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Mechanical resuscitation

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https://www.readbyqxmd.com/read/29338148/novel-applications-of-bedside-monitoring-to-plumb-patient-hemodynamic-state-and-response-to-therapy
#1
Fabio Guarracino, Pietro Bertini, Michael R Pinsky
Hemodynamic monitoring is essential during the treatment of the critically ill in order to address the hemodynamic alterations and assess the response to treatment. Traditionally classified causes of shock and underlying pathophysiological mechanisms are often neglected by resuscitative strategies included in the guidelines. Most of hemodynamic management focuses on the ability to early recognise patients susceptible to increase cardiac output (CO) and mean arterial pressure (MAP) after a defined fluid challenge by eliciting Starling's law of the heart, and less is known of the ones presenting in shock and not volume responsive...
January 16, 2018: Minerva Anestesiologica
https://www.readbyqxmd.com/read/29337172/organ-support-therapy-in-the-intensive-care-unit-and-return-to-work-in-out-of-hospital-cardiac-arrest-survivors-a-nationwide-cohort-study
#2
Signe Riddersholm, Kristian Kragholm, Rikke Nørmark Mortensen, Steen Moller Hansen, Mads Wissenberg, Freddy K Lippert, Christian Torp-Pedersen, Christian F Christiansen, Bodil Steen Rasmussen
AIM: With increased survival after out-of-hospital cardiac arrest (OHCA), impact of the post-resuscitation course has become important. Among 30-day OHCA survivors, we investigated associations between organ support therapy in the Intensive Care Unit (ICU) and return to work. METHODS: This Danish nationwide cohort-study included 30-day-OHCA-survivors who were employed prior to arrest. We linked OHCA data to information on in-hospital care and return to work. For patients admitted to an ICU and based on renal replacement therapy (RRT), cardiovascular support and mechanical ventilation, we assessed the prognostic value of organ support therapies in multivariable Cox regression models...
January 11, 2018: Resuscitation
https://www.readbyqxmd.com/read/29329694/management-of-refractory-vasodilatory-shock
#3
REVIEW
Jacob C Jentzer, Saraschandra Vallabhajosyula, Ashish K Khanna, Lakhmir S Chawla, Laurence W Busse, Kianoush B Kashani
Refractory shock is a lethal manifestation of cardiovascular failure defined by an inadequate hemodynamic response to high doses of vasopressor medications. Approximately 7% of critically ill patients will develop refractory shock, with short-term mortality exceeding 50%. Refractory vasodilatory shock develops from uncontrolled vasodilation and vascular hyporesponsiveness to endogenous vasoconstrictors, causing failure of physiologic vasoregulatory mechanisms. Standard approaches to initial management of shock include fluid resuscitation and initiation of norepinephrine...
January 9, 2018: Chest
https://www.readbyqxmd.com/read/29328743/man-behind-the-laryngoscopy-is-important
#4
Nadeem Zaidi
Tracheal intubation is the most fundamental and effective resuscitation skill in many emergency situations. It is also performed to facilitate various surgical procedures and mechanical ventilation in critically ill patients. Tracheal intubation is also one of the most commonly taught clinical skills.
March 2017: Journal of Perioperative Practice
https://www.readbyqxmd.com/read/29325421/effects-of-underwater-bubble-cpap-on-very-low-birth-weight-preterm-newborns-in-the-delivery-room-and-after-transport-to-the-neonatal-intensive-care-unit
#5
Vera Lucia Barros Abelenda, Tania Cristina Oliveira Valente, Cirlene Lima Marinho, Agnaldo José Lopes
The development of less invasive ventilatory strategies in very-low-birth-weight (VLBW) preterm newborns has been a growing concern in recent decades. This study aimed to measure differences in the clinical progression of preterm newborns using two distinct periods in a university hospital: before and after using underwater bubble continuous positive airway pressure (ubCPAP). This is a retrospective study of VLBW preterm newborns with gestational ages less than or equal to 32 weeks admitted to the neonatal intensive care unit...
