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Critial Care Papers

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59 papers 25 to 100 followers
https://www.readbyqxmd.com/read/27276234/intensive-blood-pressure-lowering-in-patients-with-acute-cerebral-hemorrhage
#1
RANDOMIZED CONTROLLED TRIAL
Adnan I Qureshi, Yuko Y Palesch, William G Barsan, Daniel F Hanley, Chung Y Hsu, Renee L Martin, Claudia S Moy, Robert Silbergleit, Thorsten Steiner, Jose I Suarez, Kazunori Toyoda, Yongjun Wang, Haruko Yamamoto, Byung-Woo Yoon
Background Limited data are available to guide the choice of a target for the systolic blood-pressure level when treating acute hypertensive response in patients with intracerebral hemorrhage. Methods We randomly assigned eligible participants with intracerebral hemorrhage (volume, <60 cm(3)) and a Glasgow Coma Scale (GCS) score of 5 or more (on a scale from 3 to 15, with lower scores indicating worse condition) to a systolic blood-pressure target of 110 to 139 mm Hg (intensive treatment) or a target of 140 to 179 mm Hg (standard treatment) in order to test the superiority of intensive reduction of systolic blood pressure to standard reduction; intravenous nicardipine to lower blood pressure was administered within 4...
September 15, 2016: New England Journal of Medicine
https://www.readbyqxmd.com/read/27239312/neurocritical-care-update
#2
REVIEW
Yasuhiro Kuroda
This update comprises six important topics under neurocritical care that require reevaluation. For post-cardiac arrest brain injury, the evaluation of the injury and its corresponding therapy, including temperature modulation, is required. Analgosedation for target temperature management is an essential strategy to prevent shivering and minimizes endogenous stress induced by catecholamine surges. For severe traumatic brain injury, the diverse effects of therapeutic hypothermia depend on the complicated pathophysiology of the condition...
2016: Journal of Intensive Care
https://www.readbyqxmd.com/read/27060027/contemporary-extracorporeal-membrane-oxygenation-therapy-in-adults-fundamental-principles-and-systematic-review-of-the-evidence
#3
EDITORIAL
John J Squiers, Brian Lima, J Michael DiMaio
Extracorporeal membrane oxygenation (ECMO) provides days to weeks of support for patients with respiratory, cardiac, or combined cardiopulmonary failure. Since ECMO was first reported in 1974, nearly 70,000 runs of ECMO have been implemented, and the use of ECMO in adults increased by more than 400% from 2006 to 2011 in the United States. A variety of factors, including the 2009 influenza A epidemic, results from recent clinical trials, and improvements in ECMO technology, have motivated this increased use in adults...
July 2016: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/27040797/physiology-of-gas-exchange-during-ecmo-for-respiratory-failure
#4
Robert H Bartlett
Management of gas exchange using extracorporeal membrane oxygenation (ECMO) in respiratory failure is very different than management when the patient is dependent on mechanical ventilation. All the gas exchange occurs in the membrane lung, and the arterial oxygenation is the result of mixing the ECMO blood with the native venous blood. To manage patients on ECMO, it is essential to understand the physiology described in this essay.
April 3, 2016: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/24363239/clinical-and-laboratory-diagnosis-of-heparin-induced-thrombocytopenia-an-integrated-approach
#5
REVIEW
Adam Cuker
Heparin-induced thrombocytopenia (HIT) is a clinicopathologic disorder that predisposes to thrombosis. Diagnosis rests on a compatible clinical picture and laboratory evidence of antiplatelet factor 4 (PF4)/heparin antibodies that activate platelets in a heparin-dependent manner. Rapid and accurate diagnosis is paramount to avoid the perils of misdiagnosis. Clinical evaluation may be guided by scoring systems such as the 4Ts and HIT Expert Probability (HEP) score. Laboratory tests include immunoassays, such as the PF4/heparin enzyme-linked immunosorbent assay (ELISA) and functional tests such as the 14C-serotonin release assay and heparin-induced platelet activation assay...
