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Coronary Care Unit

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29 papers 25 to 100 followers
Raquel S Santos, Pedro L Silva, Paolo Pelosi, Patricia Rm Rocco
Acute respiratory distress syndrome (ARDS) represents a serious problem in critically ill patients and is associated with in-hospital mortality rates of 33%-52%. Recruitment maneuvers (RMs) are a simple, low-cost, feasible intervention that can be performed at the bedside in patients with ARDS. RMs are characterized by the application of airway pressure to increase transpulmonary pressure transiently. Once non-aerated lung units are reopened, improvements are observed in respiratory system mechanics, alveolar reaeration on computed tomography, and improvements in gas exchange (functional recruitment)...
November 4, 2015: World Journal of Critical Care Medicine
Shinya Unai, Daizo Tanaka, Nicholas Ruggiero, Hitoshi Hirose, Nicholas C Cavarocchi
Extracorporeal membrane oxygenation (ECMO) in our institution resulted in near total mortality prior to the establishment of an algorithm-based program in July 2010. We hypothesized that an algorithm-based ECMO program improves the outcome of patients with acute myocardial infarction complicated with cardiogenic shock. Between March 2003 and July 2013, 29 patients underwent emergent catheterization for acute myocardial infarction due to left main or proximal left anterior descending artery occlusion complicated with cardiogenic shock (defined as systolic blood pressure <90 mm Hg despite multiple inotropes, with or without intra-aortic balloon pump, lactic acidosis)...
March 2016: Artificial Organs
David Schibilsky, Henning Lausberg, Christoph Haller, Matthias Lenglinger, Barbara Woernle, Helene Haeberle, Peter Rosenberger, Tobias Walker, Christian Schlensak
The catheter-based Impella 5.0 left ventricular assist device (LVAD) is a powerful and less invasive alternative for patients in cardiogenic shock. The use of this device as a primary mechanical circulatory support strategy in INTERMACS II patients should be evaluated. From April 2014 to August 2014, eight Impella 5.0 devices were implanted in seven patients via the axillary artery access (six right and two left). We analyzed the outcome of the four patients in whom the Impella 5.0 device was implanted for the purpose of primary stabilization of cardiogenic shock (INTERMACS II)...
August 2015: Artificial Organs
Alain Rudiger
No abstract text is available yet for this article.
May 2015: European Journal of Heart Failure
Charanjit S Rihal, Srihari S Naidu, Michael M Givertz, Wilson Y Szeto, James A Burke, Navin K Kapur, Morton Kern, Kirk N Garratt, James A Goldstein, Vivian Dimas, Thomas Tu
Although historically the intra-aortic balloon pump has been the only mechanical circulatory support device available to clinicians, a number of new devices have become commercially available and have entered clinical practice. These include axial flow pumps, such as Impella(®); left atrial to femoral artery bypass pumps, specifically the TandemHeart; and new devices for institution of extracorporeal membrane oxygenation. These devices differ significantly in their hemodynamic effects, insertion, monitoring, and clinical applicability...
May 19, 2015: Journal of the American College of Cardiology
Emma J de Louw, Pepijn O Sun, Joon Lee, Mengling Feng, Roger G Mark, Leo Anthony Celi, Kenneth J Mukamal, John Danziger
OBJECTIVE: Sodium retention occurs commonly in cardiac and liver disease, requiring the administration of diuretics to restore fluid balance. Whether obesity is associated with sodium retention has not been fully evaluated. METHODS: In a large single-center cohort of critically ill patients, we evaluated whether admission body mass index was associated with the administration of either oral or intravenous diuretics during the intensive care unit (ICU) stay. MAIN RESULTS: Of 7724 critically ill patients, 3946 (51...
June 2015: Journal of Critical Care
Elena Spinelli, Robert H Bartlett
OBJECTIVE: The objective of this report is to review the physiology and management of anemia in critical care. Selected publications on physiology and transfusion related to anemia and critical care, including the modern randomized trials of conservative versus liberal transfusion policy, were used. Anemia is compensated and tolerated in most critically ill patients as long as oxygen delivery is at least twice oxygen consumption. There are risks to blood transfusion which can be minimized by blood banking practice...
June 2016: Journal of Intensive Care Medicine
Belén Álvarez-Álvarez, Noelia Bouzas-Cruz, Emad Abu-Assi, Sergio Raposeiras-Roubin, Andrea López-López, María Cristina González Cambeiro, Carlos Peña-Gil, José María García-Acuña, José Ramón González-Juanatey
INTRODUCTION AND OBJECTIVES: There is little information on the effect of acute coronary syndrome complicated by ventricular fibrillation on the long-term incidence of sudden cardiac death. We analyzed this effect in a contemporary cohort of patients with acute coronary syndrome. METHODS: We studied 5302 consecutive patients with acute coronary syndrome between December 2003 and December 2012. We compared mortality during and after hospitalization according to the presence or absence of ventricular fibrillation...
