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Critical care

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By Varun Shetty A Med-Peds resident
https://www.readbyqxmd.com/read/29652705/is-procalcitonin-guided-therapy-associated-with-beneficial-outcomes-in-critically-ill-patients-with-sepsis
#1
Andre C Kalil, Trevor C Van Schooneveld
No abstract text is available yet for this article.
May 2018: Critical Care Medicine
https://www.readbyqxmd.com/read/29461885/physiologic-basis-of-mechanical-ventilation
#2
Martin J Tobin
The primary purpose of mechanical ventilation is to decrease work of breathing. Achieving this goal requires that cycling of the ventilator be carefully aligned with the intrinsic rhythm of a patient's respiratory center output. Problems arise at the point of ventilator triggering, post-trigger inflation, and inspiration-expiration switchover. Careful, iterative adjustments of ventilator settings are required to minimize work of breathing. Use of protocols for the selection of ventilator settings can lead to complications (including alveolar overdistention) and risk of death...
February 2018: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/27342573/mechanical-circulatory-assist-devices-a-primer-for-critical-care-and-emergency-physicians
#3
REVIEW
Ayan Sen, Joel S Larson, Kianoush B Kashani, Stacy L Libricz, Bhavesh M Patel, Pramod K Guru, Cory M Alwardt, Octavio Pajaro, J Christopher Farmer
Mechanical circulatory assist devices are now commonly used in the treatment of severe heart failure as bridges to cardiac transplant, as destination therapy for patients who are not transplant candidates, and as bridges to recovery and "decision-making". These devices, which can be used to support the left or right ventricles or both, restore circulation to the tissues, thereby improving organ function. Left ventricular assist devices (LVADs) are the most common support devices. To care for patients with these devices, health care providers in emergency departments (EDs) and intensive care units (ICUs) need to understand the physiology of the devices, the vocabulary of mechanical support, the types of complications patients may have, diagnostic techniques, and decision-making regarding treatment...
June 25, 2016: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29649820/accuracy-of-acid-base-diagnoses-using-the-central-venous-blood-gas-in-the-medical-intensive-care-unit
#4
Sarah J Schrauben, Dan Negoianu, Cristiana Costa, Raphael M Cohen, Stanley Goldfarb, Barry D Fuchs, Jeffrey S Berns
BACKGROUND: Acid-base disturbances are frequent in critically ill patients. Arterial blood gas (ABG) is the gold standard in the diagnosis of these disturbances, but it is invasive with potential hazards. For patients with a central venous catheter, venous blood gas (VBG) sampling may be an alternative, less-invasive diagnostic tool. However, the accuracy of a central VBG-based acid-base disorder diagnosis compared to an ABG is unknown. The primary objective of this study was to assess the accuracy of a central VBG-based acid-base disorder diagnosis compared to the "gold standard" ABG in critically ill patients...
April 12, 2018: Nephron
https://www.readbyqxmd.com/read/25251758/cardiac-output-monitoring-a-contemporary-assessment-and-review
#5
REVIEW
Robert H Thiele, Karsten Bartels, Tong J Gan
OBJECTIVE: An increasing number of minimally or noninvasive devices are available to measure cardiac output in the critical care setting. This article reviews the underlying physical principles of these devices in addition to examining both animal and human comparative studies in an effort to allow clinicians to make informed decisions when selecting a device to measure cardiac output. DATA SOURCES: Peer-reviewed manuscripts indexed in PubMed. STUDY SELECTION: A systematic search of the PubMed database for articles describing the use of cardiac output monitors yielded 1,526 sources that were included in the analysis...
January 2015: Critical Care Medicine
https://www.readbyqxmd.com/read/29534630/antibiotic-use-in-the-intensive-care-unit-optimization-and-de-escalation
#6
Maureen Campion, Gail Scully
Appropriate antimicrobial therapy is essential to ensuring positive patient outcomes. Inappropriate or suboptimal utilization of antibiotics can lead to increased length of stay, multidrug-resistant infections, and mortality. Critically ill intensive care patients, particularly those with severe sepsis and septic shock, are at risk of antibiotic failure and secondary infections associated with incorrect antibiotic use. Through the initiation of active empiric antibiotic therapy based upon local susceptibilities, daily evaluation of signs and symptoms of infection and narrowing of antibiotic therapy when feasible, providers can streamline the treatment of common intensive care unit (ICU) infections...
