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https://www.readbyqxmd.com/read/29410923/a-case-of-a-34-year-old-female-with-acute-hypoxemic-respiratory-failure-and-proximal-muscle-weakness
#1
Alex Diaz, Surit Sharma
Wound associated botulism is an unusual presentation. Early detection of this potentially life-threatening illness can significantly shorten length of hospital stay and improve prognosis. We present a case of a 34-year-old female with a history of heroin abuse who presented to the ED with acute respiratory failure, diplopia, and proximal muscle weakness. There was early concern for wound botulism as the instigating process. After discussion with the CDC, she was given equine serum heptavalent botulism antitoxin...
2017: Case Reports in Critical Care
https://www.readbyqxmd.com/read/29587693/a-case-of-allergic-bronchopulmonary-aspergillosis-successfully-treated-with-mepolizumab
#2
Takeshi Terashima, Taro Shinozaki, Eri Iwami, Takahiro Nakajima, Tatsu Matsuzaki
BACKGROUND: Allergic bronchopulmonary aspergillosis (ABPA) is an allergic pulmonary disease comprising a complex hypersensitivity reaction to Aspergillus fumigatus. Clinical features of ABPA are wheezing, mucoid impaction, and pulmonary infiltrates. Oral corticosteroids and anti-fungal agents are standard therapy for ABPA, but long-term use of systemic corticosteroids often causes serious side effects. CASE PRESENTATION: A 64-year-old woman was diagnosed with ABPA based on a history of bronchial asthma (from 40 years of age), elevated total IgE, the presence of serum precipitating antibodies and elevated specific IgE antibody to A...
March 27, 2018: BMC Pulmonary Medicine
https://www.readbyqxmd.com/read/29257783/the-microbiome-of-the-critically-ill-patient
#3
Kevan Akrami, Daniel A Sweeney
PURPOSE OF REVIEW: Advances in the understanding of the human microbiome outside of the ICU have led investigators to consider the role of the microbiome in critical illness. The picture that is being elucidated is one of dysbiosis occurring at multiple sites in the critically ill patient. This review describes the changes that occur in the various microbiomes of a critically ill patient, the implications of these changes and shows how advances in the understanding of dysbiosis may lead to microbiome-targeted therapies...
February 2018: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/29561288/to-intubate-or-not-to-intubate
#4
Christopher J R Gough, Jerry P Nolan
PURPOSE OF REVIEW: Cardiac arrest mortality remains high, and the impact on outcome of most advanced life support interventions is unclear. The optimal method for managing the airway during cardiac arrest remains unknown. This review will summarize and critique recently published evidence comparing basic airway management with the use of more advanced airway interventions [insertion of supraglottic airway (SGA) devices and tracheal intubation]. RECENT FINDINGS: Systematic reviews generally document an association between advanced airway management and worse neurological outcome but they are subject to considerable bias...
June 2018: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/29561289/antiarrhythmic-drug-therapy-during-cardiopulmonary-resuscitation-should-we-use-it
#5
Jasmeet Soar
PURPOSE OF REVIEW: The optimal antiarrhythmic drug therapy (amiodarone or lidocaine) in the treatment of ventricular fibrillation/pulseless ventricular tachycardia (VF/pVT) cardiac arrest that is refractory to defibrillation is uncertain. This article reviews the evidence for and against these drugs, alternatives treatments for refractory VF/pVT and aims to define the role of antiarrhythmic drugs during cardiopulmonary resuscitation (CPR). RECENT FINDINGS: A large randomized controlled trial that compared amiodarone, lidocaine and saline 0...
March 20, 2018: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/29601321/predicting-adverse-hemodynamic-events-in-critically-ill-patients
#6
Joo H Yoon, Michael R Pinsky
PURPOSE OF REVIEW: The art of predicting future hemodynamic instability in the critically ill has rapidly become a science with the advent of advanced analytical processed based on computer-driven machine learning techniques. How these methods have progressed beyond severity scoring systems to interface with decision-support is summarized. RECENT FINDINGS: Data mining of large multidimensional clinical time-series databases using a variety of machine learning tools has led to our ability to identify alert artifact and filter it from bedside alarms, display real-time risk stratification at the bedside to aid in clinical decision-making and predict the subsequent development of cardiorespiratory insufficiency hours before these events occur...
June 2018: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/29293475/pharmacokinetics-and-pharmacodynamics-of-antibiotics-in-central-nervous-system-infections
#7
Roland Nau, Jana Seele, Marija Djukic, Helmut Eiffert
PURPOSE OF REVIEW: The barriers surrounding the central nervous system (CNS) together with the emergence of multiresistant pathogens pose a therapeutic challenge for the effective treatment of CNS infections. RECENT FINDINGS: In addition to vancomycin, colistin and aminoglycosides, classically used for intrathecal injection, drug concentrations in cerebrospinal fluid after intrathecal injection of daptomycin and tigecyclin were recently studied. SUMMARY: The entry of antiinfectives into the CNS compartments is determined by the physicochemical properties of the drug and by conditions in the host...