January 1, 2018: Journal of Child Health Care: for Professionals Working with Children in the Hospital and Community
https://www.readbyqxmd.com/read/29323705/the-protective-effects-of-distal-ischemic-treatment-on-apoptosis-and-mitochondrial-permeability-in-the-hippocampus-after-cardiopulmonary-resuscitation
#6
Xiang Zhou, Liu Yong, Yang Huang, ShuiBo Zhu, XiaoYang Song, BiXi Li, Jian Zhu, HaiBo Wang
BACKGROUND: Apoptosis and mitochondrial dysfunction are the main cause of neurological injury after cardiopulmonary resuscitation (CPR). However, the effects of distal ischemic treatments on ischemia-induced apoptosis are rarely studied, and the mechanism by which mitochondrial dysfunction contributes to CPR still unclear. METHODS: A rat model of distal ischemia was established by clipping the right femoral artery. Rats were divided into blank, model, pre-distal ischemic treatment, per-treatment, and post-treatment groups...
January 11, 2018: Journal of Cellular Physiology
https://www.readbyqxmd.com/read/29317351/a-new-physiological-model-for-studying-the-effect-of-chest-compression-and-ventilation-during-cardiopulmonary-resuscitation-the-thiel-cadaver
#7
Emmanuel Charbonney, Stéphane Delisle, Dominique Savary, Gilles Bronchti, Marceau Rigollot, Adrien Drouet, Bilal Badat, Paul Ouellet, Patrice Gosselin, Alain Mercat, Laurent Brochard, Jean-Christophe M Richard
BACKGROUND: Studying ventilation and intrathoracic pressure (ITP) induced by chest compressions (CC) during Cardio Pulmonary Resuscitation is challenging and important aspects such as airway closure have been mostly ignored. We hypothesized that Thiel Embalmed Cadavers could constitute an appropriate model. METHODS: We assessed respiratory mechanics and ITP during CC in 11 cadavers, and we compared it to measurements obtained in 9 out-of-hospital cardiac arrest patients and to predicted values from a bench model...
January 6, 2018: Resuscitation
https://www.readbyqxmd.com/read/29317348/paediatric-in-hospital-cardiac-arrest-factors-associated-with-survival-and-neurobehavioural-outcome-one-year-later
#8
Kathleen Meert, Russell Telford, Richard Holubkov, Beth S Slomine, James R Christensen, John Berger, George Ofori-Amanfo, Christopher J L Newth, J Michael Dean, Frank W Moler
OBJECTIVE: To investigate clinical characteristics associated with 12-month survival and neurobehavioural function among children recruited to the Therapeutic Hypothermia after Paediatric Cardiac Arrest In-Hospital trial. METHODS: Children (n = 329) with in-hospital cardiac arrest who received chest compressions for ≥2 minutes, were comatose, and required mechanical ventilation after return of circulation were included. Neurobehavioural function was assessed using the Vineland Adaptive Behaviour Scale, second edition (VABS-II) at baseline (reflecting pre-arrest status) and 12 months post-arrest...
January 6, 2018: Resuscitation
https://www.readbyqxmd.com/read/29306595/hyperglycemia-alters-expression-of-cerebral-metabolic-genes-after-cardiac-arrest
#9
Rickard Per Fredrik Lindblom, Maria Molnar, Charlotte Israelsson, Belinda Röjsäter, Lars Wiklund, Fredrik Lennmyr
BACKGROUND: Survivors of cardiac arrest often experience neurologic deficits. To date, treatment options are limited. Associated hyperglycemia is believed to further worsen the neurologic outcome. The aim with this study was to characterize expression pathways induced by hyperglycemia in conjunction with global brain ischemia. METHODS: Pigs were randomized to high or normal glucose levels, as regulated by glucose and insulin infusions with target levels of 8.5-10 mM and 4-5...
January 3, 2018: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/29304308/acute-kidney-injury-and-sepsis
#10
Steven J Skube, Stephen A Katz, Jeffrey G Chipman, Christopher J Tignanelli
BACKGROUND: Worldwide, both acute kidney injury (AKI) and sepsis are significant clinical complications, particularly in critical care patients. Sepsis is an important cause of AKI, and AKI is a common complication of sepsis. METHODS: We reviewed the literature, including current practice guidelines, on sepsis-associated AKI. RESULTS: We assessed causes of renal failure, potential mechanisms of sepsis-associated acute kidney injury, current practice guidelines, diagnostic criteria and methods, prevention strategies, treatment options, and outcomes...
