michelle A Puchowicz
Over the past decade we have consistently shown that ketosis is neuroprotective against ischemic insults in rats. We reported that diet-induced ketotic rats had a significant reduction in infarct volume when subjected to middle cerebral artery occlusion (MCAO), and improved survival and recovery after cardiac arrest and resuscitation. The neuroprotective mechanisms of ketosis (via ketogenic diet; KG) include (i) ketones are alternate energy substrates that can restore energy balance when glucose metabolism is deficient and (ii) ketones modulate cell-signalling pathways that are cytoprotective...
2017: Advances in Experimental Medicine and Biology
https://www.readbyqxmd.com/read/28683810/effect-of-dextran-70-on-outcome-in-severe-sepsis-a-propensity-score-matching-study
#11
Peter Bentzer, Marcus Broman, Thomas Kander
BACKGROUND: Albumin may be beneficial in patients with septic shock but availability is limited and cost is high. The objective of the present study was to investigate if the use of dextran-70 in addition to albumin and crystalloids influences organ failure or mortality in patients with severe sepsis or septic shock. METHODS: Patients with severe sepsis or septic shock (n = 778) admitted to a university hospital intensive care unit (ICU) between 2007 and 2015 that received dextran-70 during resuscitation were propensity score matched to controls at a 1 to 1 ratio...
July 6, 2017: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/28682946/cerebral-alterations-following-experimental-multiple-trauma-and-hemorrhagic-shock
#12
Nina Vogt, Christiane Herden, Elke Roeb, Martin Roderfeld, Daphne Eschbach, Thorsten Steinfeldt, Hinnerk Wulf, Steffen Ruchholtz, Eberhard Uhl, Karsten Schöller
Multiple trauma (MT) associated with hemorrhagic shock (HS) might lead to cerebral hypoperfusion and brain damage. We investigated cerebral alterations using a new porcine MT/HS model without traumatic brain injury (TBI) and assessed the neuroprotective properties of mild therapeutic hypothermia. Male pigs underwent standardized MT with HS (45% or 50% loss of blood volume) and resuscitation after 90/120 minutes (T90/T120). In additional groups (TH90/TH120) mild hypothermia (33°C) was induced following resuscitation...
July 4, 2017: Shock
https://www.readbyqxmd.com/read/28682943/remote-ischemic-post-conditioning-improves-myocardial-dysfunction-via-the-risk-and-safe-pathways-in-a-rat-model-of-severe-hemorrhagic-shock
#13
Jianrong Huang, Dawei Xu, Qinyue Guo, Bing Ou, Qin Ling, Jianhua Li, Zhengfei Yang, Wanchun Tang
INTRODUCTION: Patients who have been resuscitated after severe hemorrhagic shock still have a high mortality rate. Previously published literature has suggested that remote ischemic postconditioning (RIPostC) has a cardioprotective effect, but few studies have focused on RIPostC performed after severe hemorrhagic shock. In this study, we aim to explore the effects and mechanism of RIPostC on myocardial ischemia and reperfusion injuries after hemorrhagic shock. METHODS: Fifty male rats were randomized into four groups: Sham, Control, RIPerC (remote ischemic per-conditioning) and RIPostC...
July 4, 2017: Shock
https://www.readbyqxmd.com/read/28682838/characteristics-and-outcome-of-cancer-patients-admitted-to-the-icu-in-england-wales-and-northern-ireland-and-national-trends-between-1997-and-2013
#14
Marlies Ostermann, Paloma Ferrando-Vivas, Carmen Gore, Sarah Power, David Harrison
OBJECTIVE: To describe trends in outcomes of cancer patients with an unplanned admission to the ICU between 1997 and 2013 and to identify risk factors for mortality of those admitted between 2009 and 2013. DESIGN: Retrospective analysis. SETTING: Intensive Care National Audit & Research Centre Case Mix Programme Database including data of ICUs in England, Wales, and Northern Ireland. PATIENTS: Patients (99,590) with a solid tumor and 13,538 patients with a hematological malignancy with an unplanned ICU admission between 1997 and 2013; 39,734 solid tumor patients and 6,652 patients with a hematological malignancy who were admitted between 2009 and 2013 were analyzed in depth...
