collection
https://read.qxmd.com/read/26380745/extra-corporeal-membrane-oxygenation-ecmo-review-of-a-lifesaving-technology
#21
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://read.qxmd.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
#22
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
https://read.qxmd.com/read/24219845/combining-ecmo-with-iabp-for-the-treatment-of-critically-ill-adult-heart-failure-patients
#23
JOURNAL ARTICLE
Pengyu Ma, Zaiwang Zhang, Tieying Song, Yunliang Yang, Ge Meng, Jianhui Zhao, Chunping Wang, Kunfeng Gu, Jingyan Peng, Bo Jiang, Yan Qi, Ruyu Yan, Xiaojing Ma
OBJECTIVE: To discuss the experience of combining extra-corporeal membrane oxygenation (ECMO) with intra-aortic balloon pump (IABP) for the treatment of acute heart failure in critically ill adults. METHODS: The clinical data of 54 patients who received ECMO combined with IABP due to acute heart failure between January 2008 and July 2012 were retrospectively analysed. Thirty-eight of the patients were male, and 16 were female; the mean age was 57±11. Thirty-nine of the patients received IABP first but were still unable to maintain adequate circulation, and were then given ECMO; the other 15 underwent ECMO first, but due to increased left ventricular load, the opening of the aortic valve was restricted and IABP was then introduced...
April 2014: Heart, Lung & Circulation
https://read.qxmd.com/read/24625534/ecmo-for-adult-respiratory-failure-current-use-and-evolving-applications
#24
REVIEW
Cara L Agerstrand, Matthew D Bacchetta, Daniel Brodie
Extracorporeal membrane oxygenation (ECMO) is increasingly being used to support adults with severe forms of respiratory failure. Fueling the explosive growth is a combination of technological improvements and accumulating, although controversial, evidence. Current use of ECMO extends beyond its most familiar role in the support of patients with severe acute respiratory distress syndrome (ARDS) to treat patients with various forms of severe hypoxemic or hypercapnic respiratory failure, ranging from bridging patients to lung transplantation to managing pulmonary hypertensive crises...
May 2014: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
https://read.qxmd.com/read/22186218/extracorporeal-membrane-oxygenation-for-respiratory-failure-in-adults
#25
REVIEW
Alain Combes, Matthew Bacchetta, Daniel Brodie, Thomas Müller, Vince Pellegrino
PURPOSE OF REVIEW: This article reviews case series and trials that evaluated extracorporeal membrane oxygenation (ECMO) for respiratory failure and describes patient and circuit management in the modern era of ECMO support. RECENT FINDINGS: In recent years, pivotal progress has been made in the conception and construction of ECMO circuits. They are now simpler, safer, require less anticoagulation and are associated with fewer bleeding complications. The encouraging results of the efficacy and economic assessment of conventional ventilatory support versus ECMO for severe adult respiratory failure (CESAR) trial performed in the United Kingdom and good outcomes of patients who received ECMO as rescue therapy during the recent H1N1 influenza pandemic, in which the latest generation of ECMO technology was used, reignited interest in ECMO for severe acute respiratory distress syndrome (ARDS)...
February 2012: Current Opinion in Critical Care
https://read.qxmd.com/read/15232604/acute-renal-failure-definitions-diagnosis-pathogenesis-and-therapy
#26
REVIEW
Robert W Schrier, Wei Wang, Brian Poole, Amit Mitra
Acute renal failure (ARF), characterized by sudden loss of the ability of the kidneys to excrete wastes, concentrate urine, conserve electrolytes, and maintain fluid balance, is a frequent clinical problem, particularly in the intensive care unit, where it is associated with a mortality of between 50% and 80%. In this review, the epidemiology and pathophysiology of ARF are discussed, including the vascular, tubular, and inflammatory perturbations. The clinical evaluation of ARF and implications for potential future therapies to decrease the high mortality are described...
July 2004: Journal of Clinical Investigation
https://read.qxmd.com/read/23065497/renal-failure-in-patients-with-left-ventricular-assist-devices
#27
REVIEW
Ami M Patel, Gbemisola A Adeseun, Irfan Ahmed, Nanhi Mitter, J Eduardo Rame, Michael R Rudnick
Implantable left ventricular assist devices (LVADs) are increasingly being used as a bridge to transplantation or as destination therapy in patients with end stage heart failure refractory to conventional medical therapy. A significant number of these patients have associated renal dysfunction before LVAD implantation, which may improve after LVAD placement due to enhanced perfusion. Other patients develop AKI after implantation. LVAD recipients who develop AKI requiring renal replacement therapy in the hospital or who ultimately require long-term outpatient hemodialysis therapy present management challenges with respect to hemodynamics, volume, and dialysis access...
