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Critical care

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By Varun Shetty Critical Care fellow with background training in Internal Medicine-Pediatrics
https://www.readbyqxmd.com/read/20472939/early-cpap-versus-surfactant-in-extremely-preterm-infants
#1
RANDOMIZED CONTROLLED TRIAL
Neil N Finer, Waldemar A Carlo, Michele C Walsh, Wade Rich, Marie G Gantz, Abbot R Laptook, Bradley A Yoder, Roger G Faix, Abhik Das, W Kenneth Poole, Edward F Donovan, Nancy S Newman, Namasivayam Ambalavanan, Ivan D Frantz, Susie Buchter, Pablo J Sánchez, Kathleen A Kennedy, Nirupama Laroia, Brenda B Poindexter, C Michael Cotten, Krisa P Van Meurs, Shahnaz Duara, Vivek Narendran, Beena G Sood, T Michael O'Shea, Edward F Bell, Vineet Bhandari, Kristi L Watterberg, Rosemary D Higgins
BACKGROUND: There are limited data to inform the choice between early treatment with continuous positive airway pressure (CPAP) and early surfactant treatment as the initial support for extremely-low-birth-weight infants. METHODS: We performed a randomized, multicenter trial, with a 2-by-2 factorial design, involving infants who were born between 24 weeks 0 days and 27 weeks 6 days of gestation. Infants were randomly assigned to intubation and surfactant treatment (within 1 hour after birth) or to CPAP treatment initiated in the delivery room, with subsequent use of a protocol-driven limited ventilation strategy...
May 27, 2010: New England Journal of Medicine
https://www.readbyqxmd.com/read/30409433/2018-international-consensus-on-cardiopulmonary-resuscitation-and-emergency-cardiovascular-care-science-with-treatment-recommendations-summary
#2
Jasmeet Soar, Michael W Donnino, Ian Maconochie, Richard Aickin, Dianne L Atkins, Lars W Andersen, Katherine M Berg, Robert Bingham, Bernd W Böttiger, Clifton W Callaway, Keith Couper, Thomaz Bittencourt Couto, Allan R de Caen, Charles D Deakin, Ian R Drennan, Anne-Marie Guerguerian, Eric J Lavonas, Peter A Meaney, Vinay M Nadkarni, Robert W Neumar, Kee-Chong Ng, Tonia C Nicholson, Gabrielle A Nuthall, Shinichiro Ohshimo, Brian J O'Neil, Gene Yong-Kwang Ong, Edison F Paiva, Michael J Parr, Amelia G Reis, Joshua C Reynolds, Giuseppe Ristagno, Claudio Sandroni, Stephen M Schexnayder, Barnaby R Scholefield, Naoki Shimizu, Janice A Tijssen, Patrick Van de Voorde, Tzong-Luen Wang, Michelle Welsford, Mary Fran Hazinski, Jerry P Nolan, Peter T Morley
The International Liaison Committee on Resuscitation has initiated a continuous review of new, peer-reviewed, published cardiopulmonary resuscitation science. This is the second annual summary of International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations that includes the most recent cardiopulmonary resuscitation science reviewed by the International Liaison Committee on Resuscitation. This summary addresses the role of antiarrhythmic drugs in adults and children and includes the Advanced Life Support Task Force and Pediatric Task Force consensus statements, which summarize the most recent published evidence and an assessment of the quality of the evidence based on Grading of Recommendations, Assessment, Development, and Evaluation criteria...
December 2018: Resuscitation
https://www.readbyqxmd.com/read/30374729/hemodynamic-support-in-the-early-phase-of-septic-shock-a-review-of-challenges-and-unanswered-questions
#3
REVIEW
Olivier Lesur, Eugénie Delile, Pierre Asfar, Peter Radermacher
BACKGROUND: Improving sepsis support is one of the three pillars of a 2017 resolution according to the World Health Organization (WHO). Septic shock is indeed a burden issue in the intensive care units. Hemodynamic stabilization is a cornerstone element in the bundle of supportive treatments recommended in the Surviving Sepsis Campaign (SSC) consecutive biannual reports. MAIN BODY: The "Pandera's box" of septic shock hemodynamics is an eternal debate, however, with permanent contentious issues...