July 4, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28674213/the-protective-effects-of-carboxyhemoglobin-during-the-resuscitation-from-hemorrhagic-shock-in-rats
#15
Hongyu Liu, Songyan Yu, Yaojun Peng, Xin Chang, Xinguang Yu
AIM: This study was aimed to explore the effects of carboxyhemoglobin on reperfusion injury in hemorrhagic shock, as well as its action time and related mechanisms. RESULTS: CO-RBC group showed milder oxidative injury than O2-RBC group. CO reperfusion did not show advantages in functions of kidney and lung during resuscitation. The level of Bax was decreased in CO-RBC group, especially in early CO-RBC group. Moreover, the autophay-related gene Beclin-1 was down-regulated in CO-RBC and early CO-RBC groups...
June 28, 2017: Oncotarget
https://www.readbyqxmd.com/read/28674066/contribution-of-the-chromosomal-ccdab-operon-to-bacterial-drug-tolerance
#16
Kritika Gupta, Arti Tripathi, Alishan Sahu, Raghavan Varadarajan
One of the first identified and best studied toxin-antitoxin systems in Escherichia coli is the F-plasmid based CcdAB system. This system is involved in plasmid maintenance through post-segregational killing. More recently, ccdAB homologs have been found on the chromosome, including in pathogenic strains of E. coli and other bacteria. However the functional role of chromosomal ccdAB genes, if any, has remained unclear. We show that both the native ccd operon of the E.coliO157 strain, as well as the ccd operon from the F- plasmid, when inserted on the E...
July 3, 2017: Journal of Bacteriology
https://www.readbyqxmd.com/read/28672146/stroke-volume-guided-resuscitation-in-severe-sepsis-and-septic-shock-improves-outcomes
#17
Heath E Latham, Charles D Bengtson, Lewis Satterwhite, Mindy Stites, Dipti P Subramaniam, G John Chen, Steven Q Simpson
To determine whether stroke volume (SV) guided fluid resuscitation in patients with severe sepsis and septic shock alters Intensive Care Unit (ICU) fluid balance and secondary outcomes, this retrospective cohort study evaluated consecutive patients admitted to an ICU with the primary diagnosis of severe sepsis or septic shock. Cohorts were based on fluid resuscitation guided by changes in SV or by usual care (UC). The SV group comprised 100 patients, with 91 patients in the UC group. Net fluid balance for the ICU stay was lower in the SV group (1...
June 28, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/28671898/patterns-and-outcomes-associated-with-timeliness-of-initial-crystalloid-resuscitation-in-a-prospective-sepsis-and-septic-shock-cohort
#18
Daniel E Leisman, Chananya Goldman, Martin E Doerfler, Kevin D Masick, Susan Dries, Eric Hamilton, Mangala Narasimhan, Gulrukh Zaidi, Jason A D'Amore, John K D'Angelo
OBJECTIVES: The objectives of this study were to 1) assess patterns of early crystalloid resuscitation provided to sepsis and septic shock patients at initial presentation and 2) determine the association between time to initial crystalloid resuscitation with hospital mortality, mechanical ventilation, ICU utilization, and length of stay. DESIGN: Consecutive-sample observational cohort. SETTING: Nine tertiary and community hospitals over 1...
June 30, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28663358/necrotising-coronaritis-with-fatal-outcome
#19
Lisa Schweizer, Nadja Fischer, Thomas Fehr, Stephan Schneiter
A 56-year-old woman presented with acute onset of typical chest pain. She was diagnosed with acute coronary syndrome with ST-segment elevation myocardial infarction. Although significant obstructive coronary artery disease was ruled out by coronary angiography, cardiac MRI showed transmural necrosis of the lateral free wall with extensive microvascular obstruction consistent with ischaemic heart disease. Within 48 hours after initial presentation, the patient suddenly arrested due to pulseless electrical activity with futile resuscitation efforts...
June 28, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28660810/intravenous-fluid-and-electrolyte-administration-in-elective-gastrointestinal-surgery-mechanisms-of-excessive-therapy
#20
R G Simpson, J Quayle, N Stylianides, G Carlson, M Soop
INTRODUCTION While clinical guidelines stress the importance of the judicious perioperative intravenous fluid administration, data show that adherence to these protocols is poor. The reasons have not been identified. We therefore audited the magnitude and indications of fluid and electrolyte administration in a teaching hospital. We hypothesised that epidural analgesia is associated with excessive fluid therapy. MATERIALS AND METHODS Intravenous fluid and electrolyte administration during the day of surgery and the subsequent 2 days in consecutive patients undergoing elective gastrointestinal surgery between November 2013 and May 2014 were retrospectively audited...
July 2017: Annals of the Royal College of Surgeons of England
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