March 2013: Clinical Journal of the American Society of Nephrology: CJASN
https://read.qxmd.com/read/25248364/dialysis-modality-choice-in-diabetic-patients-with-end-stage-kidney-disease-a-systematic-review-of-the-available-evidence
#28
REVIEW
Cecile Couchoud, Davide Bolignano, Ionut Nistor, Kitty J Jager, James Heaf, Olle Heimburger, Wim Van Biesen
BACKGROUND: Diabetes is the leading cause of end-stage kidney disease (ESKD). Because of conflicting results in observational studies, it is still subject to debate whether in diabetic patients the dialysis modality selected as first treatment (haemodialysis or peritoneal dialysis) may have a major impact on outcomes. We therefore aimed at performing a systematic review of the available evidence. METHODS: MEDLINE, EMBASE and CENTRAL databases were searched until February 2014 for English-language articles without time or methodology restrictions by highly sensitive search strategies focused on diabetes, end-stage kidney disease and dialysis modality...
February 2015: Nephrology, Dialysis, Transplantation
https://read.qxmd.com/read/18285591/renal-replacement-therapy-in-patients-with-acute-renal-failure-a-systematic-review
#29
REVIEW
Neesh Pannu, Scott Klarenbach, Natasha Wiebe, Braden Manns, Marcello Tonelli
CONTEXT: Acute renal failure requiring dialytic support is associated with a high risk of mortality and substantial morbidity. OBJECTIVES: To summarize current evidence guiding provision of dialysis for patients with acute renal failure, to make recommendations for management, and to identify areas in which additional research is needed. DATA SOURCES: Systematic searches of peer-reviewed publications in MEDLINE, EMBASE, and All EBM Reviews through October 2007...
February 20, 2008: JAMA
https://read.qxmd.com/read/26341945/infective-endocarditis
#30
REVIEW
Thomas J Cahill, Bernard D Prendergast
Infective endocarditis occurs worldwide, and is defined by infection of a native or prosthetic heart valve, the endocardial surface, or an indwelling cardiac device. The causes and epidemiology of the disease have evolved in recent decades with a doubling of the average patient age and an increased prevalence in patients with indwelling cardiac devices. The microbiology of the disease has also changed, and staphylococci, most often associated with health-care contact and invasive procedures, have overtaken streptococci as the most common cause of the disease...
February 27, 2016: Lancet
https://read.qxmd.com/read/21156979/maintaining-tissue-perfusion-in-high-risk-surgical-patients-a-systematic-review-of-randomized-clinical-trials
#31
REVIEW
Sanderland T Gurgel, Paulo do Nascimento
BACKGROUND: Surgical patients with limited organic reserve are considered high-risk patients and have an increased perioperative mortality. For this reason, they need a more rigorous perioperative protocol of hemodynamic control to prevent tissue hypoperfusion. In this study, we systematically reviewed the randomized controlled clinical trials that used a hemodynamic protocol to maintain adequate tissue perfusion in the high-risk surgical patient. METHODS: We searched MEDLINE, Embase, LILACS, and Cochrane databases to identify randomized controlled clinical studies of surgical patients studied using a perioperative hemodynamic protocol of tissue perfusion aiming to reduce mortality and morbidity; the latter characterized at least one dysfunctional organ in the postoperative period...
June 2011: Anesthesia and Analgesia
https://read.qxmd.com/read/24286266/obituary-pulmonary-artery-catheter-1970-to-2013
#32
JOURNAL ARTICLE
Paul E Marik
The birth of the intermittent injectate-based conventional pulmonary artery catheter (fondly nicknamed PAC) was proudly announced in the New England Journal of Medicine in 1970 by his parents HJ Swan and William Ganz. PAC grew rapidly, reaching manhood in 1986 where, in the US, he was shown to influence the management of over 40% of all ICU patients. His reputation, however, was tarnished in 1996 when Connors and colleagues suggested that he harmed patients. This was followed by randomized controlled trials demonstrating he was of little use...
November 28, 2013: Annals of Intensive Care
https://read.qxmd.com/read/17711969/the-pulmonary-artery-catheter-in-anesthesia-practice-in-2007-an-historical-overview-with-emphasis-on-the-past-6-years
#33
REVIEW
Andrew B Leibowitz, John M Oropello
The pulmonary artery catheter has been widely used in anesthesiology and critical care medicine. Until recently, only retrospective or relatively weak prospective studies examining its effect on outcome had been performed. Over the past 6 years, however, a number of well-designed prospective trials and statistically sound retrospective studies have been completed. All of these show no benefit and some even reveal a potential for increased morbidity. Reasons for this device's inability to improve outcome are numerous, including wrong patient selection and misinterpretation, but the most impressive and convincing evidence is that filling pressures measured from the catheter, particularly the pulmonary artery "wedge" pressure, have no physiologic value...
September 2007: Seminars in Cardiothoracic and Vascular Anesthesia
https://read.qxmd.com/read/22886686/the-pulmonary-artery-catheter
#34
REVIEW
Jean-Louis Vincent
The pulmonary artery catheter (PAC) has been widely used for monitoring of critically ill patients over the years, but with advances in less invasive monitoring techniques, notably echocardiography, there are fewer indications for PAC insertion. Nevertheless, the PAC provides simultaneous monitoring of pulmonary artery pressures, cardiac filling, cardiac output and mixed venous oxygen saturation, and still has an important role in complex cases. Adequate and continued training are required to ensure that PAC-derived data are correctly interpreted and applied...
