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Critical care

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72 papers 1000+ followers Foundation knowledge for critical care medicine
By Hayden Alicajic Resident medical officer on a pursuit for all things critical care and anaesthetics
C Frerk, V S Mitchell, A F McNarry, C Mendonca, R Bhagrath, A Patel, E P O'Sullivan, N M Woodall, I Ahmad
These guidelines provide a strategy to manage unanticipated difficulty with tracheal intubation. They are founded on published evidence. Where evidence is lacking, they have been directed by feedback from members of the Difficult Airway Society and based on expert opinion. These guidelines have been informed by advances in the understanding of crisis management; they emphasize the recognition and declaration of difficulty during airway management. A simplified, single algorithm now covers unanticipated difficulties in both routine intubation and rapid sequence induction...
December 2015: British Journal of Anaesthesia
Hollmann D Aya, Irina Chis Ster, Nick Fletcher, R Michael Grounds, Andrew Rhodes, Maurizio Cecconi
OBJECTIVE: This study aims to describe the pharmacodynamics of a fluid challenge over a 10-minute period in postoperative patients. DESIGN: Prospective observational study. SETTING: General and cardiothoracic ICU, tertiary hospital. PATIENTS: Twenty-six postoperative patients. INTERVENTION: Two hundred and fifty-milliliter fluid challenge performed over 5 minutes. Data were recorded over 10 minutes after the end of fluid infusion MEASUREMENTS AND MAIN RESULTS: Cardiac output was measured with a calibrated LiDCOplus (LiDCO, Cambridge, United Kingdom) and Navigator (Applied Physiology, Sydney, Australia) to obtain the Pmsf analogue (Pmsa)...
May 2016: Critical Care Medicine
R Gupta, T J Gan
'Enhanced recovery after surgery' protocols implement a series of peri-operative interventions intended to improve recovery after major operations, one aspect of which is fluid management. The pre-operative goal is to prepare a hydrated, euvolaemic patient by avoiding routine mechanical bowel preparation and by encouraging patients to drink clear liquids up to two hours before induction of anaesthesia. The intra-operative goal is to achieve a 'zero' fluid balance at the end of uncomplicated surgery: goal-directed fluid therapy is recommended for poorly prepared or sick patients or those undergoing more complex surgery...
January 2016: Anaesthesia
Bandarn Suetrong, Keith R Walley
Increased blood lactate concentration (hyperlactatemia) and lactic acidosis (hyperlactatemia and serum pH < 7.35) are common in patients with severe sepsis or septic shock and are associated with significant morbidity and mortality. In some patients, most of the lactate that is produced in shock states is due to inadequate oxygen delivery resulting in tissue hypoxia and causing anaerobic glycolysis. However, lactate formation during sepsis is not entirely related to tissue hypoxia or reversible by increasing oxygen delivery...
January 2016: Chest
Ravi G Gupta, Sarah M Hartigan, Markos G Kashiouris, Curtis N Sessler, Gonzalo M L Bearman
Severe sepsis and septic shock are among the leading causes of mortality in the intensive care unit. Over a decade ago, early goal-directed therapy (EGDT) emerged as a novel approach for reducing sepsis mortality and was incorporated into guidelines published by the international Surviving Sepsis Campaign. In addition to requiring early detection of sepsis and prompt initiation of antibiotics, the EGDT protocol requires invasive patient monitoring to guide resuscitation with intravenous fluids, vasopressors, red cell transfusions, and inotropes...
August 28, 2015: Critical Care: the Official Journal of the Critical Care Forum
Christopher W Seymour, Matthew R Rosengart
IMPORTANCE: Septic shock is a clinical emergency that occurs in more than 230,000 US patients each year. OBSERVATIONS AND ADVANCES: In the setting of suspected or documented infection, septic shock is typically defined in a clinical setting by low systolic (≤90 mm Hg) or mean arterial blood pressure (≤65 mm Hg) accompanied by signs of hypoperfusion (eg, oliguria, hyperlactemia, poor peripheral perfusion, or altered mental status). Focused ultrasonography is recommended for the prompt recognition of complicating physiology (eg, hypovolemia or cardiogenic shock), while invasive hemodynamic monitoring is recommended only for select patients...