October 29, 2018: Annals of Intensive Care
https://www.readbyqxmd.com/read/11155418/anteroapical-stunning-and-left-ventricular-outflow-tract-obstruction
#4
R P Villareal, A Achari, S Wilansky, J M Wilson
Dynamic left ventricular outflow tract (LVOT) obstruction is typically observed in the setting of hypertrophic cardiomyopathy. It has also been reported with concentric LV hypertrophy, excessive sympathetic stimulation, and acute myocardial infarction. We describe 3 patients with chest discomfort after emotional stress, who had pronounced abnormalities on electrocardiograms, insignificant obstructive coronary disease and hemodynamic instability with LVOT obstruction, and regional wall motion abnormalities. Suppression of contractility with beta-blockers resulted in resolution of the gradient and in clinical improvement...
January 2001: Mayo Clinic Proceedings
https://www.readbyqxmd.com/read/27190729/sonography-in-hypotension-and-cardiac-arrest-shoc-rates-of-abnormal-findings-in-undifferentiated-hypotension-and-during-cardiac-arrest-as-a-basis-for-consensus-on-a-hierarchical-point-of-care-ultrasound-protocol
#5
James Milne, Paul Atkinson, David Lewis, Jacqueline Fraser, Laura Diegelmann, Paul Olszynski, Melanie Stander, Hein Lamprecht
INTRODUCTION: Point of care ultrasound (PoCUS) has become an established tool in the initial management of patients with undifferentiated hypotension. Current established protocols (RUSH and ACES) were developed by expert user opinion, rather than objective, prospective data. PoCUS also provides invaluable information during resuscitation efforts in cardiac arrest by determining presence/absence of cardiac activity and identifying reversible causes such as pericardial tamponade. There is no agreed guideline on how to safely and effectively incorporate PoCUS into the advanced cardiac life support (ACLS) algorithm...
April 8, 2016: Curēus
https://www.readbyqxmd.com/read/29866583/does-point-of-care-ultrasonography-improve-clinical-outcomes-in-emergency-department-patients-with-undifferentiated-hypotension-an-international-randomized-controlled-trial-from-the-shoc-ed-investigators
#6
Paul R Atkinson, James Milne, Laura Diegelmann, Hein Lamprecht, Melanie Stander, David Lussier, Chau Pham, Ryan Henneberry, Jacqueline M Fraser, Michael K Howlett, Jayanand Mekwan, Brian Ramrattan, Joanna Middleton, Daniel J van Hoving, Mandy Peach, Luke Taylor, Tara Dahn, Sean Hurley, Kayla MacSween, Luke R Richardson, George Stoica, Samuel Hunter, Paul A Olszynski, David A Lewis
STUDY OBJECTIVE: Point-of-care ultrasonography protocols are commonly used in the initial management of patients with undifferentiated hypotension in the emergency department (ED). There is little published evidence for any mortality benefit. We compare the effect of a point-of-care ultrasonography protocol versus standard care without point-of-care ultrasonography for survival and clinical outcomes. METHODS: This international, multicenter, randomized controlled trial recruited from 6 centers in North America and South Africa and included selected hypotensive patients (systolic blood pressure <100 mm Hg or shock index >1) randomized to early point-of-care ultrasonography plus standard care versus standard care without point-of-care ultrasonography...