January 5, 2018: Surgical Infections
https://www.readbyqxmd.com/read/29300281/the-ios-have-it-a-prospective-observational-study-of-vascular-access-success-rates-in-patients-in-extremis-using-video-review
#11
Kristen M Chreiman, Ryan P Dumas, Mark J Seamon, Patrick K Kim, Patrick M Reilly, Lewis J Kaplan, Jason D Christie, Daniel N Holena
BACKGROUND: Quick and successful vascular access in injured patients arriving in extremis is crucial to enable early resuscitation and rapid OR transport for definitive repair. We hypothesized that intraosseous (IO) access would be faster and have higher success rates than peripheral IVs (PIVs) or central venous catheters (CVCs). METHODS: High-definition video recordings of resuscitations for all patients undergoing Emergency Department Thoracotomy (EDT) from 4/2016-7/2017 were reviewed as part of a quality improvement initiative...
January 4, 2018: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/29283977/divergent-effects-of-hypertonic-fluid-resuscitation-on-renal-pathophysiological-and-structural-parameters-in-rat-model-of-lower-body-ischemia-reperfusion-induced-sterile-inflammation
#12
Bulent Ergin, Coert J Zuurbier, Aysegul Kapucu, Can Ince
The pathogenesis of acute kidney injury (AKI) is characterized by the deterioration of tissue perfusion and oxygenation and enhanced inflammation. The purpose of this study was to investigate whether or not the hemodynamic and inflammatory effects of hypertonic saline (HS) protect the kidney by promoting renal microcirculatory oxygenation and possible deleterious effects of HS due to its high sodium content on renal functional and structural injury following ischemia/reperfusion. Mechanically ventilated and anesthetized rats were randomly divided into four groups (n = 6 per group): a sham-operated control group; a group subjected to renal ischemia for 45 min by supra-aortic occlusion followed by 2 h of reperfusion (I/R); and I/R group treated with a continuous i...
December 27, 2017: Shock
https://www.readbyqxmd.com/read/29283920/does-lactate-affect-the-association-of-early-hyperglycemia-and-multiple-organ-failure-in-severely-injured-blunt-trauma-patients
#13
Justin E Richards, Thomas M Scalea, Michael A Mazzeffi, Peter Rock, Samuel M Galvagno
BACKGROUND: Early hyperglycemia is associated with multiple organ failure (MOF) after traumatic injury; however, few studies have considered the contribution of depth of clinical shock. We hypothesize that when considered simultaneously, glucose and lactate are associated with MOF in severely injured blunt trauma patients. METHODS: We performed a retrospective investigation at a single tertiary care trauma center. Inclusion criteria were patient age ≥18 years, injury severity score (ISS) >15, blunt mechanism of injury, and an intensive care unit length of stay >48 hours...
December 26, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29280925/ontemporary-utilization-of-resuscitative-thoracotomy-results-from-the-aast-aortic-occlusion-for-resuscitation-in-trauma-and-acute-care-surgery-aorta-multicenter-registry
#14
Joseph DuBose, Timothy Fabian, Tiffany Bee, Laura J Moore, John B Holcomb, Megan Brenner, David Skarupa, Kenji Inaba, Todd E Rasmussen, David Turay, Thomas M Scalea
INTRODUCTION: Several reviews of Resuscitative thoracotomy (RT) use over the last 5 decades have been conducted, most recently the evidence-based practice management guideline (PMG) of the Eastern Association for the Surgery of Trauma (EAST). The present study was designed to examine contemporary RT utilization and outcomes compared to historical data (n = 10,238) from the EAST PMG review from published series 1974 - 2013. METHODS: The AAST AORTA registry was utilized to identify patients undergoing RT in the ED from Nov 2013 to Dec 2016...
December 26, 2017: Shock
https://www.readbyqxmd.com/read/29251714/early-identification-of-patients-requiring-massive-transfusion-embolization-or-hemostatic-surgery-for-traumatic-hemorrhage-a-systematic-review-and-meta-analysis
#15
Alexandre Tran, Maher Matar, Jacinthe Lampron, Ewout W Steyerberg, Monica Taljaard, Christian Vaillancourt
BACKGROUND: Delays in appropriate triage of bleeding trauma patients result in poor outcomes. Clinical gestalt is fallible and objective measures of risk stratification are needed. The objective of this review is to identify and assess prediction models and predictors for the early identification of traumatic hemorrhage patients requiring massive transfusion, surgery or embolization. METHODS: We searched electronic databases through to September 31st, 2016 for studies describing clinical, laboratory and imaging predictors available within the first hour of resuscitation for identifying patients requiring major intervention for hemorrhage within the first 24 hours...