January 1, 2018: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/29485925/balanced-crystalloids-versus-saline-in-critically-ill-adults
#7
RANDOMIZED CONTROLLED TRIAL
Matthew W Semler, Wesley H Self, Jonathan P Wanderer, Jesse M Ehrenfeld, Li Wang, Daniel W Byrne, Joanna L Stollings, Avinash B Kumar, Christopher G Hughes, Antonio Hernandez, Oscar D Guillamondegui, Addison K May, Liza Weavind, Jonathan D Casey, Edward D Siew, Andrew D Shaw, Gordon R Bernard, Todd W Rice
BACKGROUND: Both balanced crystalloids and saline are used for intravenous fluid administration in critically ill adults, but it is not known which results in better clinical outcomes. METHODS: In a pragmatic, cluster-randomized, multiple-crossover trial conducted in five intensive care units at an academic center, we assigned 15,802 adults to receive saline (0.9% sodium chloride) or balanced crystalloids (lactated Ringer's solution or Plasma-Lyte A) according to the randomization of the unit to which they were admitted...
March 1, 2018: New England Journal of Medicine
https://www.readbyqxmd.com/read/29490185/hydrocortisone-plus-fludrocortisone-for-adults-with-septic-shock
#8
RANDOMIZED CONTROLLED TRIAL
Djillali Annane, Alain Renault, Christian Brun-Buisson, Bruno Megarbane, Jean-Pierre Quenot, Shidasp Siami, Alain Cariou, Xavier Forceville, Carole Schwebel, Claude Martin, Jean-François Timsit, Benoît Misset, Mohamed Ali Benali, Gwenhael Colin, Bertrand Souweine, Karim Asehnoune, Emmanuelle Mercier, Loïc Chimot, Claire Charpentier, Bruno François, Thierry Boulain, Franck Petitpas, Jean-Michel Constantin, Gilles Dhonneur, François Baudin, Alain Combes, Julien Bohé, Jean-François Loriferne, Roland Amathieu, Fabrice Cook, Michel Slama, Olivier Leroy, Gilles Capellier, Auguste Dargent, Tarik Hissem, Virginie Maxime, Eric Bellissant
BACKGROUND: Septic shock is characterized by dysregulation of the host response to infection, with circulatory, cellular, and metabolic abnormalities. We hypothesized that therapy with hydrocortisone plus fludrocortisone or with drotrecogin alfa (activated), which can modulate the host response, would improve the clinical outcomes of patients with septic shock. METHODS: In this multicenter, double-blind, randomized trial with a 2-by-2 factorial design, we evaluated the effect of hydrocortisone-plus-fludrocortisone therapy, drotrecogin alfa (activated), the combination of the three drugs, or their respective placebos...
March 1, 2018: New England Journal of Medicine
https://www.readbyqxmd.com/read/29168046/procalcitonin-guided-antibiotic-therapy-in-intensive-care-unit-patients-a-systematic-review-and-meta-analysis
#9
Hui-Bin Huang, Jin-Min Peng, Li Weng, Chun-Yao Wang, Wei Jiang, Bin Du
BACKGROUND: Serum procalcitonin (PCT) concentration is used to guide antibiotic decisions in choice, timing, and duration of anti-infection therapy to avoid antibiotic overuse. Thus, we performed a systematic review and meta-analysis to seek evidence of different PCT-guided antimicrobial strategies for critically ill patients in terms of predefined clinical outcomes. METHODS: We searched for relevant studies in PubMed, Embase, Web of Knowledge, and the Cochrane Library up to 25 February 2017...
November 22, 2017: Annals of Intensive Care
https://www.readbyqxmd.com/read/29373802/peep-lower-than-the-ards-network-protocol-is-associated-with-higher-pediatric-ards-mortality
#10
Robinder G Khemani, Kaushik Parvathaneni, Nadir Yehya, Anoopindar K Bhalla, Neal J Thomas, Christopher J L Newth
RATIONALE: The ARDS Network used a Positive End-Expiratory Pressure (PEEP)/FiO2 model in many studies. In general, pediatric intensivists use less PEEP and higher FiO2 than this model. OBJECTIVES: To evaluate whether children managed with PEEP lower than recommended by the ARDSNet PEEP/FiO2 model had higher mortality. METHODS: Multi-center, retrospective analysis of patients with Pediatric ARDS (PARDS), managed without a formal PEEP/FiO2 protocol...