October 2015: Revista Española de Cardiología
Jin Sup Park, Kwang Soo Cha, Dae Sung Lee, Donghun Shin, Hye Won Lee, Jun-Hyok Oh, Jeong Su Kim, Jung Hyun Choi, Yong Hyun Park, Han Cheol Lee, June Hong Kim, Kook-Jin Chun, Taek Jong Hong, Myung Ho Jeong, Youngkeun Ahn, Shung Chull Chae, Young Jo Kim
OBJECTIVE: The value of multivessel revascularisation in cardiogenic shock and multivessel disease (MVD) is still not clear. We compared outcomes following culprit vessel or multivessel revascularisation in patients with ST-elevation myocardial infarction (STEMI), cardiogenic shock and MVD. METHODS: From 16 620 patients with STEMI who underwent primary percutaneous coronary intervention (PCI) in a nationwide, prospective, multicentre registry between January 2006 and December 2012, 510 eligible patients were selected and divided into culprit vessel revascularisation (n=386, 75...
August 2015: Heart: Official Journal of the British Cardiac Society
Charles L Sprung, Djillali Annane, Didier Keh, Rui Moreno, Mervyn Singer, Klaus Freivogel, Yoram G Weiss, Julie Benbenishty, Armin Kalenka, Helmuth Forst, Pierre-Francois Laterre, Konrad Reinhart, Brian H Cuthbertson, Didier Payen, Josef Briegel
BACKGROUND: Hydrocortisone is widely used in patients with septic shock even though a survival benefit has been reported only in patients who remained hypotensive after fluid and vasopressor resuscitation and whose plasma cortisol levels did not rise appropriately after the administration of corticotropin. METHODS: In this multicenter, randomized, double-blind, placebo-controlled trial, we assigned 251 patients to receive 50 mg of intravenous hydrocortisone and 248 patients to receive placebo every 6 hours for 5 days; the dose was then tapered during a 6-day period...
January 10, 2008: New England Journal of Medicine
Paul M Palevsky, Jane Hongyuan Zhang, Theresa Z O'Connor, Glenn M Chertow, Susan T Crowley, Devasmita Choudhury, Kevin Finkel, John A Kellum, Emil Paganini, Roland M H Schein, Mark W Smith, Kathleen M Swanson, B Taylor Thompson, Anitha Vijayan, Suzanne Watnick, Robert A Star, Peter Peduzzi
BACKGROUND: The optimal intensity of renal-replacement therapy in critically ill patients with acute kidney injury is controversial. METHODS: We randomly assigned critically ill patients with acute kidney injury and failure of at least one nonrenal organ or sepsis to receive intensive or less intensive renal-replacement therapy. The primary end point was death from any cause by day 60. In both study groups, hemodynamically stable patients underwent intermittent hemodialysis, and hemodynamically unstable patients underwent continuous venovenous hemodiafiltration or sustained low-efficiency dialysis...
July 3, 2008: New England Journal of Medicine
Prashant N Mohite, Sundeep Kaul, Anton Sabashnikov, Naufal Rashid, Javid Fatullayev, Bartlomiej Zych, Aron-Frederik Popov, Olaf Maunz, Nikhil P Patil, Diana Garcia-Saez, Fabio DeRobertis, Toufan Bahrami, Mohamed Amrani, Nicholas R Banner, Andre R Simon
OBJECTIVES: Traditionally, patients on extracorporeal life support (ECLS) are sedated and mechanically ventilated and therefore prone to complications related to immobility and ventilation. We adopted this 'Awake ECLS' strategy for the patients with refractory cardiogenic shock (RCS) as a bridge to decision. METHODS: Sixty-eight patients with RCS were supported by ECLS (All veno-arterial) in years 2010-2014. Patients that could not survive 24 h after ECLS implantation (9 patients) were excluded from the study...
June 2015: Interactive Cardiovascular and Thoracic Surgery
Christian Jung, Georg Fuernau, Suzanne de Waha, Ingo Eitel, Steffen Desch, Gerhard Schuler, Hans R Figulla, Holger Thiele
OBJECTIVES: This study sought to evaluate the influence of intraaortic balloon pump (IABP) counterpulsation on the microcirculation in patients with cardiogenic shock (CS) complicating acute myocardial infarction. BACKGROUND: In patients with shock profound alterations of the microcirculation have been observed and their clinical relevance has been described. Different treatment strategies exist to improve microvascular perfusion in patients with CS; however, the role of IABP treatment is not clearly defined...
