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Cardiovascular intensive care

Kanchi Muralidhar, Deepak Tempe, Yatin Mehta, Poonam Malhotra Kapoor, Chirojit Mukherjee, Thomas Koshy, Prabhat Tewari, Naman Shastri, Satyajeet Misra, Kumar Belani
During current medical care, perioperative transesophageal echocardiography (TEE) has become a vital component of patient management, especially in cardiac operating rooms and in critical care medicine. Information derived from echocardiography has an important bearing on the patient's outcome. The Indian Association of Cardiovascular and Thoracic Anaesthesiologists (IACTA) has promoted the use of TEE during routine clinical care of patients undergoing cardiac surgery. An important mission of IACTA is to oversee training and certify anesthesiologists in the perioperative and intensive care use of TEE...
October 2016: Annals of Cardiac Anaesthesia
Priyamvada Gupta, Durga Jethava, Ruchika Choudhary, Dharam Das Jethava
BACKGROUND AND AIMS: Laryngoscopy and endotracheal intubation are considered as potent stimuli which lead to an increase in heart rate and blood pressure. Melatonin (N-acetyl-5-methoxytryptamine) has been studied for pre-operative anxiolysis and sedation in Intensive Care Unit. We made a hypothesis that melatonin can provide haemodynamic stability during laryngoscopy and intubation when given 120 min before the procedure. METHODS: Sixty American Society of Anesthesiologists physical status Grade I and II patients of either gender, 20-45 years old, 40-65 kg body weight, scheduled to undergo elective surgical procedures under general anaesthesia were assigned into two equal groups - Group C (control) and Group M (melatonin)...
October 2016: Indian Journal of Anaesthesia
Flavia Petrini, Ida Di Giacinto, Rita Cataldo, Clelia Esposito, Vittorio Pavoni, Paolo Donato, Antonella Trolio, Guido Merli, Massimiliano Sorbello, Paolo Pelosi
Proper management of obese patients requires a team vision and appropriate behaviors by all health care providers in hospital. Specialist competencies are fundamental, as are specific clinical pathways and good clinical practices designed to deal with patients whose body mass index is ≥30 kg/m2. Standards of care for bariatric and non-bariatric surgery and for the critical care management of this population exist but are not well defined nor clearly followed in every hospital. Thus every anesthesiologist is likely to deal with this challenging population...
October 19, 2016: Minerva Anestesiologica
Nan Liu, Wei Zhang, Weiguo Ma, Wei Shang, Jun Zheng, Lizhong Sun
OBJECTIVES: To identify the risk factors for hypoxaemia following surgical repair of acute type A aortic dissection. METHODS: This was a retrospective study of patients treated between October 2013 and December 2014 at the Department of Cardiovascular Surgery, Anzhen Hospital, China. Univariable and multivariable analyses were performed on the clinical data of 160 patients with acute type A dissection and who underwent ascending aortic and arch replacement under deep hypothermic circulatory arrest...
October 17, 2016: Interactive Cardiovascular and Thoracic Surgery
Yarelis Alvarado Reyes, Alexandra Perez, Gloria Rodriguez-Vega
OBJECTIVE: Vitamin D deficiency has been associated with increased risk and adverse outcomes in many clinical settings including cardiovascular disease, stroke, and critically ill patients. Therefore we aimed to determine whether vitamin D deficiency had any effect in aneurysmal subarachnoid hemorrhage (aSAH) clinical outcomes. METHODS: A retrospective record review was conducted in a tertiary community hospital in Puerto Rico. Adult patients admitted to the neurosurgical intensive care unit (NICU) with a diagnosis of aSAH from January 2013 to July 2014, who had a 25-hydroxyvitamin-D level drawn, were included...
October 15, 2016: World Neurosurgery
Jongha Park
Cardiovascular (CV) risk assessment is not easy in chronic kidney disease (CKD) patients. Age, male sex, race, family history of CV disease, smoking status and diabetes should be considered as CV risk factors as the general population. It is also accepted that hypertension (HTN) is associated with the greater risk of CV complications in this population. However, there are some concerns in this issue.First, supporting evidence for specific blood pressure (BP) targets in CKD is scarce. Many observational studies reported a J-shaped association between BP level and CV mortality unlike a linear association in the general population...
September 2016: Journal of Hypertension
Rae Woong Park
Big data indicates the large and ever-increasing volumes of data adhere to the following 4Vs: volume (ever-increasing amount), velocity (quickly generated), variety (many different types), veracity (from trustable sources). The last decade has seen huge advances in the amount of data we routinely generate and collect in pretty much everything we do, as well as our ability to use technology to analyze and understand it. The routine operation of modern health care systems also produces an abundance of electronically stored data on an ongoing basis as a byproduct of clinical practice...