February 2014: Seminars in Thrombosis and Hemostasis
https://www.readbyqxmd.com/read/25955872/nonsurgical-acute-traumatic-subdural-hematoma-what-is-the-risk
#6
Paul Bajsarowicz, Ipshita Prakash, Julie Lamoureux, Rajeet Singh Saluja, Mitra Feyz, Mohammad Maleki, Judith Marcoux
OBJECT: The Brain Trauma Foundation has published guidelines on the surgical management of traumatic subdural hematoma (SDH). However, no data exist on the proportion of patients with SDH that can be selected for conservative management and what is the outcome of these patients. The goals of this study were as follows: 1) to establish what proportion of patients are initially treated conservatively; 2) to determine what proportion of patients will deteriorate and require surgical evacuation; and 3) to identify risk factors associated with deterioration and delayed surgery...
November 2015: Journal of Neurosurgery
https://www.readbyqxmd.com/read/24363148/treatment-of-acute-subdural-hematoma
#7
Carter Gerard, Katharina M Busl
Clinical presentation, neurologic condition, and imaging findings are the key components in establishing a treatment plan for acute SDH. Location and size of the SDH and presence of midline shift can rapidly be determined by computed tomography of the head. Immediate laboratory work up must include PT, PTT, INR, and platelet count. Presence of a coagulopathy or bleeding diathesis requires immediate reversal and treatment with the appropriate agent(s), in order to lessen the risk of hematoma expansion. Reversal protocols used are similar to those for intracerebral hemorrhage, with institutional variations...
January 2014: Current Treatment Options in Neurology
https://www.readbyqxmd.com/read/26558188/hepatorenal-syndrome-update-on-diagnosis-and-treatment
#8
REVIEW
Olga Baraldi, Chiara Valentini, Gabriele Donati, Giorgia Comai, Vania Cuna, Irene Capelli, Maria Laura Angelini, Maria Ilaria Moretti, Andrea Angeletti, Fabio Piscaglia, Gaetano La Manna
Acute kidney injury (AKI) is a common complication in patients with end-stage liver disease and advanced cirrhosis regardless of the underlying cause. Hepatorenal syndrome (HRS), a functional form of kidney failure, is one of the many possible causes of AKI. HRS is potentially reversible but involves highly complex pathogenetic mechanisms and equally complex clinical and therapeutic management. Once HRS has developed, it has a very poor prognosis. This review focuses on the diagnostic approach to HRS and discusses the therapeutic protocols currently adopted in clinical practice...
November 6, 2015: World Journal of Nephrology
https://www.readbyqxmd.com/read/26385583/management-of-heart-failure-with-preserved-ejection-fraction-a-review
#9
REVIEW
Shane Nanayakkara, David M Kaye
PURPOSE: The purpose of this article was to review the clinical management of patients with heart failure with preserved ejection fraction (HFPEF). METHODS: For this critical review, electronic databases (MEDLINE, EMBASE, PubMed) were searched for relevant basic research studies and randomized clinical trials recently published or presented at major meetings. Details of in-progress or planned studies were obtained from the ClinicalTrials.gov website. The range of publication dates was the year 2000 to 2015...
October 1, 2015: Clinical Therapeutics
https://www.readbyqxmd.com/read/26517857/management-of-the-traumatized-airway
#10
REVIEW
Uday Jain, Maureen McCunn, Charles E Smith, Jean-Francois Pittet
There is a lack of evidence-based approach regarding the best practice for airway management in patients with a traumatized airway. General recommendations for the management of the traumatized airway are summarized in table 5. Airway trauma may not be readily apparent, and its evaluation requires a high level of suspicion for airway disruption and compression. For patients with facial trauma, control of the airway may be significantly impacted by edema, bleeding, inability to clear secretions, loss of bony support, and difficulty with face mask ventilation...