February 2018: Current Opinion in Infectious Diseases
https://www.readbyqxmd.com/read/29373381/outpatient-management-of-community-acquired-pneumonia
#8
Filipe Froes, João Gonçalves Pereira, Pedro Póvoa
PURPOSE OF REVIEW: The first guidelines on community-acquired pneumonia (CAP) were published in 1993, but since then many of the challenges regarding the outpatient management of CAP persist. These include the difficulty in establishing the initial clinical diagnosis, its risk stratification, which will dictate the place of treatment, the empirical choice of antibiotics, the relative scarcity of novel antibiotics and the importance of knowing local microbiological susceptibility patterns...
April 2018: Current Opinion in Infectious Diseases
https://www.readbyqxmd.com/read/29482907/does-fluid-type-and-amount-affect-kidney-function-in-critical-illness
#9
REVIEW
Neil J Glassford, Rinaldo Bellomo
Acute kidney injury (AKI) is common, although commonly used clinical diagnostic markers are imperfect. Intravenous fluid administration remains a cornerstone of therapy worldwide, but there is minimal evidence of efficacy for the use of fluid bolus therapy outside of specific circumstances, and emerging evidence associates fluid accumulation with worse renal outcomes and even increased mortality among critically ill patients. Artificial colloid solutions have been associated with harm, and chloride-rich solutions may adversely affect renal function...
April 2018: Critical Care Clinics
https://www.readbyqxmd.com/read/29482908/blood-product-administration-in-the-critical-care-and-perioperative-settings
#10
REVIEW
Sofie Louise Rygård, Lars Broksø Holst, Anders Perner
The critical care and perioperative settings are high consumers of blood products, with multiple units and different products often given to an individual patient. The recommendation of this review is always to consider the risks and benefits for a specific blood product for a specific patient in a specific clinical setting. Optimize patient status by treating anemia and preventing the need for red blood cell transfusion. Consider other options for correction of anemia and coagulation disorders and use an imperative non-overtransfusion policy for all blood products...
April 2018: Critical Care Clinics
https://www.readbyqxmd.com/read/29357392/prevention-detection-evaluation-and-management-of-high-blood-pressure-in-adults-synopsis-of-the-2017-american-college-of-cardiology-american-heart-association-hypertension-guideline
#11
Robert M Carey, Paul K Whelton
Description: In November 2017, the American College of Cardiology (ACC) and the American Heart Association (AHA) released a clinical practice guideline for the prevention, detection, evaluation, and treatment of high blood pressure (BP) in adults. This article summarizes the major recommendations. Methods: In 2014, the ACC and the AHA appointed a multidisciplinary committee to update previous reports of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure...
March 6, 2018: Annals of Internal Medicine
https://www.readbyqxmd.com/read/29507970/palliative-care
#12
Keith M Swetz, Arif H Kamal
Palliative care prioritizes symptom management and quality of life throughout the course of serious illness. Regardless of whether care is inpatient or outpatient, primary or subspecialty, a solid understanding of the basics of effective communication, symptom management, and end-of-life care is crucial. This article reviews these essentials and provides an overview of current evidence to support patient-centered palliative care.
March 6, 2018: Annals of Internal Medicine
https://www.readbyqxmd.com/read/29208005/recovery-after-critical-illness-putting-the-puzzle-together-a-consensus-of-29
#13
REVIEW
Elie Azoulay, Jean-Louis Vincent, Derek C Angus, Yaseen M Arabi, Laurent Brochard, Stephen J Brett, Giuseppe Citerio, Deborah J Cook, Jared Randall Curtis, Claudia C Dos Santos, E Wesley Ely, Jesse Hall, Scott D Halpern, Nicholas Hart, Ramona O Hopkins, Theodore J Iwashyna, Samir Jaber, Nicola Latronico, Sangeeta Mehta, Dale M Needham, Judith Nelson, Kathleen Puntillo, Michael Quintel, Kathy Rowan, Gordon Rubenfeld, Greet Van den Berghe, Johannes Van der Hoeven, Hannah Wunsch, Margaret Herridge
In this review, we seek to highlight how critical illness and critical care affect longer-term outcomes, to underline the contribution of ICU delirium to cognitive dysfunction several months after ICU discharge, to give new insights into ICU acquired weakness, to emphasize the importance of value-based healthcare, and to delineate the elements of family-centered care. This consensus of 29 also provides a perspective and a research agenda about post-ICU recovery.