August 18, 2015: JAMA: the Journal of the American Medical Association
Andreas Greinacher
New England Journal of Medicine, Volume 373, Issue 3, Page 252-261, July 2015.
July 16, 2015: New England Journal of Medicine
Ryoichi Ochiai
Acute respiratory distress syndrome (ARDS) has been intensively and continuously studied in various settings, but its mortality is still as high as 30-40 %. For the last 20 years, lung protective strategy has become a standard care for ARDS, but we still do not know the best way to ventilate patients with ARDS. Tidal volume itself does not seem to have an important role to develop ventilator-induced lung injury (VILI), but the driving pressure, which is inspiratory plateau pressure-PEEP, is the most important to predict and affect the outcome of ARDS, though there is no safe limit for the driving pressure...
2015: Journal of Intensive Care
G Gruartmoner, J Mesquida, Can Ince
PURPOSE OF REVIEW: In shock states, optimizing intravascular volume is crucial to promote an adequate oxygen delivery to the tissues. Our current practice in fluid management pivots on the Frank-Starling law of the heart, and the effects of fluids are measured according to the induced changes on stroke volume. The purpose of this review is to evaluate the boundaries of current macrohemodynamic approach to fluid administration, and to introduce the microcirculatory integration as a fundamental part of tissue perfusion monitoring...
August 2015: Current Opinion in Critical Care
Gennaro De Pascale, Mario Tumbarello
PURPOSE OF REVIEW: The aim of this review is to give an update on the available diagnostic approaches and currently adopted therapeutic management of severe fungal diseases in the ICU setting. RECENT FINDINGS: In order to reduce the clinical impact of life-threatening Candida infections, prompt diagnosis and appropriate treatment are strictly required. Preemptive strategies, mainly based on serological markers [i.e., (1-3)-β-D-glucan assay] are progressively replacing prophylactic and empirical approaches, limiting inadequate antifungal use...
October 2015: Current Opinion in Critical Care
Bruno Levy, Olivier Bastien, Bendjelid Karim, Karim Benjelid, Alain Cariou, Tahar Chouihed, Alain Combes, Alexandre Mebazaa, Bruno Megarbane, Patrick Plaisance, Alexandre Ouattara, Christian Spaulding, Christian Splaulding, Jean-Louis Teboul, Fabrice Vanhuyse, Thierry Boulain, Kaldoun Kuteifan
Unlike for septic shock, there are no specific international recommendations regarding the management of cardiogenic shock (CS) in critically ill patients. We present herein recommendations for the management of cardiogenic shock in adults, developed with the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system by an expert group of the French-Language Society of Intensive Care (Société de Réanimation de Langue Française (SRLF)), with the participation the French Society of Anesthesia and Intensive Care (SFAR), the French Cardiology Society (SFC), the French Emergency Medicine Society (SFMU), and the French Society of Thoracic and Cardiovascular Surgery (SFCTCV)...
December 2015: Annals of Intensive Care
R Scott Stephens, Glenn J R Whitman
OBJECTIVES: The armamentarium of cardiac surgery continues to expand, and the cardiac intensivist must be familiar with a broad spectrum of procedures and their specific management concerns. In the conclusion of this two-part review, we will review procedure-specific concerns after cardiac surgery and the management of common complications. We also discuss performance improvement and outcome assurance. DATA SOURCE AND SYNTHESIS: Narrative review of relative English language peer-reviewed medical literature...
September 2015: Critical Care Medicine
Hafid Ait-Oufella, Simon Bourcier, Sophie Lehoux, Bertrand Guidet
PURPOSE OF REVIEW: Despite the progress made over the past 20 years in the treatment of septic shock, mortality remains high. Microcirculatory disorders raise considerable interest aiming to improve the understanding of the physiopathology of septic shock and its management. RECENT FINDINGS: Numerous experimental and clinical studies have gradually focused on the analysis of microcirculatory blood flow and identified alterations in small vessels. These microcirculatory abnormalities appear early, are heterogeneous, and are directly linked to organ failure, as well as the patient's prognosis...
