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https://www.readbyqxmd.com/read/30072710/intravenous-fluid-therapy-in-critically-ill-adults
#1
REVIEW
Simon Finfer, John Myburgh, Rinaldo Bellomo
Intravenous fluid therapy is one of the most common interventions in acutely ill patients. Each day, over 20% of patients in intensive care units (ICUs) receive intravenous fluid resuscitation, and more than 30% receive fluid resuscitation during their first day in the ICU. Virtually all hospitalized patients receive intravenous fluid to maintain hydration and as diluents for drug administration. Until recently, the amount and type of fluids administered were based on a theory described over 100 years ago, much of which is inconsistent with current physiological data and emerging knowledge...
September 2018: Nature Reviews. Nephrology
https://www.readbyqxmd.com/read/29968985/guideline-for-antibiotic-use-in-adults-with-community-acquired-pneumonia
#2
REVIEW
Mi Suk Lee, Jee Youn Oh, Cheol In Kang, Eu Suk Kim, Sunghoon Park, Chin Kook Rhee, Ji Ye Jung, Kyung Wook Jo, Eun Young Heo, Dong Ah Park, Gee Young Suh, Sungmin Kiem
Community-acquired pneumonia is common and important infectious disease in adults. This work represents an update to 2009 treatment guideline for community-acquired pneumonia in Korea. The present clinical practice guideline provides revised recommendations on the appropriate diagnosis, treatment, and prevention of community-acquired pneumonia in adults aged 19 years or older, taking into account the current situation regarding community-acquired pneumonia in Korea. This guideline may help reduce the difference in the level of treatment between medical institutions and medical staff, and enable efficient treatment...
June 2018: Infection & Chemotherapy
https://www.readbyqxmd.com/read/29887195/misconceptions-in-acute-heart-failure-diagnosis-and-management-in-the-emergency-department
#3
REVIEW
Brit Long, Alex Koyfman, Eric J Chin
INTRODUCTION: Acute heart failure (AHF) accounts for a significant number of emergency department (ED) visits, and the disease may present along a spectrum with a variety of syndromes. OBJECTIVE: This review evaluates several misconceptions concerning heart failure evaluation and management in the ED, followed by several pearls. DISCUSSION: AHF is a heterogeneous syndrome with a variety of presentations. Physicians often rely on natriuretic peptides, but the evidence behind their use is controversial, and these should not be used in isolation...
September 2018: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29880020/antiepileptic-drugs-in-critically-ill-patients
#4
REVIEW
Salia Farrokh, Pouya Tahsili-Fahadan, Eva K Ritzl, John J Lewin, Marek A Mirski
BACKGROUND: The incidence of seizures in intensive care units ranges from 3.3% to 34%. It is therefore often necessary to initiate or continue anticonvulsant drugs in this setting. When a new anticonvulsant is initiated, drug factors, such as onset of action and side effects, and patient factors, such as age, renal, and hepatic function, should be taken into account. It is important to note that the altered physiology of critically ill patients as well as pharmacological and nonpharmacological interventions such as renal replacement therapy, extracorporeal membrane oxygenation, and target temperature management may lead to therapeutic failure or toxicity...
June 7, 2018: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29850422/endovascular-management-of-acute-aortic-dissection
#5
REVIEW
Mamdouh Khayat, Kyle J Cooper, Minhaj S Khaja, Ripal Gandhi, Yolanda C Bryce, David M Williams
Acute dissection of the thoracic aorta is a potentially life-threatening condition which requires collaborative treatment from multiple specialties for optimal patient outcomes. Dissections involving the ascending aorta and aortic arch have traditionally been managed entirely by surgery, while dissections beyond the arch vessels have most commonly been relegated to medical management. This algorithm has been undergoing a paradigm shift over the past two decades due to improvements in stent graft technology, better understanding of the hemodynamic interactions of the true and false lumen and their influence on organ and limb perfusion, and improvements in medical management and long term surveillance for dissection-related complications...
April 2018: Cardiovascular Diagnosis and Therapy
https://www.readbyqxmd.com/read/29730088/aspiration-pneumonia-and-related-syndromes
#6
REVIEW
Augustine S Lee, Jay H Ryu
Aspiration is a syndrome with variable respiratory manifestations that span acute, life-threatening illnesses, such as acute respiratory distress syndrome, to chronic, sometimes insidious, respiratory disorders such as aspiration bronchiolitis. Diagnostic testing is limited by the insensitivity of histologic testing, and although gastric biomarkers for aspiration are increasingly available, none have been clinically validated. The leading mechanism for microaspiration is thought to be gastroesophageal reflux disease, largely driven by the increased prevalence of gastroesophageal reflux across a variety of respiratory disorders, including chronic obstructive pulmonary disease, asthma, idiopathic pulmonary fibrosis, and chronic cough...