January 2016: Anesthesiology
https://www.readbyqxmd.com/read/25543217/venoarterial-extracorporeal-membrane-oxygenation-for-cardiogenic-shock-and-cardiac-arrest-a-meta-analysis
#11
Ashleigh Xie, Kevin Phan, Yi-Chin Tsai, Tristan D Yan, Paul Forrest
OBJECTIVE: To evaluate the effect of extracorporeal membrane oxygenation (ECMO) on survival and complication rates in adults with refractory cardiogenic shock or cardiac arrest. DESIGN: Meta-analysis. SETTING: University hospitals. PARTICIPANTS: One thousand one hundred ninety-nine patients from 22 observational studies. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Observational studies published from the year 2000 onwards, examining at least 10 adult patients who received ECMO for refractory cardiogenic shock or cardiac arrest were included...
2015: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/25449345/resuscitative-extracorporeal-membrane-oxygenation-for-in-hospital-cardiac-arrest-a-canadian-observational-experience
#12
Joseph M Bednarczyk, Christopher W White, Robin A Ducas, Mehrdad Golian, Roman Nepomuceno, Brett Hiebert, Derek Bueddefeld, Rizwan A Manji, Rohit K Singal, Farrukh Hussain, Darren H Freed
BACKGROUND: Among patients with reversible conditions who sustain cardiac arrest, extracorporeal membrane oxygenation (ECMO) may support end organ perfusion while bridging to definitive therapy. METHODS: A single center retrospective review (February 2008–September 2013) of adults receiving ECMO for cardiac arrest ≥15 min duration refractory to conventional management (E-CPR) or profound cardiogenic shock following IHCA (E-CS) was conducted. The primary outcome was 30-day survival with good neurologic function defined as a cerebral performance category (CPC) of 1–2...
December 2014: Resuscitation
https://www.readbyqxmd.com/read/22899771/should-we-emergently-revascularize-occluded-coronaries-for-cardiac-arrest-rapid-response-extracorporeal-membrane-oxygenation-and-intra-arrest-percutaneous-coronary-intervention
#13
MULTICENTER STUDY
Eisuke Kagawa, Keigo Dote, Masaya Kato, Shota Sasaki, Yoshinori Nakano, Masato Kajikawa, Akifumi Higashi, Kiho Itakura, Akihiko Sera, Ichiro Inoue, Takuji Kawagoe, Masaharu Ishihara, Yuji Shimatani, Satoshi Kurisu
BACKGROUND: Extracorporeal membrane oxygenation (ECMO) and percutaneous coronary intervention (PCI) may be useful in cardiopulmonary resuscitation. However, little is known about the combination of ECMO and intra-arrest PCI. This study investigated the efficacy of rapid-response ECMO and intra-arrest PCI in patients with cardiac arrest complicated by acute coronary syndrome who were unresponsive to conventional cardiopulmonary resuscitation. METHODS AND RESULTS: This multicenter cohort study was conducted with the use of the database of ECMO in Hiroshima City, Japan...
September 25, 2012: Circulation
https://www.readbyqxmd.com/read/24324020/noninvasive-ventilation-as-a-weaning-strategy-for-mechanical-ventilation-in-adults-with-respiratory-failure-a-cochrane-systematic-review
#14
REVIEW
Karen E A Burns, Maureen O Meade, Azra Premji, Neill K J Adhikari
BACKGROUND: Noninvasive ventilation has been studied as a means of reducing complications among patients being weaned from invasive mechanical ventilation. We sought to summarize evidence comparing noninvasive and invasive weaning and their effects on mortality. METHODS: We identified relevant randomized and quasirandomized trials through searches of databases, conference proceedings and grey literature. We included trials comparing extubation and immediate application of noninvasive ventilation with continued invasive weaning in adults on mechanical ventilation...
