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critical care

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14 papers 25 to 100 followers
By Yasser Abbas Sr Consultant general surgery
Mitchell M Levy, Laura E Evans, Andrew Rhodes
No abstract text is available yet for this article.
April 19, 2018: Intensive Care Medicine
Xavier Monnet, Jean-Louis Teboul
PURPOSE OF REVIEW: In the field of prediction of fluid responsiveness, the most recent studies have focused on validating new tests, on clarifying the limitations of older ones, and better defining their modalities. RECENT FINDINGS: The limitations of pulse pressure/stroke volume variations are numerous, but recent efforts have been made to overcome these limitations, like in case of low tidal volume ventilation. Following pulse pressure/stroke volume variations, new tests have emerged which assess preload responsiveness by challenging cardiac preload through heart-lung interactions, like during recruitment manoeuvres and end-expiratory/inspiratory occlusions...
June 2018: Current Opinion in Critical Care
Sung Yeon Hwang, Ik Joon Jo, Se Uk Lee, Tae Rim Lee, Hee Yoon, Won Chul Cha, Min Seob Sim, Tae Gun Shin
STUDY OBJECTIVE: We determine the diagnostic performance of positive Quick Sequential Organ Failure Assessment (qSOFA) scores for predicting 28-day mortality among critically ill septic patients during the early period after emergency department (ED) presentation. METHODS: This was a retrospective cohort study at a tertiary care academic center. We reviewed a registry of adult (≥18 years) patients who received a diagnosis of severe sepsis or septic shock during an ED stay from August 2008 through September 2014...
January 2018: Annals of Emergency Medicine
Kathryn M Rowan, Derek C Angus, Michael Bailey, Amber E Barnato, Rinaldo Bellomo, Ruth R Canter, Timothy J Coats, Anthony Delaney, Elizabeth Gimbel, Richard D Grieve, David A Harrison, Alisa M Higgins, Belinda Howe, David T Huang, John A Kellum, Paul R Mouncey, Edvin Music, Sandra L Peake, Francis Pike, Michael C Reade, M Zia Sadique, Mervyn Singer, Donald M Yealy
BACKGROUND: After a single-center trial and observational studies suggesting that early, goal-directed therapy (EGDT) reduced mortality from septic shock, three multicenter trials (ProCESS, ARISE, and ProMISe) showed no benefit. This meta-analysis of individual patient data from the three recent trials was designed prospectively to improve statistical power and explore heterogeneity of treatment effect of EGDT. METHODS: We harmonized entry criteria, intervention protocols, outcomes, resource-use measures, and data collection across the trials and specified all analyses before unblinding...
June 8, 2017: New England Journal of Medicine
Anders Winther Voldby, Birgitte Brandstrup
BACKGROUND: Perioperative hypovolemia and fluid overload have effects on both complications following surgery and on patient survival. Therefore, the administration of intravenous fluids before, during, and after surgery at the right time and in the right amounts is of great importance. This review aims to analyze the literature concerning perioperative fluid therapy in abdominal surgery and to provide evidence-based recommendations for clinical practice. RESULTS: Preoperative oral or intravenous administration of carbohydrate containing fluids has been shown to improve postoperative well-being and muscular strength and to reduce insulin resistance...
2016: Journal of Intensive Care
Jeffrey E Gotts, Michael A Matthay
Sepsis, severe sepsis, and septic shock represent increasingly severe systemic inflammatory responses to infection. Sepsis is common in the aging population, and it disproportionately affects patients with cancer and underlying immunosuppression. In its most severe form, sepsis causes multiple organ dysfunction that can produce a state of chronic critical illness characterized by severe immune dysfunction and catabolism. Much has been learnt about the pathogenesis of sepsis at the molecular, cell, and intact organ level...
May 23, 2016: BMJ: British Medical Journal
Gunnar Elke, Arthur R H van Zanten, Margot Lemieux, Michele McCall, Khursheed N Jeejeebhoy, Matthias Kott, Xuran Jiang, Andrew G Day, Daren K Heyland
BACKGROUND: Enteral nutrition (EN) is recommended as the preferred route for early nutrition therapy in critically ill adults over parenteral nutrition (PN). A recent large randomized controlled trial (RCT) showed no outcome differences between the two routes. The objective of this systematic review was to evaluate the effect of the route of nutrition (EN versus PN) on clinical outcomes of critically ill patients. METHODS: An electronic search from 1980 to 2016 was performed identifying relevant RCTs...
