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Circulatory shock

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https://www.readbyqxmd.com/read/29465438/the-evolving-role-of-percutaneous-ventricular-assist-devices-in-high-risk-cardiac-patients
#1
Ilan A Marcuschamer, Aryeh Abelow, Ran Kornowski
The Impella is a mechanical circulatory support device that supports ventricular function. Since 2008, when the first Impella device received Food and Drug Administration clearance, its use has become increasingly prevalent. A variety of Impella devices are available, and are differentiated by size, power, and insertion techniques. These versions of the Impella have been used in a multitude of clinical scenarios, both emergent and elective, including high-risk coronary interventions, acute myocardial infarction complicated by cardiogenic shock, decompensated left and right heart failure, high-risk ventricular tachycardia ablations, and aortic valvuloplasty...
February 20, 2018: Coronary Artery Disease
https://www.readbyqxmd.com/read/29465166/full-percutaneous-biventricular-support-with-two-impella-pumps-the-bi-pella-approach
#2
Federico Pappalardo, Anna Mara Scandroglio, Azeem Latib
Extracorporeal membrane oxygenation is used for acute respiratory distress syndrome, refractory cardiogenic shock, and out-of-hospital cardiac arrest with uncertain neurological status, and, until recently, it was the only minimally invasive option to achieve biventricular support. However, extracorporeal membrane oxygenation increases left ventricular afterload and requires systemic anticoagulation, which is a major contraindication in the context of thrombolytic therapy following an ischaemic stroke. Conversely, the Impella heart pumps by design unload the ventricle and require minimal anticoagulation...
February 21, 2018: ESC Heart Failure
https://www.readbyqxmd.com/read/29460404/the-five-key-ingredients-for-improving-outcomes-in-cardiogenic-shock-complicating-acute-myocardial-infarction
#3
EDITORIAL
Emmanouil S Brilakis, Peter Eckman
Cardiogenic shock in the setting of acute myocardial infarction (AMICS) carries high mortality. A systematic, protocol-driven, approach to AMICS may improve outcomes. The 5 key "ingredients" for the managements of AMICS are: (a) early diagnosis; (b) hemodynamic assessment; (c) culprit-only coronary revascularization; (d) judicious use of mechanic circulatory support; (e) expert in-hospital treatment.
February 15, 2018: Catheterization and Cardiovascular Interventions
https://www.readbyqxmd.com/read/29453477/effects-of-bilateral-nasal-packing-on-oxygen-saturation-and-blood-pressure
#4
Meera Bista
INTRODUCTION: Nasal packing is one of the most common rhinological procedures in ENT practice exerting local in nose and systemic effects. Systemic effects may be due to poor sleep quality, respiratory difficulty, decreased oxygen saturation, circulatory problems and toxic shock syndrome which can threaten the life of a person.The study was done to investigate the effect on bilateral nasal packing on blood oxygen saturation and blood pressure changes. METHODS: A cross-sectional prospective study was undertaken in Kathmandu Medical College from January 2017 to June 2017...
October 2017: JNMA; Journal of the Nepal Medical Association
https://www.readbyqxmd.com/read/29444276/extracorporeal-resuscitation-as-a-further-modifier-of-clinical-outcome-in-patients-with-left-ventricular-assist-device-implantation-and-interagency-registry-for-mechanically-assisted-circulatory-support-level-1
#5
Edis Ljajikj, Armin Zittermann, Andreas Koster, Jochen Börgermann, Michael Schönbrodt, Kavous Hakim-Meibodi, Jan Gummert, Michiel Morshuis
In cardiogenic shock patients with Interagency Registry for Mechanical Circulatory Support (INTERMACS) level 1, the need for temporary circulatory support is a predictor and modifier of patient outcome. Because this group includes patients with and without cardiopulmonary resuscitation (CPR) and is thus very heterogeneous, we investigated whether a further subclassification is useful. We compared 30-day and 1-year mortality of patients who underwent left ventricular assist device implantation after extracorporeal CPR with the aid of an extracorporeal life support system (CPR+ group; n = 40) with cardiogenic shock patients in which the extracorporeal life support system was implanted under non-CPR conditions (CPR- group, n = 68)...