February 18, 2014: CMAJ: Canadian Medical Association Journal, Journal de L'Association Medicale Canadienne
https://www.readbyqxmd.com/read/25486576/noninvasive-ventilation-for-acute-respiratory-failure
#15
REVIEW
Miquel Ferrer, Antoni Torres
PURPOSE OF REVIEW: This article reviews the use of noninvasive ventilation (NIV) in patients with acute respiratory failure (ARF), with a critical review of the most recent literature in this setting. RECENT FINDINGS: The efficacy of NIV is variable depending on the cause of the episode of ARF. In community-acquired pneumonia, NIV is often associated with poor response, with better response in patients with preexisting cardiac or respiratory disease. In patients with pandemic influenza H1N1 and severe ARF, NIV has been associated with high failure rates but relatively favorable mortality...
February 2015: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/26539932/heparin-induced-thrombocytopenia
#16
REVIEW
Theodore E Warkentin
PURPOSE OF REVIEW: Thrombocytopenia and heparin exposure are common in critically ill patients, yet immune heparin-induced thrombocytopenia (HIT), a prothrombotic adverse effect of heparin, rarely accounts for thrombocytopenia in this patient population. The review discusses the clinical and laboratory features that distinguish HIT from non-HIT thrombocytopenia. RECENT FINDINGS: The frequency of HIT in heparin-exposed critically ill patients is approximately 0.3-0...
December 2015: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/26469321/cpap-in-the-perioperative-setting-evidence-of-support
#17
REVIEW
Frances Chung, Mahesh Nagappa, Mandeep Singh, Babak Mokhlesi
OSA is a commonly encountered comorbid condition in surgical patients. The risk of cardiopulmonary complications is increased by two to threefold with OSA. Among the different treatment options for OSA, CPAP is an efficacious modality. This review examines the evidence regarding the use of CPAP in the preoperative and postoperative periods in surgical patients with diagnosed and undiagnosed OSA.
February 2016: Chest
https://www.readbyqxmd.com/read/26491863/a-donation-after-circulatory-death-program-has-the-potential-to-increase-the-number-of-donors-after-brain-death
#18
Andrew R Broderick, Alex Manara, Simon Bramhall, Maria Cartmill, Dale Gardiner, James Neuberger
OBJECTIVES: Donation after circulatory death has been responsible for 75% of the increase in the numbers of deceased organ donors in the United Kingdom. There has been concern that the success of the donation after circulatory death program has been at the expense of donation after brain death. The objective of the study was to ascertain the impact of the donation after circulatory death program on donation after brain death in the United Kingdom. DESIGN: Retrospective cohort study...
February 2016: Critical Care Medicine
https://www.readbyqxmd.com/read/26380745/extra-corporeal-membrane-oxygenation-ecmo-review-of-a-lifesaving-technology
#19
REVIEW
George Makdisi, I-Wen Wang
Extra Corporeal Membrane Oxygenation (ECMO) indications and usage has strikingly progressed over the last 20 years; it has become essential tool in the care of adults and children with severe cardiac and pulmonary dysfunction refractory to conventional management. In this article we will provide a review of ECMO development, clinical indications, patients' management, options and cannulations techniques, complications, outcomes, and the appropriate strategy of organ management while on ECMO.
July 2015: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/26468897/bradycardia-during-targeted-temperature-management-an-early-marker-of-lower-mortality-and-favorable-neurologic-outcome-in-comatose-out-of-hospital-cardiac-arrest-patients
#20
RANDOMIZED CONTROLLED TRIAL
Jakob Hartvig Thomsen, Niklas Nielsen, Christian Hassager, Michael Wanscher, Steen Pehrson, Lars Køber, John Bro-Jeppesen, Helle Søholm, Matilde Winther-Jensen, Tommaso Pellis, Michael Kuiper, David Erlinge, Hans Friberg, Jesper Kjaergaard
OBJECTIVES: Bradycardia is common during targeted temperature management, likely being a physiologic response to lower body temperature, and has recently been associated with favorable outcome following out-of-hospital cardiac arrest in smaller observational studies. The present study sought to confirm this finding in a large multicenter cohort of patients treated with targeted temperature management at 33°C and explore the response to targeted temperature management targeting 36°C...
February 2016: Critical Care Medicine
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