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Critical care

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By Varun Shetty A Med-Peds resident
https://www.readbyqxmd.com/read/30171861/the-septic-heart-current-understanding-of-molecular-mechanisms-and-clinical-implications
#1
REVIEW
Lukas Martin, Matthias Derwall, Sura Al Zoubi, Elisabeth Zechendorf, Daniel A Reuter, Chris Thiemermann, Tobias Schuerholz
Septic cardiomyopathy is a key feature of sepsis-associated cardiovascular failure. Despite the lack of consistent diagnostic criteria, patients typically exhibit ventricular dilatation, reduced ventricular contractility and/or both right and left ventricular dysfunction with a reduced response to volume infusion. Although there is solid evidence that the presence of septic cardiomyopathy is a relevant contributor to organ dysfunction and an important factor in the already-complicated therapeutic management of septic patients, there are still several questions to be asked: Which factors/mechanisms cause a cardiac dysfunction associated with sepsis? How do we diagnose septic cardiomyopathy? How do we treat septic cardiomyopathy? How does septic cardiomyopathy influence the long-term outcome of the patient? Each of these questions is interrelated, and the answers require a profound understanding of the underlying pathophysiology that involves a complex mix of systemic factors and molecular, metabolic, and structural changes of the cardiomyocyte...
August 29, 2018: Chest
https://www.readbyqxmd.com/read/30137444/management-of-antithrombotic-therapy-in-af-patients-presenting-with-acs-and-or-undergoing-pci-a-summary-of-the-joint-consensus-document-of-the-european-heart-rhythm-association-ehra-european-society-of-cardiology-working-group-on-thrombosis-european-association
#2
https://www.readbyqxmd.com/read/30111343/airway-and-ventilation-management-during-cardiopulmonary-resuscitation-and-after-successful-resuscitation
#3
REVIEW
Christopher Newell, Scott Grier, Jasmeet Soar
After cardiac arrest a combination of basic and advanced airway and ventilation techniques are used during cardiopulmonary resuscitation (CPR) and after a return of spontaneous circulation (ROSC). The optimal combination of airway techniques, oxygenation and ventilation is uncertain. Current guidelines are based predominantly on evidence from observational studies and expert consensus; recent and ongoing randomised controlled trials should provide further information. This narrative review describes the current evidence, including the relative roles of basic and advanced (supraglottic airways and tracheal intubation) airways, oxygenation and ventilation targets during CPR and after ROSC in adults...
August 15, 2018: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/30094030/preliminary-guideline-and-pathophysiology-based-protocols-for-neurocritical-care
#4
REVIEW
Yasuhiro Norisue, Yoshihisa Fujimoto, Kazuma Nakagawa
Background: Because of the complex pathophysiological processes involved, neurocritical care has been driven by anecdotal experience and physician preferences, which has led to care variation worldwide. Standardization of practice has improved outcomes for many of the critical conditions encountered in the intensive care unit. Main body: In this review article, we introduce preliminary guideline- and pathophysiology-based protocols for (1) prompt shivering management, (2) traumatic brain injury and intracranial pressure management, (3) neurological prognostication after cardiac arrest, (4) delayed cerebral ischemia after subarachnoid hemorrhage, (5) nonconvulsive status epilepticus, and (6) acute or subacute psychosis and seizure...
2018: Journal of Intensive Care
https://www.readbyqxmd.com/read/30165426/incidence-of-acute-kidney-injury-among-critically-ill-patients-with-brief-empiric-use-of-anti-pseudomonal-beta-lactams-with-vancomycin
#5
Diana J Schreier, Kianoush B Kashani, Ankit Sakhuja, Kristin C Mara, Mohammad S Tootooni, Heather A Personett, Sarah Nelson, Andrew D Rule, James M Steckelberg, Aaron J Tande, Erin F Barreto
Background: Nephrotoxins contribute to 20-40% of acute kidney injury (AKI) cases in the intensive care unit (ICU). The combination of piperacillin/tazobactam and vancomycin (PTZ/VAN) has been identified as nephrotoxic, but existing studies focus on extended durations of therapy rather than the brief empiric courses often used in the ICU. Objective: Compare the risk of AKI with a short course of PTZ/VAN to other anti-pseudomonal beta-lactam/vancomycin combinations...