February 12, 2018: Interactive Cardiovascular and Thoracic Surgery
https://www.readbyqxmd.com/read/29404656/-hypovolemic-and-hemorrhagic-shock
#6
H Lier, M Bernhard, B Hossfeld
The term "shock" refers to a life-threatening circulatory failure caused by an imbalance between the supply and demand of cellular oxygen. Hypovolemic shock is characterized by a reduction of intravascular volume and a subsequent reduction in preload. The body compensates the loss of volume by increasing the stroke volume, heart frequency, oxygen extraction rate, and later by an increased concentration of 2,3-diphosphoglycerate with a rightward shift of the oxygen dissociation curve. Hypovolemic hemorrhagic shock impairs the macrocirculation and microcirculation and therefore affects many organ systems (e...
February 5, 2018: Der Anaesthesist
https://www.readbyqxmd.com/read/29400657/national-trends-predictors-of-use-and-in-hospital-outcomes-in-the-mechanical-circulatory-support-for-cardiogenic-shock
#7
Jordan B Strom, Yuansong Zhao, Changyu Shen, Mabel Chung, Duane S Pinto, Jeffrey J Popma, Robert W Yeh
AIMS: Despite rising rates of cardiogenic shock (CS), data on trends and in-hospital outcomes of shortterm non-durable mechanical circulatory support (MCS) are limited. METHODS AND RESULTS: Hospitalizations of US adults with a discharge diagnosis of CS, 1/1/2004- 12/31/2014, in the National Inpatient Sample, were included. Rates of MCS were stratified by device type and clinical presentation. Outcomes included in-hospital mortality, hospitalization costs, and number of procedures...
February 6, 2018: EuroIntervention
https://www.readbyqxmd.com/read/29391354/metformin-associated-lactic-acidosis-mimicking-ischaemic-bowel
#8
Sajjad Ali, Heloise Labuschagne, Nickolay Azarov, Zakaria Hindi, Lavi Oud
Metformin-associated lactic acidosis (MALA) is a rare complication among patients who are diabetic, commonly presenting with non-specific findings, and developing mostly among those with other risk factors for lactic acidosis. We report the development of MALA in a 67-year-old man with diabetes who presented with progressive abdominal pain and bloody diarrhoea. On presentation the patient was in shock, with signs suggestive of peritonitis, and with severe lactic acidosis, renal failure and non-specific findings on abdominal CT...
February 1, 2018: BMJ Case Reports
https://www.readbyqxmd.com/read/29390545/rare-upper-gastrointestinal-hemorrhage-of-cetuximab-a-case-report
#9
Shi-Jie Duan, Zi-Ming Gao, Peng-Liang Wang, Bao-Cheng Gong, Han-Wei Huang, Lei Luo, Xin Wang, Ya-Nan Xing, Hui-Mian Xu, Fu-Nan Liu
RATIONALE: cetuximab, an epidermal growth factor receptor inhibitor, is a targeted therapeutic regimen of colorectal cancers. Several common adverse effects have been found, such as cutaneous or gastrointestinal toxicity. However, according to the articles had been published, upper gastrointestinal bleeding (UGIB) is considered to be rare and its mechanism remains unclear. PATIENT CONCERNS: In this report, we presented a 42-year-old male patient with advanced recto-sigmoid cancer...
December 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/29390289/endovascular-stent-graft-repair-of-aortogastric-fistula-caused-by-peptic-ulcer-after-esophagectomy-a-case-report
#10
Xiao-Qing Wei, Lei Song, Xue-Song Zhang, Kui-Yang Wang, Jie Wu
RATIONALE: Aortogastric fistula (AGF) is a rare but devastating clinical complication after esophagectomy. In a recent report, nearly all AGF patients died of massive hemorrhage or aspiration of massive hematemesis. Therefore, timely appropriate treatment of AGF remains a challenge.Herein, we report a case of AGF that resulted from peptic ulceration after esophagectomy and was successfully treated with endovascular stent graft placement. PATIENT CONCERNS: A 59-year-old man had undergone video-assisted thoracoscopic esophagectomy for squamous cell carcinoma and esophageal reconstruction using a gastric tube 14 months previously...
