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Coronary Care Unit

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53 papers 25 to 100 followers
Srijan Tandukar, Paul M Palevsky
Continuous renal replacement therapy (CRRT) is commonly employed to provide renal support for critically ill patients with acute kidney injury (AKI); particularly patients who are hemodynamically unstable. A variety of techniques that vary in their mode of solute clearance may be used, including continuous venovenous hemofiltration (CVVH) with predominantly convective solute clearance, continuous venovenous hemodialysis (CVVHD) with predominantly diffusive solute clearance and continuous venovenous hemodiafiltration (CVVHDF), which combines both dialysis and hemofiltration...
September 25, 2018: Chest
Thomas F Lüscher
No abstract text is available yet for this article.
September 21, 2018: European Heart Journal
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
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
Alex Calhoun
Extracorporeal membrane oxygenation (ECMO) is used for both cardiac and pulmonary failure when conventional measures are no longer substantial in supporting life. ECMO is not a permanent device. It is used as a temporary measure to allow the lungs and heart, as well as other organs to recover. If recovery is not possible, it may also be used as a bridge to a more permanent device such as the left ventricular assist device or heart or lung transplantation. This is a detailed description of the differences between venovenous ECMO and venoarterial ECMO and the nursing care that is associated with the two...
October 2018: Critical Care Nursing Quarterly
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
Raphaël P Martins, Erwan Flecher, Solène Le Pennec-Prigent, Vincent Galand
No abstract text is available yet for this article.
August 24, 2018: Revista Española de Cardiología
Elena Puerto, Ana Viana-Tejedor, Manuel Martínez-Sellés, Laura Domínguez-Pérez, Guillermo Moreno, Roberto Martín-Asenjo, Héctor Bueno
BACKGROUND: Reperfusion therapy led to an important decline in mortality after ST-segment elevation myocardial infarction (STEMI). Because the rate of cardiogenic shock has not changed dramatically, the authors speculated that a reduction in the incidence or fatality rate of mechanical complications (MCs), the second cause of death in these patients, could explain this decrease. OBJECTIVES: This study sought to assess time trends in the incidence, management, and fatality rates of MC, and its influence on short-term mortality in old patients with STEMI...
August 28, 2018: Journal of the American College of Cardiology
Holger Thiele, Ibrahim Akin, Marcus Sandri, Suzanne de Waha-Thiele, Roza Meyer-Saraei, Georg Fuernau, Ingo Eitel, Peter Nordbeck, Tobias Geisler, Ulf Landmesser, Carsten Skurk, Andreas Fach, Alexander Jobs, Harald Lapp, Jan J Piek, Marko Noc, Tomaž Goslar, Stephan B Felix, Lars S Maier, Janina Stepinska, Keith Oldroyd, Pranas Serpytis, Gilles Montalescot, Olivier Barthelemy, Kurt Huber, Stephan Windecker, Lukas Hunziker, Stefano Savonitto, Patrizia Torremante, Christiaan Vrints, Steffen Schneider, Uwe Zeymer, Steffen Desch
Background Among patients with acute myocardial infarction, cardiogenic shock, and multivessel coronary artery disease, the risk of a composite of death from any cause or severe renal failure leading to renal-replacement therapy at 30 days was found to be lower with percutaneous coronary intervention (PCI) of the culprit lesion only than with immediate multivessel PCI. We evaluated clinical outcomes at 1 year. Methods We randomly assigned 706 patients to either culprit-lesion-only PCI or immediate multivessel PCI...
August 25, 2018: New England Journal of Medicine
Nicolas Meneveau, Benoit Guillon, Benjamin Planquette, Gaël Piton, Antoine Kimmoun, Lucie Gaide-Chevronnay, Nadia Aissaoui, Arthur Neuschwander, Elie Zogheib, Hervé Dupont, Sebastien Pili-Floury, Fiona Ecarnot, François Schiele, Nicolas Deye, Nicolas de Prost, Raphaël Favory, Philippe Girard, Mircea Cristinar, Alexis Ferré, Guy Meyer, Gilles Capellier, Olivier Sanchez
Aims: The role of extracorporeal membrane oxygenation (ECMO) remains ill defined in pulmonary embolism (PE). We investigated outcomes in patients with high-risk PE undergoing ECMO according to initial therapeutic strategy. Methods and results: From 01 January 2014 to 31 December 2015, 180 patients from 13 Departments in nine centres with high-risk PE were retrospectively included. Among those undergoing ECMO, we compared characteristics and outcomes according to adjunctive treatment strategy (systemic thrombolysis, surgical embolectomy, or no reperfusion therapy)...
August 22, 2018: European Heart Journal
Mathew Jose Chakaramakkil, Cumaraswamy Sivathasan
PURPOSE OF REVIEW: This review aims to discuss the role of ECMO in the treatment of cardiogenic shock in heart failure. RECENT FINDINGS: Trials done previously have shown that IABP does not improve survival in cardiogenic shock compared to medical treatment, and that neither Impella 2.5 nor TandemHeart improves survival compared to IABP. The "IMPRESS in severe shock" trial compared Impella CP with IABP and found no difference in survival. A meta-analysis of cohort studies comparing ECMO with IABP showed 33% improved 30-day survival with ECMO (risk difference 33%; 95% CI 14-52%; p = 0...