April 29, 2016: Critical Care: the Official Journal of the Critical Care Forum
P Marik, R Bellomo
Aggressive fluid resuscitation to achieve a central venous pressure (CVP) greater than 8 mm Hg has been promoted as the standard of care, in the management of patients with severe sepsis and septic shock. However recent clinical trials have demonstrated that this approach does not improve the outcome of patients with severe sepsis and septic shock. Pathophysiologically, sepsis is characterized by vasoplegia with loss of arterial tone, venodilation with sequestration of blood in the unstressed blood compartment and changes in ventricular function with reduced compliance and reduced preload responsiveness...
March 2016: British Journal of Anaesthesia
Bin Yu, Hui-yan Tian, Zhen-jie Hu, Chai Zhao, Li-xia Liu, Yong Zhang, Gui-jun Zhu, Lan-tao Wang, Xin-hui Wu, Juan Li
OBJECTIVE: To compare the efficacy of fluid resuscitation as guided by lactate clearance rate (LCR) and central venous oxygen saturation (ScvO2) in patients with sepsis. METHODS: A prospective randomized control study was conducted. Fifty patients diagnosed with severe sepsis or septic shock from January 2011 to February 2012 in department of critical care medicine of Fourth Hospital of Hebei Medical University were enrolled in the study. The patients were randomly divided into two groups according to the sequence (each n=25): ScvO2 group and LCR group...
October 2013: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
Lence Neloska, Katerna Damevska, Lidija Pavleska
No abstract text is available yet for this article.
2015: Acta Dermatovenerologica Croatica: ADC
Colin H Murphy, John R Hess
PURPOSE OF REVIEW: The aim of this short study is to review recently published data bearing on how to resuscitate massive uncontrolled hemorrhage. RECENT FINDINGS: New data inform our understanding of the mechanisms of the acute coagulopathy of trauma, the median time to death of trauma patients with uncontrolled hemorrhage, the effects of blood product composition on the coagulation capacity of infused resuscitation mixtures, the outcomes of patients resuscitated according to common massive transfusion protocols in clinical situations associated with massive hemorrhage, and who might benefit from balanced, blood-product-based resuscitation...
November 2015: Current Opinion in Hematology
Jason Chertoff, Michael Chisum, Bryan Garcia, Jorge Lascano
Over the last two decades, there have been vast improvements in sepsis-related outcomes, largely resulting from the widespread adoption of aggressive fluid resuscitation and infection control. With increased understanding of the pathophysiology of sepsis, novel diagnostics and resuscitative interventions are being discovered. In recent years, few diagnostic tests like lactate have engendered more attention and research in the sepsis arena. Studies highlighting lactate's prognostic potential for mortality and other outcomes are ubiquitous and largely focus on the early stage of sepsis management, defined as the initial 6 h and widely referred to as the "golden hours...
2015: Journal of Intensive Care
Sarah K Orr, Kathryn L Butler, Douglas Hayden, Ronald G Tompkins, Charles N Serhan, Daniel Irimia
OBJECTIVES: Specialized proresolving lipid mediators have emerged as powerful modulators of inflammation and activators of resolution. Animal models show significant benefits of specialized proresolving lipid mediators on survival and wound healing after major burn trauma. To date, no studies have investigated specialized proresolving lipid mediators and their relation to other lipid mediator pathways in humans after trauma. Here we determine if patients with poor outcomes after trauma have dysregulated lipid mediator pathways...
December 2015: Critical Care Medicine
Bandarn Suetrong, Keith R Walley
Increased blood lactate concentration (hyperlactatemia) and lactic acidosis (hyperlactatemia and serum pH < 7.35) are common in patients with severe sepsis or septic shock and are associated with significant morbidity and mortality. In some patients, most of the lactate that is produced in shock states is due to inadequate oxygen delivery resulting in tissue hypoxia and causing anaerobic glycolysis. However, lactate formation during sepsis is not entirely related to tissue hypoxia or reversible by increasing oxygen delivery...
January 2016: Chest
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