December 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/29389838/too-little-too-late-hypotension-and-blood-transfusion-in-the-trauma-bay-are-independent-predictors-of-death-in-injured-children
#11
Christine M Leeper, Christine McKenna, Barbara A Gaines
BACKGROUND: Hypotension is a late finding in pediatric shock despite significant blood loss; consequently, recognition of hemodynamic compromise can be delayed. We sought to describe the impact of late stage shock in children, indicated by hypotension or trauma bay blood transfusion, and quantify the association with poor outcome. METHODS: Children age<18 from the Pennsylvania Trauma Outcome Study registry (2000-2013) were included. Primary outcome was mortality...
January 31, 2018: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/29384994/inotropic-therapy-for-sepsis
#12
Drew Taylor Louden, Lori Ellen Rutman
Sepsis, severe sepsis, and septic shock represent a dynamic clinical syndrome involving a systemic inflammatory response, circulatory changes, and end-organ dysfunction from an infection. Early aggressive management to restore perfusion and/or improve hypotension is critical to improving outcomes. Although the basic management principles of early goal-directed therapy for sepsis have not undergone significant changes, there has been a recent shift in recommendations related to the timing and type of inotropic support...
February 2018: Pediatric Emergency Care
https://www.readbyqxmd.com/read/29383510/epidemiology-causes-evolution-and-outcome-in-a-single-center-cohort-of-1116-critically-ill-patients-with-hypoxic-hepatitis
#13
Astrid Van den Broecke, Laura Van Coile, Alexander Decruyenaere, Kirsten Colpaert, Dominique Benoit, Hans Van Vlierberghe, Johan Decruyenaere
BACKGROUND: Hypoxic hepatitis (HH) is a type of acute hepatic injury that is histologically characterized by centrilobular liver cell necrosis and that is caused by insufficient oxygen delivery to the hepatocytes. Typical for HH is the sudden and significant increase of aspartate aminotransferase (AST) in response to cardiac, circulatory or respiratory failure. The aim of this study is to investigate its epidemiology, causes, evolution and outcome. METHODS: The screened population consisted of all adults admitted to the intensive care unit (ICU) at the Ghent University Hospital between January 1, 2007 and September 21, 2015...
January 30, 2018: Annals of Intensive Care
https://www.readbyqxmd.com/read/29373361/urgent-chemotherapy-in-sepsis-like-shock-related-to-hematologic-malignancies
#14
Marlène Cherruault, Marielle Le Goff, Jérôme Tamburini, Frédéric Pène
OBJECTIVES: Hematologic malignancies may result in multiple organ involvement including pulmonary and renal dysfunctions, and the less common acute circulatory failure. We herein addressed the outcome of patients with sepsis-like shock related to aggressive hematologic malignancies. DESIGN: A 10-year (2007-2016) monocenter retrospective study. SETTINGS: A medical ICU in a tertiary care center. PATIENTS: Patients with circulatory shock requiring vasopressors and who subsequently received chemotherapy...
January 25, 2018: Critical Care Medicine
https://www.readbyqxmd.com/read/29370923/the-role-of-mechanical-circulatory-support-during-percutaneous-coronary-intervention-in-patients-without-severely-depressed-left-ventricular-function
#15
Khaldoon Alaswad, Mir Babar Basir, Akshay Khandelwal, Theodore Schreiber, William Lombardi, William O'Neill
Currently, there are no data on the use of mechanical circulatory support (MCS) in patients without severely depressed left ventricular ejection fraction (LVEF) during high-risk percutaneous coronary intervention (PCI). We analyzed data from the global catheter-based ventricular assist device (cVAD) registry on the clinical use of MCS in high-risk PCI in patients without severely depressed LVEF, defined as LVEF > 35%. Patients without cardiogenic shock from the catheter-based ventricular assist device registry, who underwent elective or urgent PCI with an Impella 2...