September 2016: Journal of Hypertension
Suzanne Oparil
Heart disease, stroke, and kidney failure are leading causes of death worldwide, and hypertension is a significant risk factor for each. Hypertension is less common in women, compared to men, in those younger than 45 years of age. This trend is reversed in those 65 years and older. In the US between 2011-2014, the prevalence of hypertension in women and men by age group was 6% vs 8% (18-39 years), 30% vs 35% (40-59 years), and 67% vs 63% (60 years and over). Awareness, treatment, and control rates differ between genders with women being more aware of their diagnosis (85% vs 80%), more likely to take their medications (81% vs 71%) and more frequently having controlled hypertension (55% vs 49%)...
September 2016: Journal of Hypertension
Kwang-Il Kim
With the life-expectancy increased, the older population expected to grow all around the world. Especially, the increase of elderly population leads to increase of vulnerable or frail elderly people, who require special consideration in caring and managing chronic medical condition. Considering the substantial diversity in the prevalence of chronic medical conditions and functional impairment, elderly people are often highly heterogeneous and their physiological ability and vulnerability vary widely even in same chronological age...
September 2016: Journal of Hypertension
James Sharman
Millions of clinical exercise stress tests are conducted annually worldwide. The fundamental rationale underlying the conduct of these tests is that cardiovascular irregularities may be revealed during an exercise bout that would otherwise remain unnoticed if testing was only conducted under resting conditions. In order to reveal electrocardiographic abnormalities indicative of cardiac disease, maximal intensity exercise may need to be undertaken, whereas the presence of hypertension can be revealed by the blood pressure response at low to moderate intensity exercise...
September 2016: Journal of Hypertension
Ernesto Schiffrin
Clinical practice guidelines, which are systematically developed statements aimed at helping people make clinical, policy-related and system-related decisions, frequently vary widely in quality. A strategy is needed to differentiate among guidelines and ensure that those of the highest quality are implemented. Hypertension Canada provides annually updated standardized recommendations and clinical practice guidelines to detect, treat and control hypertension. The annual, evidence-based recommendations are developed through intense discussion of the clinical implications via a systematic review of the literature followed by critical appraisals of all the new clinical research, taking into account the assessment criteria in the Appraisal of Guidelines for Research & Evaluation (AGREE) II instrument that evaluates the process of practice guideline development and the quality of reporting...
September 2016: Journal of Hypertension
Tetsurou Satoh, Osamu Isozaki, Atsushi Suzuki, Shu Wakino, Tadao Iburi, Kumiko Tsuboi, Naotetsu Kanamoto, Hajime Otani, Yasushi Furukawa, Satoshi Teramukai, Takashi Akamizu
Thyroid storm is an endocrine emergency which is characterized by multiple organ failure due to severe thyrotoxicosis, often associated with triggering illnesses. Early suspicion, prompt diagnosis and intensive treatment will improve survival in thyroid storm patients. Because of its rarity and high mortality, prospective intervention studies for the treatment of thyroid storm are difficult to carry out. We, the Japan Thyroid Association and Japan Endocrine Society taskforce committee, previously developed new diagnostic criteria and conducted nationwide surveys for thyroid storm in Japan...
October 15, 2016: Endocrine Journal
Agnieszka Ciarka, Lars H Lund, Johan Van Cleemput, Gabor Voros, Walter Droogne, Johan Vanhaecke
Heart transplantation (HT) recipients may have tachycardia secondary to cardiac denervation. As higher heart rate predicts worse outcomes in cardiovascular disease, we hypothesized that tachycardia and nonuse of β blockers are associated with increased mortality after HT. All patients who underwent HT at our institution from 1987 to 2010 were included. The association of heart rate 3 months after HT and β-blocker use during follow-up to mortality was assessed using Kaplan-Meier and multivariate Cox proportional hazards regression analyses adjusting for clinically relevant baseline variables...
September 15, 2016: American Journal of Cardiology
Nikolai Blanik, Konrad Heimann, Carina Pereira, Michael Paul, Vladimir Blazek, Boudewijn Venema, Thorsten Orlikowsky, Steffen Leonhardt
Vital parameter monitoring of term and preterm infants during incubator care with self-adhesive electrodes or sensors directly positioned on the skin [e.g. photoplethysmography (PPG) for oxygen saturation or electrocardiography (ECG)] is an essential part of daily routine care in neonatal intensive care units. For various reasons, this kind of monitoring contains a lot of stress for the infants. Therefore, there is a need to measure vital parameters (for instance respiration, temperature, pulse, oxygen saturation) without mechanical or conductive contact...