October 2012: Journal of Clinical Monitoring and Computing
https://read.qxmd.com/read/25480764/pulmonary-artery-catheter
#35
JOURNAL ARTICLE
Stephanie Whitener, Ryan Konoske, Jonathan B Mark
Since its inception, the pulmonary artery catheter has enjoyed widespread use in both medical and surgical critically ill patients. It has also endured criticism and skepticism about its benefit in these patient populations. By providing information such as cardiac output, mixed venous oxygen saturation, and intracardiac pressures, the pulmonary artery catheter may improve care of the most complex critically ill patients in the intensive care unit and the operating room. With its ability to transduce pressures through multiple ports, one of the primary clinical uses for pulmonary artery catheters is real-time intracardiac pressure monitoring...
December 2014: Best Practice & Research. Clinical Anaesthesiology
https://read.qxmd.com/read/23876703/the-current-state-of-fellowship-training-in-pulmonary-artery-catheter-placement-and-data-interpretation-a-national-survey-of-pulmonary-and-critical-care-fellowship-program-directors
#36
JOURNAL ARTICLE
Melissa H Tukey, Renda Soylemez Wiener
PURPOSE: Given decreasing use of pulmonary artery (PA) catheterization, we sought to evaluate whether current pulmonary and critical care fellows have adequate opportunity to obtain proficiency in PA catheter placement and data interpretation. METHODS: All US pulmonary and critical care program directors were invited to participate in an anonymous online survey regarding current training opportunities in PA catheterization. RESULTS: The response rate was 51% (69/136)...
October 2013: Journal of Critical Care
https://read.qxmd.com/read/17164019/which-general-intensive-care-unit-patients-can-benefit-from-placement-of-the-pulmonary-artery-catheter
#37
REVIEW
Didier Payen, Etienne Gayat
From the report by Connors and coworkers in 1996 until now, much effort has been directed at demonstrating the safety and/or effectiveness of strategies based on pulmonary artery catheter (PAC) data. Although studies have failed to demonstrate a clear benefit of PAC use, neither have any corroborated the initial report of PAC-induced mortality. With this in mind, it is important to clarify the indications for PAC, taking into account the development of new technologies to measure cardiac output and stroke volume...
2006: Critical Care: the Official Journal of the Critical Care Forum
https://read.qxmd.com/read/21499096/pulmonary-artery-catheter-monitoring-in-2011
#38
REVIEW
Christian Richard, Xavier Monnet, Jean-Louis Teboul
PURPOSE OF REVIEW: Hemodynamic monitoring has gained widespread acceptance in intensive care units. Despite ongoing debate regarding its safety and efficacy, monitoring with the pulmonary artery catheter (PAC) remains used for the management of severe heart failure and shock. RECENT FINDINGS: To reanalyze using the most recently published literature in the field, the role of the PAC to manage critically ill patients with right ventricular failure, pulmonary hypertension and weaning failure from cardiac origin...
June 2011: Current Opinion in Critical Care
https://read.qxmd.com/read/16891389/extravascular-lung-water-measurements-and-hemodynamic-monitoring-in-the-critically-ill-bedside-alternatives-to-the-pulmonary-artery-catheter
#39
REVIEW
Warren Isakow, Daniel P Schuster
The recently completed Fluid and Catheter Treatment Trial conducted by the National Institutes of Health ARDSNetwork casts doubt on the value of routine pulmonary artery catheterization for hemodynamic management of the critically ill. Several alternatives are available, and, in this review, we evaluate the theoretical, validation, and empirical databases for two of these: transpulmonary thermodilution measurements (yielding estimates of cardiac output, intrathoracic blood volume, and extravascular lung water) that do not require a pulmonary artery catheter, and hemodynamic measurements (including estimates of cardiac output and ejection time, a variable sensitive to intravascular volume) obtained by esophageal Doppler analysis of blood flow through the descending aorta...
December 2006: American Journal of Physiology. Lung Cellular and Molecular Physiology
https://read.qxmd.com/read/19700347/validity-of-an-arterial-pressure-waveform-analysis-device-does-the-puncture-site-play-a-role-in-the-agreement-with-intermittent-pulmonary-artery-catheter-thermodilution-measurements
#40
COMPARATIVE STUDY
Sebastian Schramm, Eric Albrecht, Philippe Frascarolo, Pierre-Guy Chassot, Donat R Spahn
OBJECTIVE: The measurement of cardiac output is a key element in the assessment of cardiac function. Recently, a pulse contour analysis-based device without need for calibration became available (FloTrac/Vigileo, Edwards Lifescience, Irvine, CA). This study was conducted to determine if there is an impact of the arterial catheter site and to investigate the accuracy of this system when compared with the pulmonary artery catheter using the bolus thermodilution technique (PAC). DESIGN: Prospective study...
April 2010: Journal of Cardiothoracic and Vascular Anesthesia
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