August 16, 2018: Current Cardiology Reports
Jessica O'Brien, Christopher M Reid, Nick Andrianopoulos, Andrew E Ajani, David J Clark, Henry Krum, Philippa Loane, Melanie Freeman, Martin Sebastian, Angela L Brennan, James Shaw, Anthony M Dart, Stephen J Duffy
Data from previous studies of patients with heart failure and coronary artery disease suggest that those with higher resting heart rates (HRs) have worse cardiovascular outcomes. We sought to evaluate whether HR immediately before percutaneous coronary intervention (PCI) is an independent predictor for 30-day outcome. We analyzed the outcome of 3,720 patients who had HR recorded before PCI from the Melbourne Interventional Group registry. HR and outcomes were analyzed by quintiles, and secondarily by dichotomizing into <70 or ≥70 beats/min...
October 1, 2018: American Journal of Cardiology
Chi-Cheng Huang, Jung-Cheng Hsu, Yen-Wen Wu, Shin-Rong Ke, Jih-Hsin Huang, Kuan-Ming Chiu, Pen-Chih Liao
BACKGROUND: The mortality of patients with ST-segment elevation myocardial infarction (STEMI) and refractory cardiogenic shock (RCS) is high. Extracorporeal membrane oxygenation (ECMO) before percutaneous coronary intervention (PCI) has shown some favorable results, but this may delay door-to-balloon (D2B) time. Whether the benefit surpasses the risk of longer D2B time remains controversial. METHODS: From January 2005 to December 2014, there were 46 patients with STEMI RCS who received ECMO and PCI...
July 7, 2018: International Journal of Cardiology
Nir Uriel, Gabriel Sayer, Shiva Annamalai, Navin K Kapur, Daniel Burkhoff
Myocardial injury induces significant changes in ventricular structure and function at both the cellular and anatomic level, leading to ventricular remodeling and subsequent heart failure. Unloading left ventricular pressure has been studied in both the short-term and long-term settings, as a means of preventing or reversing cardiac remodeling. In acute myocardial infarction, cardiac unloading is used to reduce oxygen demand and limit infarct size. Research has demonstrated the benefits of short-term unloading with mechanical circulatory support devices before reperfusion in the context of acute myocardial infarction with cardiogenic shock, and a confirmatory trial is ongoing...
July 31, 2018: Journal of the American College of Cardiology
David A Talan
No abstract text is available yet for this article.
July 24, 2018: JAMA: the Journal of the American Medical Association
Georg Fuernau, Johannes Beck, Steffen Desch, Ingo Eitel, Christian Jung, Sandra Erbs, Norman Mangner, Philipp Lurz, Karl Fengler, Alexander Jobs, Reinhard Vonthein, Suzanne de Waha-Thiele, Marcus Sandri, Gerhard Schuler, Holger Thiele
Background -Experimental trials suggest improved outcome by mild therapeutic hypothermia for cardiogenic shock following acute myocardial infarction. The objective of this study was to inves-tigate hemodynamic effects of mild therapeutic hypothermia in patients with cardiogenic shock complicating acute myocardial infarction. Methods -Patients (n=40) with cardiogenic shock undergoing primary percutaneous coronary in-tervention without classical indication for mild therapeutic hypothermia underwent randomization in a 1:1 fashion to mild therapeutic hypothermia for 24 h or control...
July 19, 2018: Circulation
Simon Lambden, Ben C Creagh-Brown, Julie Hunt, Charlotte Summers, Lui G Forni
Vasoplegia is the syndrome of pathological low systemic vascular resistance, the dominant clinical feature of which is reduced blood pressure in the presence of a normal or raised cardiac output. The vasoplegic syndrome is encountered in many clinical scenarios, including septic shock, post-cardiac bypass and after surgery, burns and trauma, but despite this, uniform clinical definitions are lacking, which renders translational research in this area challenging. We discuss the role of vasoplegia in these contexts and the criteria that are used to describe it are discussed...
July 6, 2018: Critical Care: the Official Journal of the Critical Care Forum
Robin Hofmann, Stefan K James, Tomas Jernberg, Bertil Lindahl, David Erlinge, Nils Witt, Gabriel Arefalk, Mats Frick, Joakim Alfredsson, Lennart Nilsson, Annica Ravn-Fischer, Elmir Omerovic, Thomas Kellerth, David Sparv, Ulf Ekelund, Rickard Linder, Mattias Ekström, Jörg Lauermann, Urban Haaga, John Pernow, Ollie Östlund, Johan Herlitz, Leif Svensson
BACKGROUND: The clinical effect of routine oxygen therapy in patients with suspected acute myocardial infarction who do not have hypoxemia at baseline is uncertain. METHODS: In this registry-based randomized clinical trial, we used nationwide Swedish registries for patient enrollment and data collection. Patients with suspected myocardial infarction and an oxygen saturation of 90% or higher were randomly assigned to receive either supplemental oxygen (6 liters per minute for 6 to 12 hours, delivered through an open face mask) or ambient air...
September 28, 2017: New England Journal of Medicine
Sean van Diepen
No abstract text is available yet for this article.
July 10, 2018: Journal of the American College of Cardiology
Rodrigo Santos Biondi, Vitor Salvatore Barzilai, André Luis Conde Watanabe, Gustavo de Sousa Arantes Ferreira, Fernando Antibas Atik
We report the case of a female patient, 58 years of age, without known heart disease, who underwent liver transplantation without complications. On the second postoperative day, the patient developed cardiogenic shock secondary to stress-induced cardiomyopathy (Takotsubo-like syndrome). The patient was successfully managed with veno-arterial peripheral extracorporeal membrane oxygenation for 6 days, with complete recovery of cardiac function and of the hepatic graft. Coronary syndrome and acute myocarditis were excluded as the causes of the shock...
April 2018: Revista Brasileira de Terapia Intensiva
2018-07-13 15:23:31
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