January 26, 2018: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/29377333/permissive-or-trophic-enteral-nutrition-and-full-enteral-nutrition-had-similar-effects-on-clinical-outcomes-in-intensive-care-a-systematic-review-of-randomized-clinical-trials
#11
REVIEW
Camila F A Silva, Simone G de Vasconcelos, Thales A da Silva, Flávia M Silva
The aim of this study was to systematically review the effect of permissive underfeeding/trophic feeding on the clinical outcomes of critically ill patients. A systematic review of randomized clinical trials to evaluate the mortality, length of stay, and mechanical ventilation duration in patients randomized to either hypocaloric or full-energy enteral nutrition was performed. Data sources included PubMed and Scopus and the reference lists of the articles retrieved. Two independent reviewers participated in all phases of this systematic review as proposed by the Cochrane Handbook, and the review was reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines...
January 26, 2018: Nutrition in Clinical Practice
https://www.readbyqxmd.com/read/28298398/management-of-copd-exacerbations-a-european-respiratory-society-american-thoracic-society-guideline
#12
Jadwiga A Wedzicha, Marc Miravitlles, John R Hurst, Peter M A Calverley, Richard K Albert, Antonio Anzueto, Gerard J Criner, Alberto Papi, Klaus F Rabe, David Rigau, Pawel Sliwinski, Thomy Tonia, Jørgen Vestbo, Kevin C Wilson, Jerry A Krishnan
This document provides clinical recommendations for treatment of chronic obstructive pulmonary disease (COPD) exacerbations.Comprehensive evidence syntheses, including meta-analyses, were performed to summarise all available evidence relevant to the Task Force's questions. The evidence was appraised using the Grading of Recommendations, Assessment, Development and Evaluation approach and the results were summarised in evidence profiles. The evidence syntheses were discussed and recommendations formulated by a multidisciplinary Task Force of COPD experts...
March 2017: European Respiratory Journal: Official Journal of the European Society for Clinical Respiratory Physiology
https://www.readbyqxmd.com/read/28320807/inferior-st-elevation-on-the-ecg-what-is-the-diagnosis
#13
Andrei D Mărgulescu
No abstract text is available yet for this article.
March 21, 2017: Circulation
https://www.readbyqxmd.com/read/28286222/2017-acc-aha-hrs-guideline-for-the-evaluation-and-management-of-patients-with-syncope-executive-summary-a-report-of-the-american-college-of-cardiology-american-heart-association-task-force-on-clinical-practice-guidelines-and-the-heart-rhythm-society
#14
Win-Kuang Shen, Robert S Sheldon, David G Benditt, Mitchell I Cohen, Daniel E Forman, Zachary D Goldberger, Blair P Grubb, Mohamed H Hamdan, Andrew D Krahn, Mark S Link, Brian Olshansky, Satish R Raj, Roopinder Kaur Sandhu, Dan Sorajja, Benjamin C Sun, Clyde W Yancy
No abstract text is available yet for this article.
August 1, 2017: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/29227368/septic-cardiomyopathy
#15
Sarah J Beesley, Gerhard Weber, Todd Sarge, Sara Nikravan, Colin K Grissom, Michael J Lanspa, Sajid Shahul, Samuel M Brown
OBJECTIVES: To describe, with an emphasis on clinical applications, what is known about the pathophysiology, management, and implications of septic cardiomyopathy in the adult ICU. DATA SOURCES AND STUDY SELECTION: A PubMed literature review was performed for relevant articles. Only articles in English that studied human adults with sepsis were included. DATA EXTRACTION AND DATA SYNTHESIS: Multiple competing definitions for septic cardiomyopathy hinder understanding of this entity...
