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Coronary Care Unit

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42 papers 25 to 100 followers
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...
July 4, 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
Allison K Guitor, Gerard D Wright
Since their introduction into healthcare and clinical practice in the early 20th century, antibiotics have revolutionized medicine. Alarmingly, these drugs are increasingly threatened by bacteria that have developed a broad diversity of resistance mechanisms. Antibiotic resistance can be transferred between bacteria, often on mobile genetic elements, acquired from the environment, or arise through mutation due to selective pressures of the drugs themselves. There are various strategies to resistance including active efflux of the drug from the bacterial cell, reduced permeability of the cell envelope, alteration of the drug's target within the bacterial cell, and modification or destruction of the antibiotic...
June 27, 2018: Chest
Vivian H Chu
No abstract text is available yet for this article.
July 3, 2018: JAMA: the Journal of the American Medical Association
Andrew Wang, Jeffrey G Gaca, Vivian H Chu
Importance: Infective endocarditis occurs in approximately 15 of 100 000 people in the United States and has increased in incidence. Clinicians must make treatment decisions with respect to prophylaxis, surgical management, specific antibiotics, and the length of treatment in the setting of emerging, sometimes inconclusive clinical research findings. Observations: Community-associated infective endocarditis remains the predominant form of the disease; however, health care accounts for one-third of cases in high-income countries...
July 3, 2018: JAMA: the Journal of the American Medical Association
Manu L N G Malbrain, Niels Van Regenmortel, Bernd Saugel, Brecht De Tavernier, Pieter-Jan Van Gaal, Olivier Joannes-Boyau, Jean-Louis Teboul, Todd W Rice, Monty Mythen, Xavier Monnet
In patients with septic shock, the administration of fluids during initial hemodynamic resuscitation remains a major therapeutic challenge. We are faced with many open questions regarding the type, dose and timing of intravenous fluid administration. There are only four major indications for intravenous fluid administration: aside from resuscitation, intravenous fluids have many other uses including maintenance and replacement of total body water and electrolytes, as carriers for medications and for parenteral nutrition...
May 22, 2018: Annals of Intensive Care
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
2015-04-18 09:00:41
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