August 24, 2018: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
https://www.readbyqxmd.com/read/30165710/neurotrauma-and-critical-care-of-the-brain
#6
Rob Forsyth
No abstract text is available yet for this article.
August 30, 2018: Neuropediatrics
https://www.readbyqxmd.com/read/30122506/predicting-fluid-responsiveness-a-review-of-literature-and-a-guide-for-the-clinician
#7
REVIEW
Bilal A Jalil, Rodrigo Cavallazzi
Volume resuscitation is of utmost importance in the treatment of shock. It is imperative that this resuscitation be guided using a reliable method of ascertaining volume status to avoid the ill-effects of hypovolemia while also avoiding those of over-resuscitation. There are numerous tools and methods available in this era to aid the bedside physician in guiding volume resuscitation, many of which will be described in this review of literature. The methods to assess preload responsiveness are broadly divided into static and dynamic measurements...
August 14, 2018: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/30138176/update-on-perioperative-acute-kidney-injury
#8
Alexander Zarbock, Jay L Koyner, Eric A J Hoste, John A Kellum
Acute kidney injury (AKI) in the perioperative period is a common complication and is associated with increased morbidity and mortality. A standard definition and staging system for AKI has been developed, incorporating a reduction of the urine output and/or an increase of serum creatinine. Novel biomarkers may detect kidney damage in the absence of a change in function and can also predict the development of AKI. Several specific considerations for AKI risk are important in surgical patients. The surgery, especially major and emergency procedures in critically ill patients, may cause AKI...
August 22, 2018: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/30072710/intravenous-fluid-therapy-in-critically-ill-adults
#9
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/30129466/re-expansion-pulmonary-oedema
#10
Alice Petiot, Sammy Tawk, BenoƮt Ghaye
No abstract text is available yet for this article.
August 11, 2018: Lancet
https://www.readbyqxmd.com/read/29501369/acute-pancreatitis-guideline
#11
Seth Crockett, Yngve Falck-Ytter, Sachin Wani, Timothy B Gardner
No abstract text is available yet for this article.
March 2018: Gastroenterology
https://www.readbyqxmd.com/read/28416525/treatment-of-patients-with-atrial-fibrillation-and-heart-failure-with-reduced-ejection-fraction
#12
REVIEW
Atul Verma, Jonathan M Kalman, David J Callans
Atrial fibrillation (AF) and heart failure with reduced ejection fraction (HFrEF) frequently coexist, and each complicates the course and treatment of the other. Recent population-based studies have demonstrated that the 2 conditions together increase the risk of stroke, heart failure hospitalization, and all-cause mortality, especially soon after the clinical onset of AF. Guideline-directed pharmacological therapy for HFrEF is important; however, although there are various treatment modalities for AF, there is no clear consensus on how best to treat AF with concomitant HFrEF...
April 18, 2017: Circulation
https://www.readbyqxmd.com/read/27522622/lactic-acidosis-an-update
#13
REVIEW
Jansen Seheult, Gerard Fitzpatrick, Gerard Boran
Lactate is one of the most crucial intermediates in carbohydrate and nonessential amino acid metabolism. The complexity of cellular interactions and metabolism means that lactate can be considered a waste product for one cell but a useful substrate for another. The presence of elevated lactate levels in critically ill patients has important implications for morbidity and mortality. In this review, we provide a brief outline of the metabolism of lactate, the pathophysiology of lactic acidosis, the clinical significance of D-lactate, the role of lactate measurement in acutely ill patients, the methods used to measure lactate in blood or plasma and some of the methodological issues related to interferences in these assays, especially in the case of ethylene glycol poisoning...