December 25, 2017: American Journal of Cardiology
https://www.readbyqxmd.com/read/29364955/removal-of-stabilizers-from-human-serum-albumin-by-adsorbents-and-dialysis-used-in-blood-purification
#16
Stephan Harm, Claudia Schildböck, Jens Hartmann
INTRODUCTION: Human serum albumin (HSA) is a monomeric multi-domain protein that possesses an extraordinary binding capacity. It plays an important role in storing and transporting endogenous substances, metabolites, and drugs throughout the human circulatory system. Clinically, HSA is used to treat a variety of diseases such as hypovolemia, shock, burns, hemorrhage, and trauma in critically ill patients. Pharmaceutical-grade HSA contains the stabilizers sodium caprylate and N-acetyltryptophanate to protect the protein from oxidative stress and to stabilize it for heat treatment which is applied for virus inactivation...
2018: PloS One
https://www.readbyqxmd.com/read/29357499/effects-of-hypothermia-and-rewarming-on-cardiovascular-autonomic-control-in-vivo
#17
Erik Sveberg Dietrichs, Brage Håheim, Timofei Kondratiev, Erik Traasdahl, Torkjel Tveita
BACKGROUND: Rewarming from accidental hypothermia is associated with cardiovascular dysfunction that complicates rewarming and contributes to a high mortality rate. We investigated autonomic cardiovascular control, as well as the separate effects of cooling, hypothermia and rewarming on hemodynamic function, aiming to provide knowledge of the pathophysiology causing such complications in these patients. METHODS: A rat model designed for circulatory studies during cooling, hypothermia (15{degree sign}C) and rewarming was used...
December 21, 2017: Journal of Applied Physiology
https://www.readbyqxmd.com/read/29350305/percutaneous-mechanical-circulatory-support-devices-for-high-risk-percutaneous-coronary-intervention
#18
REVIEW
Subrata Kar
PURPOSE OF REVIEW: Percutaneous mechanical circulatory support devices (PMCSD) consist of the intra-aortic balloon pump (IABP), Impella (Abiomed Inc., Danvers, Massachusetts), Tandem Heart (Cardiac Assist, Inc., Pittsburgh, Pennsylvania), or extracorporeal membranous oxygenation (ECMO). They augment cardiac output, cardiac index, and cardiac power which allow the operator to mitigate hemodynamic perturbations during high-risk percutaneous coronary intervention (HR-PCI). This review discusses PMCSD and their contemporary literature...
January 19, 2018: Current Cardiology Reports
https://www.readbyqxmd.com/read/29349674/extracorporeal-life-support-in-cardiogenic-shock-indications-and-management-in-current-practice
#19
REVIEW
C L Meuwese, F Z Ramjankhan, S A Braithwaite, N de Jonge, M de Jong, M P Buijsrogge, J G D Janssen, C Klöpping, J H Kirkels, D W Donker
Veno-arterial extracorporeal life support (VA-ECLS) provides circulatory and respiratory stabilisation in patients with severe refractory cardiogenic shock. Although randomised controlled trials are lacking, the use of VA-ECLS is increasing and observational studies repeatedly have shown treatment benefits in well-selected patients. Current clinical challenges in VA-ECLS relate to optimal management of the individual patient on extracorporeal support given its inherent complexity. In this review article we will discuss indications, daily clinical management and complications of VA-ECLS in cardiogenic shock refractory to conventional treatment strategies...
January 18, 2018: Netherlands Heart Journal
https://www.readbyqxmd.com/read/29345584/mechanical-support-in-cardiogenic-shock-complicating-acute-coronary-syndrome-ready-for-prime-time
#20
Guillaume Schurtz, Marc Laine, Clement Delmas, Francois Kerbaul, Etienne Puymirat, Gilles Lemesle, Laurent Bonello
Cardiogenic shock (CS) is a major challenge in current cardiology. Over the last decade, cardiogenic shock mortality has decreased somewhat, but it still remains high, particularly when associated with ischaemic heart disease. The challenges are numerous and include prevention, accurate diagnosis, prompt management and effective therapies to support a failing heart and prevent multi-organ failure. Despite improvements in the care of acute coronary syndrome (ACS), it remains the most common cause of CS. In addition to existing medical therapy, mechanical circulatory support has been proposed for the management of ventricular failure...
January 16, 2018: Current Vascular Pharmacology
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