June 2018: Mayo Clinic Proceedings
https://www.readbyqxmd.com/read/29789983/principles-of-fluid-management-and-stewardship-in-septic-shock-it-is-time-to-consider-the-four-d-s-and-the-four-phases-of-fluid-therapy
#7
REVIEW
Manu L N G Malbrain, Niels Van Regenmortel, Bernd Saugel, Brecht De Tavernier, Pieter-Jan Van Gaal, Olivier Joannes-Boyau, Jean-Louis Teboul, Todd W Rice, Monty Mythen, Xavier Monnet
In patients with septic shock, the administration of fluids during initial hemodynamic resuscitation remains a major therapeutic challenge. We are faced with many open questions regarding the type, dose and timing of intravenous fluid administration. There are only four major indications for intravenous fluid administration: aside from resuscitation, intravenous fluids have many other uses including maintenance and replacement of total body water and electrolytes, as carriers for medications and for parenteral nutrition...
May 22, 2018: Annals of Intensive Care
https://www.readbyqxmd.com/read/29767636/the-surviving-sepsis-campaign-bundle-2018-update
#8
Mitchell M Levy, Laura E Evans, Andrew Rhodes
No abstract text is available yet for this article.
June 2018: Critical Care Medicine
https://www.readbyqxmd.com/read/29675566/the-surviving-sepsis-campaign-bundle-2018-update
#9
EDITORIAL
Mitchell M Levy, Laura E Evans, Andrew Rhodes
No abstract text is available yet for this article.
June 2018: Intensive Care Medicine
https://www.readbyqxmd.com/read/29704160/there-is-more-to-septic-shock-than-arterial-hypotension-and-elevated-lactate-levels-another-appeal-to-rethink-current-resuscitation-strategies
#10
REVIEW
Martin W Dünser, Arnaldo Dubin
No abstract text is available yet for this article.
April 27, 2018: Annals of Intensive Care
https://www.readbyqxmd.com/read/29443814/danger-signals-in-the-icu
#11
Edward J Schenck, Kevin C Ma, Santosh B Murthy, Augustine M K Choi
OBJECTIVES: Sterile and infectious critical illnesses often result in vasoplegic shock and a robust systemic inflammatory response that are similar in presentation. The innate immune system is at the center of the response to both infectious and traumatic insults. Damage-associated molecular patterns are small molecules that are released from stressed or dying cells. Damage-associated molecular patterns activate pattern recognition receptors and coordinate the leading edge of the innate immune response...
May 2018: Critical Care Medicine
https://www.readbyqxmd.com/read/29347874/adjunctive-glucocorticoid-therapy-in-patients-with-septic-shock
#12
RANDOMIZED CONTROLLED TRIAL
Balasubramanian Venkatesh, Simon Finfer, Jeremy Cohen, Dorrilyn Rajbhandari, Yaseen Arabi, Rinaldo Bellomo, Laurent Billot, Maryam Correa, Parisa Glass, Meg Harward, Christopher Joyce, Qiang Li, Colin McArthur, Anders Perner, Andrew Rhodes, Kelly Thompson, Steve Webb, John Myburgh
BACKGROUND: Whether hydrocortisone reduces mortality among patients with septic shock is unclear. METHODS: We randomly assigned patients with septic shock who were undergoing mechanical ventilation to receive hydrocortisone (at a dose of 200 mg per day) or placebo for 7 days or until death or discharge from the intensive care unit (ICU), whichever came first. The primary outcome was death from any cause at 90 days. RESULTS: From March 2013 through April 2017, a total of 3800 patients underwent randomization...
March 1, 2018: New England Journal of Medicine
https://www.readbyqxmd.com/read/29406201/proton-pump-inhibitors-review-of-emerging-concerns
#13
REVIEW
Avinash K Nehra, Jeffrey A Alexander, Conor G Loftus, Vandana Nehra
First introduced in 1989, proton pump inhibitors (PPIs) are among the most widely utilized medications worldwide, both in the ambulatory and inpatient clinical settings. The PPIs are currently approved by the US Food and Drug Administration for the management of a variety of gastrointestinal disorders including symptomatic peptic ulcer disease, gastroesophageal reflux disease, and nonulcer dyspepsia as well as for prevention of gastrointestinal bleeding in patients receiving antiplatelet therapy. PPIs inhibit gastric acid secretion, and the most commonly associated adverse effects include abdominal pain, diarrhea, and headache...