June 2, 2018: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/27998322/international-federation-for-emergency-medicine-consensus-statement-sonography-in-hypotension-and-cardiac-arrest-shoc-an-international-consensus-on-the-use-of-point-of-care-ultrasound-for-undifferentiated-hypotension-and-during-cardiac-arrest
#7
REVIEW
Paul Atkinson, Justin Bowra, James Milne, David Lewis, Mike Lambert, Bob Jarman, Vicki E Noble, Hein Lamprecht, Tim Harris, Jim Connolly
Introduction The International Federation for Emergency Medicine (IFEM) Ultrasound Special Interest Group (USIG) was tasked with development of a hierarchical consensus approach to the use of point of care ultrasound (PoCUS) in patients with hypotension and cardiac arrest. METHODS: The IFEM USIG invited 24 recognized international leaders in PoCUS from emergency medicine and critical care to form an expert panel to develop the sonography in hypotension and cardiac arrest (SHoC) protocol...
November 2017: CJEM
https://www.readbyqxmd.com/read/30186937/oral-anticoagulant-use-for-stroke-prevention-in-atrial-fibrillation-patients-with-difficult-scenarios
#8
REVIEW
Ting-Yung Chang, Jo-Nan Liao, Tze-Fan Chao, Jennifer Jeanne Vicera, Chin-Yu Lin, Ta-Chuan Tuan, Yenn-Jiang Lin, Shih-Lin Chang, Li-Wei Lo, Yu-Feng Hu, Fa-Po Chung, Shih-Ann Chen
Atrial fibrillation (AF) has become the most prevalent arrhythmia and it will increase the risk of ischemic stroke, heart failure, mortality, sudden cardiac death, myocardial infarction, and dementia. Stroke prevention with oral anticoagulant is crucial for management of AF patients. Vitamin K antagonist, which inhibits the clotting factors II, VII, IX and X, has been recommended for stroke prevention for decades. Non-Vitamin K antagonist oral anticoagulants (NOACs), including dabigatran, rivaroxaban, apixaban and edoxaban are at least as effective as warfarin in reducing ischemic stroke with a lower rate of major bleeding...
September 2018: IJC Heart & Vasculature
https://www.readbyqxmd.com/read/30372119/lung-ultrasound-for-critically-ill-patients
#9
Francesco Mojoli, Bélaid Bouhemad, Silvia Mongodi, Daniel Lichtenstein
Point-of-care ultrasound is increasingly used at the bedside to integrate the clinical assessment of the critically ill; in particular, lung ultrasound greatly developed in the last decade. This review describes basic lung ultrasound signs and focuses on their applications in critical care. Lung semiotic is made both of artifacts (derived by air/tissue interface) and real images (i.e. effusions and consolidations), both providing significant information to identify the main acute respiratory disorders. Lung ultrasound signs, either alone or combined to other point-of-care ultrasound techniques, are helpful in the diagnostic approach to patients with acute respiratory failure, circulatory shock or cardiac arrest...
October 29, 2018: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/30295762/managing-the-patient-with-heart-failure-in-the-emergency-department
#10
Tal Hasin, Todd Zalut, Yonathan Hasin
No abstract text is available yet for this article.
October 7, 2018: European Heart Journal
https://www.readbyqxmd.com/read/30334906/renal-replacement-therapy-modalities-in-critically-ill-children
#11
Fernando Beltramo, Joseph DiCarlo, Joshua B Gruber, Thom Taylor, Balagangadhar R Totapally
OBJECTIVES: The objective of this study is to describe the relative frequency of use of continuous renal replacement therapy, intermittent hemodialysis, and peritoneal dialysis and to analyze characteristics and outcomes of critically ill children receiving renal replacement therapies admitted to PICUs that participate in the Virtual PICU (VPS LLC, Los Angeles, CA) registry.. DESIGN: Retrospective, database analysis. SETTING: PICUs that participate in the Virtual PICU (VPS LLC) registry...