April 2018: Critical Care Medicine
https://www.readbyqxmd.com/read/28938253/guidelines-for-the-diagnosis-and-management-of-critical-illness-related-corticosteroid-insufficiency-circi-in-critically-ill-patients-part-i-society-of-critical-care-medicine-sccm-and-european-society-of-intensive-care-medicine-esicm-2017
#16
Djillali Annane, Stephen M Pastores, Bram Rochwerg, Wiebke Arlt, Robert A Balk, Albertus Beishuizen, Josef Briegel, Joseph Carcillo, Mirjam Christ-Crain, Mark S Cooper, Paul E Marik, Gianfranco Umberto Meduri, Keith M Olsen, Sophia C Rodgers, James A Russell, Greet Van den Berghe
OBJECTIVE: To update the 2008 consensus statements for the diagnosis and management of critical illness-related corticosteroid insufficiency (CIRCI) in adult and pediatric patients. PARTICIPANTS: A multispecialty task force of 16 international experts in critical care medicine, endocrinology, and guideline methods, all of them members of the Society of Critical Care Medicine and/or the European Society of Intensive Care Medicine. DESIGN/METHODS: The recommendations were based on the summarized evidence from the 2008 document in addition to more recent findings from an updated systematic review of relevant studies from 2008 to 2017 and were formulated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology...
December 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28870355/mechanical-ventilation-state-of-the-art
#17
REVIEW
Tài Pham, Laurent J Brochard, Arthur S Slutsky
Mechanical ventilation is the most used short-term life support technique worldwide and is applied daily for a diverse spectrum of indications, from scheduled surgical procedures to acute organ failure. This state-of-the-art review provides an update on the basic physiology of respiratory mechanics, the working principles, and the main ventilatory settings, as well as the potential complications of mechanical ventilation. Specific ventilatory approaches in particular situations such as acute respiratory distress syndrome and chronic obstructive pulmonary disease are detailed along with protective ventilation in patients with normal lungs...
September 2017: Mayo Clinic Proceedings
https://www.readbyqxmd.com/read/28577069/prevention-of-acute-kidney-injury-and-protection-of-renal-function-in-the-intensive-care-unit-update-2017-expert-opinion-of-the-working-group-on-prevention-aki-section-european-society-of-intensive-care-medicine
#18
REVIEW
M Joannidis, W Druml, L G Forni, A B J Groeneveld, P M Honore, E Hoste, M Ostermann, H M Oudemans-van Straaten, M Schetz
BACKGROUND: Acute kidney injury (AKI) in the intensive care unit is associated with significant mortality and morbidity. OBJECTIVES: To determine and update previous recommendations for the prevention of AKI, specifically the role of fluids, diuretics, inotropes, vasopressors/vasodilators, hormonal and nutritional interventions, sedatives, statins, remote ischaemic preconditioning and care bundles. METHOD: A systematic search of the literature was performed for studies published between 1966 and March 2017 using these potential protective strategies in adult patients at risk of AKI...
June 2017: Intensive Care Medicine
https://www.readbyqxmd.com/read/28509668/norepinephrine-in-septic-shock-when-and-how-much
#19
Olfa Hamzaoui, Thomas W L Scheeren, Jean-Louis Teboul
PURPOSE OF REVIEW: Norepinephrine is the first-line agent recommended during resuscitation of septic shock to correct hypotension due to depressed vascular tone. Important clinical issues are the best timing to start norepinephrine, the optimal blood pressure target, and the best therapeutic options to face refractory hypotension when high doses of norepinephrine are required to reach the target. RECENT FINDINGS: Recent literature has reported benefits of early administration of norepinephrine because of the following reasons: profound and durable hypotension is an independent factor of increased mortality, early administration of norepinephrine increases cardiac output, improves microcirculation and avoids fluid overload...
August 2017: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/28320242/early-goal-directed-therapy-for-septic-shock-a-patient-level-meta-analysis
#20
Kathryn M Rowan, Derek C Angus, Michael Bailey, Amber E Barnato, Rinaldo Bellomo, Ruth R Canter, Timothy J Coats, Anthony Delaney, Elizabeth Gimbel, Richard D Grieve, David A Harrison, Alisa M Higgins, Belinda Howe, David T Huang, John A Kellum, Paul R Mouncey, Edvin Music, Sandra L Peake, Francis Pike, Michael C Reade, M Zia Sadique, Mervyn Singer, Donald M Yealy
BACKGROUND: After a single-center trial and observational studies suggesting that early, goal-directed therapy (EGDT) reduced mortality from septic shock, three multicenter trials (ProCESS, ARISE, and ProMISe) showed no benefit. This meta-analysis of individual patient data from the three recent trials was designed prospectively to improve statistical power and explore heterogeneity of treatment effect of EGDT. METHODS: We harmonized entry criteria, intervention protocols, outcomes, resource-use measures, and data collection across the trials and specified all analyses before unblinding...
June 8, 2017: New England Journal of Medicine
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