February 2018: Mayo Clinic Proceedings
https://www.readbyqxmd.com/read/29427013/assessment-of-fluid-responsiveness-in-spontaneously-breathing-patients-a-systematic-review-of-literature
#14
REVIEW
Renato Carneiro de Freitas Chaves, Thiago Domingos Corrêa, Ary Serpa Neto, Bruno de Arruda Bravim, Ricardo Luiz Cordioli, Fabio Tanzillo Moreira, Karina Tavares Timenetsky, Murillo Santucci Cesar de Assunção
Patients who increase stoke volume or cardiac index more than 10 or 15% after a fluid challenge are usually considered fluid responders. Assessment of fluid responsiveness prior to volume expansion is critical to avoid fluid overload, which has been associated with poor outcomes. Maneuvers to assess fluid responsiveness are well established in mechanically ventilated patients; however, few studies evaluated maneuvers to predict fluid responsiveness in spontaneously breathing patients. Our objective was to perform a systematic review of literature addressing the available methods to assess fluid responsiveness in spontaneously breathing patients...
February 9, 2018: Annals of Intensive Care
https://www.readbyqxmd.com/read/29329694/management-of-refractory-vasodilatory-shock
#15
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 the initial management of shock include fluid resuscitation and initiation of norepinephrine...
August 2018: Chest
https://www.readbyqxmd.com/read/29376560/inotropic-agents-and-vasodilator-strategies-for-the-treatment-of-cardiogenic-shock-or-low-cardiac-output-syndrome
#16
REVIEW
Julia Schumann, Eva C Henrich, Hellen Strobl, Roland Prondzinsky, Sophie Weiche, Holger Thiele, Karl Werdan, Stefan Frantz, Susanne Unverzagt
BACKGROUND: Cardiogenic shock (CS) and low cardiac output syndrome (LCOS) as complications of acute myocardial infarction (AMI), heart failure (HF) or cardiac surgery are life-threatening conditions. While there is a broad body of evidence for the treatment of people with acute coronary syndrome under stable haemodynamic conditions, the treatment strategies for people who become haemodynamically unstable or develop CS remain less clear. We have therefore summarised here the evidence on the treatment of people with CS or LCOS with different inotropic agents and vasodilative drugs...
January 29, 2018: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/29406187/choice-of-fluid-type-physiological-concepts-and-perioperative-indications
#17
REVIEW
C Boer, S M Bossers, N J Koning
The consensus that i.v. resuscitation fluids should be considered as drugs with specific dose recommendations, contraindications, and side-effects has led to an increased attention for the choice of fluid during perioperative care. In particular, the debate concerning possible adverse effects of unbalanced fluids and hydroxyethyl starches resulted in a re-evaluation of the roles of different fluid types in the perioperative setting. This review provides a concise overview of the current knowledge regarding the efficacy and safety of distinct fluid types for perioperative use...
February 2018: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/29203195/2017-acc-expert-consensus-decision-pathway-on-management-of-bleeding-in-patients-on-oral-anticoagulants-a-report-of-the-american-college-of-cardiology-task-force-on-expert-consensus-decision-pathways
#18
Gordon F Tomaselli, Kenneth W Mahaffey, Adam Cuker, Paul P Dobesh, John U Doherty, John W Eikelboom, Roberta Florido, William Hucker, Roxana Mehran, Steven R Messé, Charles V Pollack, Fatima Rodriguez, Ravindra Sarode, Deborah Siegal, Barbara S Wiggins
No abstract text is available yet for this article.
December 19, 2017: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/29201914/acute-right-ventricular-dysfunction-in-intensive-care-unit
#19
REVIEW
Juan C Grignola, Enric Domingo
The role of the left ventricle in ICU patients with circulatory shock has long been considered. However, acute right ventricle (RV) dysfunction causes and aggravates many common critical diseases (acute respiratory distress syndrome, pulmonary embolism, acute myocardial infarction, and postoperative cardiac surgery). Several supportive therapies, including mechanical ventilation and fluid management, can make RV dysfunction worse, potentially exacerbating shock. We briefly review the epidemiology, pathophysiology, diagnosis, and recommendations to guide management of acute RV dysfunction in ICU patients...
2017: BioMed Research International
https://www.readbyqxmd.com/read/28073314/safety-of-the-peripheral-administration-of-vasopressor-agents
#20
Tyler Lewis, Cristian Merchan, Diana Altshuler, John Papadopoulos
Vasopressors are an integral component of the management of septic shock and are traditionally given via a central venous catheter (CVC) due to the risk of tissue injury and necrosis if extravasated. However, the need for a CVC for the management of septic shock has been questioned, and the risk of extravasation and incidence of severe injury when vasopressors are given via a peripheral venous line (PVL) remains poorly defined. We performed a retrospective chart review of 202 patients who received vasopressors through a PVL...
January 1, 2017: Journal of Intensive Care Medicine
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