October 15, 2016: Biomedizinische Technik. Biomedical Engineering
Hui Wang, Yihua Bei, Peipei Huang, Qiulian Zhou, Jing Shi, Qi Sun, Jiuchang Zhong, Xinli Li, Xiangqing Kong, Junjie Xiao
Sepsis-induced myocardial dysfunction represents a major cause of death in intensive care units. Dysregulated microRNAs (miR)-155 has been implicated in multiple cardiovascular diseases and miR-155 can be induced by lipopolysaccharide (LPS). However, the role of miR-155 in LPS-induced cardiac dysfunction is unclear. Septic cardiac dysfunction in mice was induced by intraperitoneal injection of LPS (5 mg/kg) and miR-155 was found to be significantly increased in heart challenged with LPS. Pharmacological inhibition of miR-155 using antagomiR improved cardiac function and suppressed cardiac apoptosis induced by LPS in mice as determined by echocardiography, terminal deoxynucleotidyl transferase nick-end labeling (TUNEL) assay, and Western blot for Bax and Bcl-2, while overexpression of miR-155 using agomiR had inverse effects...
October 11, 2016: Molecular Therapy. Nucleic Acids
Samuel M Brown, Jeffrey Sorensen, Michael J Lanspa, Matthew T Rondina, Colin K Grissom, Sajid Shahul, V J Mathews
BACKGROUND: Septic shock is a common and often devastating syndrome marked by severe cardiovascular dysfunction commonly managed with vasopressors. Whether markers of heart rate complexity before vasopressor up-titration could be used to predict success of the up-titration is not known. METHODS: We studied patients with septic shock requiring vasopressor, newly admitted to the intensive care unit. We measured the complexity of heart rate variability (using the ratio of fractal exponents from detrended fluctuation analysis) in the 5 min before all vasopressor up-titrations in the first 24 h of an intensive care unit (ICU) admission...
October 10, 2016: BMC Infectious Diseases
Dominika Batycka-Stachnik, Agnieszka Piwoda, Tomasz Darocha, Malgorzata Spiewak, Sylweriusz Kosinski, Anna Jarosz, Hubert Hymczak, Tomasz Sanak, Robert Galazkowski, Jacek Piatek, Janusz Konstanty-Kalandyk, Rafal Drwila
: The objectives: To show and discuss the most frequent functional problems encountered in patients who underwent extracorporeal membrane oxygenation (ECMO) treatment after severe hypothermia and point out appropriate physiotherapy procedures used in order to diminish the effects of hypothermia on the human organism. It is necessary to look for effective physiotherapeutic solutions, especially that the number of scientific publications on the subject is very limited. DESIGN: Retrospective analysis Setting: Severe Accidental Hypothermia Center ( medical intensive care unit of a university hospital) Patients or participants: Nineteen patients who were qualified for ECMO in Severe Accidental Hypothermia Center Intervention: At least three times a day rehabilitation session (physiotherapeutic procedures adequate to patient problems) and interventions in case of emergency...
2016: Wiadomości Lekarskie: Organ Polskiego Towarzystwa Lekarskiego
Milo Engoren, Michael D Maile, Michael Heung, Elizabeth S Jewell, Christie Vahabzadeh, Jonathan W Haft, Sachin Kheterpal
BACKGROUND: Acute kidney injury can be defined by a fall in urine output, and urine output criteria may be more sensitive in identifying acute kidney injury than traditional serum creatinine criteria. However, as pointed out in the Kidney Disease Improving Global Outcome guidelines, the association of urine output with subsequent creatinine elevations and death is poorly characterized. The purpose of this study was to determine what degrees of reduced urine output are associated with subsequent creatinine elevation and death...
October 4, 2016: Annals of Thoracic Surgery
Mindl M Messinger, Kimberly L Dinh, Erin J McDade, Brady S Moffett, Angus A Wilfong, Antonio G Cabrera
BACKGROUND: Advances in cardiac operations over the last few decades, including corrective operations in early life, have dramatically increased the survival of children with congenital heart disease. However, postoperative care has been associated with neurologic complications, with seizures being the most common manifestation. The primary objective of this study is to describe the outcomes in pediatric patients who received an antiepileptic drug (AED) post-cardiac surgery. METHOD: A retrospective cohort study was performed in all patients less than 18 years of age who received an AED in the cardiovascular intensive care unit at Texas Children's Hospital from June 2002 until June 2012...
July 2016: Journal of Pediatric Pharmacology and Therapeutics: JPPT: the Official Journal of PPAG
Paul A Checchia
The growth of Pediatric Cardiovascular Intensive Care as a subspecialty has been incredible. Outcomes have improved, care delivery has matured, and research has made advances. Within this review, we take the opportunity to examine the subspecialty's past accomplishments with pride, take stock in its current state, and look forward with excitement to its future. While outcomes in general have improved dramatically, we must always be aware of the outcomes that matter to families and patients. Additionally, we must constantly ask ourselves to improve...
July 2016: Translational pediatrics
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