March 1, 2017: Clinical Chemistry and Laboratory Medicine: CCLM
https://www.readbyqxmd.com/read/29962118/pneumonia-in-patients-with-chronic-obstructive-pulmonary-disease
#14
REVIEW
Marcos I Restrepo, Oriol Sibila, Antonio Anzueto
Chronic obstructive pulmonary disease (COPD) is a frequent comorbid condition associated with increased morbidity and mortality. Pneumonia is the most common infectious disease condition. The purpose of this review is to evaluate the impact of pneumonia in patients with COPD. We will evaluate the epidemiology and factors associated with pneumonia. We are discussing the clinical characteristics of COPD that may favor the development of infections conditions such as pneumonia. Over the last 10 years, there is an increased evidence that COPD patients treated with inhaled corticosteroids are at increased risk to develp pneumonia...
July 2018: Tuberculosis and Respiratory Diseases
https://www.readbyqxmd.com/read/29953167/interventions-for-chronic-non-hypovolaemic-hypotonic-hyponatraemia
#15
REVIEW
Evi V Nagler, Maria C Haller, Wim Van Biesen, Raymond Vanholder, Jonathan C Craig, Angela C Webster
BACKGROUND: Chronic (present > 48 hours) non-hypovolaemic hyponatraemia occurs frequently, can be caused by various conditions, and is associated with shorter survival and longer hospital stays. Many treatments, such as fluid restriction or vasopressin receptor antagonists can be used to improve the hyponatraemia, but whether that translates into improved patient-important outcomes is less certain. OBJECTIVES: This review aimed to 1) look at the benefits and harms of interventions for chronic non-hypovolaemic hypotonic hyponatraemia when compared with placebo, no treatment or head-to-head; and 2) determine if benefits and harms vary in absolute or relative terms dependent on the specific compound within a drug class, on the dosage used, or the underlying disorder causing the hyponatraemia...
June 28, 2018: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/30003555/treatment-strategies-for-persistent-methicillin-resistant-staphylococcus-aureus-bacteraemia
#16
REVIEW
Paul O Lewis, Emily L Heil, Kelly L Covert, David B Cluck
WHAT IS KNOWN AND OBJECTIVE: Treatment of methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia is a long-standing challenge to health care, often complicated by metastatic infections, treatment failure and mortality. When MRSA bacteraemia persists despite adequate initial treatment, current Infectious Diseases Society of America guidelines recommend evaluation and removal of possible sources of infection. In addition, a change in therapy may be considered. The objective of this review was to explore the therapeutic options for the treatment of persistent MRSA bacteraemia...
October 2018: Journal of Clinical Pharmacy and Therapeutics
https://www.readbyqxmd.com/read/30002466/current-management-of-hepatic-encephalopathy
#17
REVIEW
Chathur Acharya, Jasmohan S Bajaj
Hepatic encephalopathy is a state of brain dysfunction resulting from decompensation of cirrhosis. The mortality and morbidity associated with the overt form of hepatic encephalopathy are high, and even the covert form associates with poor outcomes and poor quality of life. We know that the dysfunction is not just an acute insult to the brain but rather results in long-standing cognitive issues that get worse with each episode of HE. Hence, there is an urgency to accurately diagnose these conditions, start appropriate therapy, and to maintain remission...
July 13, 2018: American Journal of Gastroenterology
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
#18
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/30048974/understanding-left-ventricular-assist-devices
#19
REVIEW
Nadia Aissaoui, Jerome Jouan, Melissa Gourjault, Benoit Diebold, Sofia Ortuno, Amer Hamdan, Christian Latremouille, Romain Pirracchio, Michiel Morshuis
BACKGROUND/AIMS: Long-term mechanical assist devices are now commonly used in the treatment of severe heart failure to unload the failing ventricle, maintain sufficient end-organ perfusion and improve functional capacity. Depending on the assisted ventricles, 3 categories of long-term assist devices are available: left ventricular assist device (LVAD), biventricular assist device and total artificial heart. Improvements in technology, especially the advent of smaller, durable continuous flow pumps, have led to the use of LVADs in a much broader population of patients in the last 10 years...
July 26, 2018: Blood Purification
https://www.readbyqxmd.com/read/29754310/the-ten-pitfalls-of-lactate-clearance-in-sepsis
#20
Glenn Hernandez, Rinaldo Bellomo, Jan Bakker
No abstract text is available yet for this article.
May 12, 2018: Intensive Care Medicine
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