August 2015: Clinical Research in Cardiology: Official Journal of the German Cardiac Society
Holger Thiele, E Magnus Ohman, Steffen Desch, Ingo Eitel, Suzanne de Waha
Cardiogenic shock (CS) remains the most common cause of death in patients with acute myocardial infarction although mortality could be reduced from formerly ∼80% to 40-50%. In addition to percutaneous coronary intervention or coronary artery bypass grafting, catecholamines, fluids, intraaortic balloon pumping (IABP), and also active assist devices are widely used for CS management. However, there is only limited evidence for any of the above treatments except for early revascularization and the relative ineffectiveness of IABP...
May 21, 2015: European Heart Journal
N Aghili, S Kang, N K Kapur
During the past 50 years, pharmacologic advancements for cardiovascular risk factors and device innovation for the management of coronary disease, including acute myocardial infarction have radically changed the landscape of heart disease. At present, nearly 25% of individuals develop chronic heart failure after an acute myocardial infarction. It is estimated that nearly 2.6% of the American population suffers from heart failure. In the modern era, miniaturized continuous flow ventricular assist devices are now demonstrating nearly 75% 2-year survival rates with improved patient functionality...
February 2015: Minerva Cardioangiologica
Leonardo P de Carvalho, Fei Gao, Qifeng Chen, Ling-Ling Sim, Tian-Hai Koh, David Foo, Hean-Yee Ong, Khim-Leng Tong, Huay-Cheem Tan, Tiong-Cheng Yeo, Khuan-Yew Chow, A Mark Richards, Eric D Peterson, Terrance Chua, Mark Y Chan
The Killip classification of acute heart failure was developed decades ago to predict short-term mortality in patients with acute myocardial infarction (AMI). The aim of this study was to determine the long-term prognosis of acute heart failure graded according to the Killip classification in 15,235 unselected patients hospitalized for AMI from 2000 to 2005. Vital status for each patient was ascertained, through to March 1, 2012, from linkage with national death records. A stepwise gradient in the adjusted hazard ratio (HR) for 12-year mortality was observed with increasing Killip class: class I (n = 10,123), HR 1...
April 1, 2015: American Journal of Cardiology
Patrick R Lawler, David A Silver, Benjamin M Scirica, Gregory S Couper, Gerald L Weinhouse, Phillip C Camp
No abstract text is available yet for this article.
February 17, 2015: Circulation
Stephen A Esper, Christian Bermudez, Eric J Dueweke, Robert Kormos, Kathirvel Subramaniam, Suresh Mulukutla, Penny Sappington, Jonathan Waters, Sameer J Khandhar
BACKGROUND: Acute coronary syndrome (ACS) complicated by shock is associated with high mortality despite the use of percutaneous support devices. Extracorporeal membrane oxygenation (ECMO) offers cardiopulmonary support but its safety and efficacy in the ACS setting is still under investigation. METHODS: We reviewed the clinical characteristics and course of 18 consecutive patients who received femoral veno-arterial ECMO in the cardiac catheterization lab for severe shock due to ACS at our center between 2007 and 2013...
October 2015: Catheterization and Cardiovascular Interventions
Jozef L Van Herck, Marc J Claeys, Rudi De Paep, Paul L Van Herck, Christiaan J Vrints, Philippe G Jorens
Cardiogenic shock complicates approximately 5-10% of cases with acute myocardial infarction and carries a poor prognosis. Early revascularization remains the cornerstone treatment of cardiogenic shock complicating myocardial infarction. Inotropic and/or vasopressor agents can be used for haemodynamic stabilization, although this comes at the expense of increased myocardial oxygen consumption and extended myocardial ischaemia. In recent years, the use of mechanical circulatory support has significantly increased...
June 2015: European Heart Journal. Acute Cardiovascular Care
Eisuke Kagawa
Cardiac arrest is a major cause of unexpected death in developed countries, and patients with cardiac arrest generally have a poor prognosis. Despite the use of conventional cardiopulmonary resuscitation (CPR), few patients could achieve return of spontaneous circulation (ROSC). Even if ROSC was achieved, some patients showed re-arrest and many survivors were unable to fully resume their former lifestyles because of severe neurological deficits. Safar et al reported the effectiveness of emergency cardiopulmonary bypass in an animal model and discussed the possibility of employing cardiopulmonary bypass as a CPR method...
April 4, 2012: World Journal of Critical Care Medicine
2015-01-18 12:26:03
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