October 16, 2018: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/30346242/haloperidol-and-ziprasidone-for-treatment-of-delirium-in-critical-illness
#12
Timothy D Girard, Matthew C Exline, Shannon S Carson, Catherine L Hough, Peter Rock, Michelle N Gong, Ivor S Douglas, Atul Malhotra, Robert L Owens, Daniel J Feinstein, Babar Khan, Margaret A Pisani, Robert C Hyzy, Gregory A Schmidt, William D Schweickert, R Duncan Hite, David L Bowton, Andrew L Masica, Jennifer L Thompson, Rameela Chandrasekhar, Brenda T Pun, Cayce Strength, Leanne M Boehm, James C Jackson, Pratik P Pandharipande, Nathan E Brummel, Christopher G Hughes, Mayur B Patel, Joanna L Stollings, Gordon R Bernard, Robert S Dittus, E Wesley Ely
BACKGROUND: There are conflicting data on the effects of antipsychotic medications on delirium in patients in the intensive care unit (ICU). METHODS: In a randomized, double-blind, placebo-controlled trial, we assigned patients with acute respiratory failure or shock and hypoactive or hyperactive delirium to receive intravenous boluses of haloperidol (maximum dose, 20 mg daily), ziprasidone (maximum dose, 40 mg daily), or placebo. The volume and dose of a trial drug or placebo was halved or doubled at 12-hour intervals on the basis of the presence or absence of delirium, as detected with the use of the Confusion Assessment Method for the ICU, and of side effects of the intervention...
October 22, 2018: New England Journal of Medicine
https://www.readbyqxmd.com/read/30236315/positive-pressure-ventilation-in-the-cardiac-intensive-care-unit
#13
REVIEW
Carlos L Alviar, P Elliott Miller, Dorothea McAreavey, Jason N Katz, Burton Lee, Brad Moriyama, Jeffrey Soble, Sean van Diepen, Michael A Solomon, David A Morrow
Contemporary cardiac intensive care units (CICUs) provide care for an aging and increasingly complex patient population. The medical complexity of this population is partly driven by an increased proportion of patients with respiratory failure needing noninvasive or invasive positive pressure ventilation (PPV). PPV often plays an important role in the management of patients with cardiogenic pulmonary edema, cardiogenic shock, or cardiac arrest, and those undergoing mechanical circulatory support. Noninvasive PPV, when appropriately applied to selected patients, may reduce the need for invasive mechanical PPV and improve survival...
September 25, 2018: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/30231909/refractory-septic-shock-our-pragmatic-approach
#14
Prashanth Nandhabalan, Nicholas Ioannou, Christopher Meadows, Duncan Wyncoll
Despite timely intervention, there exists a small subgroup of patients with septic shock who develop progressive multi-organ failure. Seemingly refractory to conventional therapy, they exhibit a very high mortality. Such patients are often poorly represented in large clinical trials. Consequently, good evidence for effective treatment strategies is lacking. In this article, we describe a pragmatic, multi-faceted approach to managing patients with refractory septic shock based on our experience of toxin-mediated sepsis in a specialist referral centre...
September 19, 2018: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/30260732/effects-from-continuous-infusions-of-dexmedetomidine-and-propofol-on-hemodynamic-stability-in-critically-ill-adult-patients-with-septic-shock
#15
Kristen M Nelson, Gourang P Patel, Drayton A Hammond
PURPOSE: To compare the development of clinically significant hemodynamic event (ie, hypotension or bradycardia) in adults with septic shock receiving either propofol or dexmedetomidine. MATERIALS AND METHODS: A retrospective cohort study of adults with septic shock admitted to an intensive care unit (ICU) at an academic medical center between July 2013 and July 2017. RESULTS: Patients in the propofol (n = 35) and dexmedetomidine (n = 37) groups developed a clinically significant hemodynamic event at similar frequencies (31...
September 27, 2018: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/30171861/the-septic-heart-current-understanding-of-molecular-mechanisms-and-clinical-implications
#16
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 patients with sepsis, 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
#17
https://www.readbyqxmd.com/read/30111343/airway-and-ventilation-management-during-cardiopulmonary-resuscitation-and-after-successful-resuscitation
#18
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
#19
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
#20
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
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