December 5, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29228951/hypovitaminosis-c-and-vitamin-c-deficiency-in-critically-ill-patients-despite-recommended-enteral-and-parenteral-intakes
#14
Anitra C Carr, Patrice C Rosengrave, Simone Bayer, Steve Chambers, Jan Mehrtens, Geoff M Shaw
BACKGROUND: Vitamin C is an essential water-soluble nutrient which cannot be synthesised or stored by humans. It is a potent antioxidant with anti-inflammatory and immune-supportive roles. Previous research has indicated that vitamin C levels are depleted in critically ill patients. In this study we have assessed plasma vitamin C concentrations in critically ill patients relative to infection status (septic shock or non-septic) and level of inflammation (C-reactive protein concentrations)...
December 11, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29262831/antimicrobials-for-the-treatment-of-drug-resistant-acinetobacter-baumannii-pneumonia-in-critically-ill-patients-a-systemic-review-and-bayesian-network-meta-analysis
#15
Su Young Jung, Seung Hee Lee, Soo Young Lee, Seungwon Yang, Hayeon Noh, Eun Kyoung Chung, Jangik I Lee
BACKGROUND: An optimal therapy for the treatment of pneumonia caused by drug-resistant Acinetobacter baumannii remains unclear. This study aims to compare various antimicrobial strategies and to determine the most effective therapy for pneumonia using a network meta-analysis. METHODS: Systematic search and quality assessment were performed to select eligible studies reporting one of the following outcomes: all-cause mortality, clinical cure, and microbiological eradication...
December 20, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29284503/bronchoscopy-versus-an-endotracheal-tube-mounted-camera-for-the-peri-interventional-visualization-of-percutaneous-dilatational-tracheostomy-a-prospective-randomized-trial-vivapdt
#16
Jörn Grensemann, Lars Eichler, Sophie Kähler, Dominik Jarczak, Marcel Simon, Hans O Pinnschmidt, Stefan Kluge
BACKGROUND: Percutaneous dilatational tracheostomy (PDT) in critically ill patients often involves bronchoscopic optical guidance. However, this procedure is not without disadvantages. Therefore, we aimed to study a recently introduced endotracheal tube-mounted camera (VivaSightTM -SL tube [VST]; ETView, Misgav, Israel) for guiding PDT. METHODS: This was a randomized controlled trial involving 46 critically ill patients who received PDT using optical guidance with a VST or with bronchoscopy...
December 29, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29297397/time-sensitive-therapeutics
#17
REVIEW
John J Marini
Much of what we now do in Critical Care carries an air of urgency, a pressing need to discover and act, with priorities biased toward a reactive response. However, efficacy often depends not simply upon what we do, but rather on whether, when, and how persistently we intervene. The practice of medicine is based upon diagnosis, integration of multiple sources of information, keen judgment, and appropriate intervention. Timing may not be everything, as the well-known adage suggests, but in the intensive care unit (ICU) timing issues clearly deserve more attention than they are currently given...
December 28, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29297399/the-coming-era-of-precision-medicine-for-intensive-care
#18
REVIEW
Jean-Louis Vincent
Recent advances in technology and better understanding of mechanisms underlying disease are beginning to enable us to better characterize critically ill patients. Instead of using nonspecific syndromic groupings, such as sepsis or acute respiratory distress syndrome, we can now classify individual patients according to various specific characteristics, such as immune status. This "personalized" medicine approach will enable us to distinguish patients who have similar clinical presentations but different cellular and molecular responses that will influence their need for and responses (both negative and positive) to specific treatments...
December 28, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29297400/seven-unconfirmed-ideas-to-improve-future-icu-practice
#19
REVIEW
John J Marini, Daniel De Backer, Can Ince, Mervyn Singer, Frank Van Haren, Martin Westphal, Paul Wischmeyer
With imprecise definitions, inexact measurement tools, and flawed study execution, our clinical science often lags behind bedside experience and simply documents what appear to be the apparent faults or validity of ongoing practices. These impressions are later confirmed, modified, or overturned by the results of the next trial. On the other hand, insights that stem from the intuitions of experienced clinicians, scientists and educators-while often neglected-help place current thinking into proper perspective and occasionally point the way toward formulating novel hypotheses that direct future research...
December 28, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29095723/antiviral-treatment-of-severe-non-influenza-respiratory-virus-infection
#20
Nathan J Brendish, Tristan W Clark
PURPOSE OF REVIEW: Non-influenza respiratory virus infections are a frequent cause of severe acute respiratory infections, especially in infants, the elderly, and the immunocompromised. We review here the current treatment options for non-influenza respiratory viruses and promising candidate antiviral agents currently in development. RECENT FINDINGS: Small molecule antiviral agents active against respiratory syncytial virus (RSV), such as ALS-8176 and GS-5806, show considerable promise in challenge studies and are undergoing late-phase clinical trials in hospitalised adults and children...
December 2017: Current Opinion in Infectious Diseases
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