August 2015: Current Opinion in Critical Care
Nader Makki, Theresa M Brennan, Saket Girotra
Acute coronary syndrome (ACS) is a major health care and economic burden in the United States and accounts for more than 1 million hospitalizations annually. The morbidity and mortality due to ACS are substantial-nearly half of all deaths due to coronary heart disease occur following an ACS. This review provides an up-to-date summary of the pathophysiology, diagnosis, and treatment of ACS. We also provide an overview of the management of common hemodynamic disturbances and myocardial infarction complications that physicians often encounter in an intensive care setting...
May 2015: Journal of Intensive Care Medicine
Julian L Seifter
No abstract text is available yet for this article.
November 6, 2014: New England Journal of Medicine
Duane J Funk, Eric Jacobsohn, Anand Kumar
OBJECTIVE: To provide a conceptual and clinical review of the physiology of the venous system as it is relates to cardiac function in health and disease. DATA: An integration of venous and cardiac physiology under normal conditions, critical illness, and resuscitation. SUMMARY: The usual teaching of cardiac physiology focuses on left ventricular function. As a result of the wide array of shock states with which intensivists contend, an approach that takes into account the function of the venous system and its interaction with the right and left heart may be more useful...
January 2013: Critical Care Medicine
Jonathan Ailon, Ophyr Mourad, Vince Chien, Tomas Saun, Shelly P Dev
New England Journal of Medicine, Volume 371, Issue 15, October 2014.
October 9, 2014: New England Journal of Medicine
Lars B Holst, Nicolai Haase, Jørn Wetterslev, Jan Wernerman, Anne B Guttormsen, Sari Karlsson, Pär I Johansson, Anders Aneman, Marianne L Vang, Robert Winding, Lars Nebrich, Helle L Nibro, Bodil S Rasmussen, Johnny R M Lauridsen, Jane S Nielsen, Anders Oldner, Ville Pettilä, Maria B Cronhjort, Lasse H Andersen, Ulf G Pedersen, Nanna Reiter, Jørgen Wiis, Jonathan O White, Lene Russell, Klaus J Thornberg, Peter B Hjortrup, Rasmus G Müller, Morten H Møller, Morten Steensen, Inga Tjäder, Kristina Kilsand, Suzanne Odeberg-Wernerman, Brit Sjøbø, Helle Bundgaard, Maria A Thyø, David Lodahl, Rikke Mærkedahl, Carsten Albeck, Dorte Illum, Mary Kruse, Per Winkel, Anders Perner
BACKGROUND: Blood transfusions are frequently given to patients with septic shock. However, the benefits and harms of different hemoglobin thresholds for transfusion have not been established. METHODS: In this multicenter, parallel-group trial, we randomly assigned patients in the intensive care unit (ICU) who had septic shock and a hemoglobin concentration of 9 g per deciliter or less to receive 1 unit of leukoreduced red cells when the hemoglobin level was 7 g per deciliter or less (lower threshold) or when the level was 9 g per deciliter or less (higher threshold) during the ICU stay...
October 9, 2014: New England Journal of Medicine
Daniel F McAuley, John G Laffey, Cecilia M O'Kane, Gavin D Perkins, Brian Mullan, T John Trinder, Paul Johnston, Philip A Hopkins, Andrew J Johnston, Cliona McDowell, Christine McNally
BACKGROUND: Studies in animals and in vitro and phase 2 studies in humans suggest that statins may be beneficial in the treatment of the acute respiratory distress syndrome (ARDS). This study tested the hypothesis that treatment with simvastatin would improve clinical outcomes in patients with ARDS. METHODS: In this multicenter, double-blind clinical trial, we randomly assigned (in a 1:1 ratio) patients with an onset of ARDS within the previous 48 hours to receive enteral simvastatin at a dose of 80 mg or placebo once daily for a maximum of 28 days...
October 30, 2014: New England Journal of Medicine
Paul C Hébert, Jeffrey L Carson
New England Journal of Medicine, Volume 0, Issue 0, Ahead of Print.
October 9, 2014: New England Journal of Medicine
2014-10-12 05:10:47
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