December 14, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/29251706/valproic-acid-induces-pro-survival-transcriptomic-changes-in-swine-subjected-to-traumatic-injury-and-hemorrhagic-shock
#16
Patrick E Georgoff, Vahagn C Nikolian, Gerald Higgins, Kiril Chtraklin, Hassan Eidy, Mohamed H Ghandour, Aaron Williams, Brian Athey, Hasan B Alam
BACKGROUND: Valproic acid (VPA) is a histone deacetylase inhibitor that improves outcomes in large animal models of trauma. However, its protective mechanism of action is not completely understood. We sought to characterize the genetic changes induced by VPA treatment following traumatic injuries. METHODS: Six female Yorkshire swine were subjected to traumatic brain injury (TBI, controlled cortical impact), polytrauma (liver and splenic laceration, rib fracture, rectus crush), and hemorrhagic shock (HS, 40% total blood volume)...
December 14, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/29249614/extracorporeal-cardiopulmonary-resuscitation-for-refractory-out-of-hospital-cardiac-arrest-the-state-of-the-evidence-and-framework-for-application
#17
REVIEW
Brian Grunau, Laura Hornby, Rohit K Singal, Jim Christenson, Ivan Ortega-Deballon, Sam D Shemie, Jamil Bashir, Steve C Brooks, Clifton W Callaway, Elena Guadagno, Dave Nagpal
Out-of-hospital cardiac arrest (OHCA) affects 134 per 100,000 citizens annually. Extracorporeal cardiopulmonary resuscitation (ECPR), providing mechanical circulatory support, may improve the likelihood of survival among those with refractory OHCA. Compared with in-hospital ECPR candidates, those in the out-of-hospital setting tend to be sudden unexpected arrests in younger and healthier patients. The aims of this review were to summarize, and identify the limitations of, the evidence evaluating ECPR for OHCA, and to provide an approach for ECPR program application...
September 9, 2017: Canadian Journal of Cardiology
https://www.readbyqxmd.com/read/29247112/protocol-for-a-randomised-pilot-multiple-centre-trial-of-conservative-versus-liberal-oxygenation-targets-in-critically-ill-children-oxy-picu
#18
Gareth A L Jones, Padmanabhan Ramnarayan, Sainath Raman, David Inwald, Michael P W Grocott, Simon Eaton, Samiran Ray, Michael J Griksaitis, John Pappachan, Daisy Wiley, Paul R Mouncey, Jerome Wulff, David A Harrison, Kathryn M Rowan, Mark J Peters
INTRODUCTION: Optimal targets for systemic oxygenation in paediatric critical illness are unknown. Observational data indicate that high levels of arterial oxygenation are associated with poor outcomes in resuscitation of the newborn and in adult critical illness. Within paediatric intensive care units (PICUs), staff prevent severe hypoxia wherever possible, but beyond this there is no consensus. Practice varies widely with age, diagnosis, treating doctor and local or national guidelines followed, though peripheral blood oxygen saturations (SpO2) of >95% are often targeted...
December 14, 2017: BMJ Open
https://www.readbyqxmd.com/read/29241382/causes-of-mortality-in-icu-acquired-weakness
#19
Linda van Wagenberg, Esther Witteveen, Luuk Wieske, Janneke Horn
BACKGROUND: Intensive care unit-acquired weakness (ICU-AW) is a common complication of critical illness and is associated with increased mortality, longer mechanical ventilation and longer hospital stay. Little is known about the causes of mortality in patients with ICU-AW. In this study, we aimed to give an overview of the causes of death in a population diagnosed with ICU-AW during hospital admission. METHODS: Data from a prospective cohort study in the mixed medical-surgical ICU of the Academic Medical Center in Amsterdam were used...
January 1, 2017: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/29239577/mechanical-compression-devices-for-cardiac-arrest-report-of-three-cases
#20
Marjut Varpula, Piia Simonen, Jouni Nurmi, Jukka Lehtonen, Ilkka Tierala
Mechanical compression devices enable transportation of patients with cardiac arrest to the catheterization laboratory. Coronary angiography and coronary interventions can be performed while the patients are being resuscitated with these devices. In this report, we describe three cases in whom resuscitation with mechanical compression devices and rapid transportation to the catheterization laboratory resulted in favorable cardiac and neurological outcome.
2017: Duodecim; Lääketieteellinen Aikakauskirja
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