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JB General Surgical ICU

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Smita Padhi, Ian Bullock, Lilian Li, Mike Stroud
No abstract text is available yet for this article.
December 10, 2013: BMJ: British Medical Journal
Tài Pham, Laurent J Brochard, Arthur S Slutsky
Mechanical ventilation is the most used short-term life support technique worldwide and is applied daily for a diverse spectrum of indications, from scheduled surgical procedures to acute organ failure. This state-of-the-art review provides an update on the basic physiology of respiratory mechanics, the working principles, and the main ventilatory settings, as well as the potential complications of mechanical ventilation. Specific ventilatory approaches in particular situations such as acute respiratory distress syndrome and chronic obstructive pulmonary disease are detailed along with protective ventilation in patients with normal lungs...
September 2017: Mayo Clinic Proceedings
Joshua A Greenberg, Jonathan Hsu, Mohammad Bawazeer, John Marshall, Jan O Friedrich, Avery Nathens, Natalie Coburn, Gary R May, Emily Pearsall, Robin S McLeod
There has been an increase in the incidence of acute pancreatitis reported worldwide. Despite improvements in access to care, imaging and interventional techniques, acute pancreatitis continues to be associated with significant morbidity and mortality. Despite the availability of clinical practice guidelines for the management of acute pancreatitis, recent studies auditing the clinical management of the condition have shown important areas of noncompliance with evidence-based recommendations. This underscores the importance of creating understandable and implementable recommendations for the diagnosis and management of acute pancreatitis...
April 2016: Canadian Journal of Surgery. Journal Canadien de Chirurgie
Andrew Thomson
INTRODUCTION: Fluid management is a cornerstone of treatment in acute pancreatitis (AP). METHODS: Identification of existing randomized prospective trials of patients with AP, in which intravenous fluid management was a significant parameter in the experimental design, was undertaken using the PubMed and ENDOBASE databases. RESULTS: Included patients in the seven studies identified were on the whole very unwell with deaths occurring in six trials...
November 22, 2017: ANZ Journal of Surgery
David A Story
No abstract text is available yet for this article.
August 2016: Anesthesia and Analgesia
B Taylor Thompson, Rachel C Chambers, Kathleen D Liu
New England Journal of Medicine, Volume 377, Issue 6, Page 562-572, August 2017.
August 10, 2017: New England Journal of Medicine
Sven M van Dijk, Nora D L Hallensleben, Hjalmar C van Santvoort, Paul Fockens, Harry van Goor, Marco J Bruno, Marc G Besselink
Acute pancreatitis is one of the most common GI conditions requiring acute hospitalisation and has a rising incidence. In recent years, important insights on the management of acute pancreatitis have been obtained through numerous randomised controlled trials. Based on this evidence, the treatment of acute pancreatitis has gradually developed towards a tailored, multidisciplinary effort, with distinctive roles for gastroenterologists, radiologists and surgeons. This review summarises how to diagnose, classify and manage patients with acute pancreatitis, emphasising the evidence obtained through randomised controlled trials...
November 2017: Gut
Athina Lavrentieva
Recent publications on treatment options in critically ill patients change beliefs and clinical behaviors. Many dogmas, which the modern management of critical illness relies on, have been questioned. These publications (consensus articles, reviews, meta-analysis and original papers) concern some fundamental issues of critical care: interventions in acute respiratory distress syndrome (ARDS), hemodynamic monitoring, glucose control and nutritional support and revise our views on many key points of critical care of burn patients...
February 2016: Burns: Journal of the International Society for Burn Injuries
Sheena Sikora, Anthony Papp
BACKGROUND: Venous thromboembolisms (VTE) including deep venous thrombosis and pulmonary embolism are serious complications following burn trauma. There are inconsistencies in the literature regarding thromboembolic prevention strategies and data suggests that complications occur despite chemoprophylaxis. OBJECTIVE: To determine the prevalence of deep venous thromboembolism and pulmonary embolism in burn patients who are actively being treated with VTE prophylaxis and to determine factors that help predict which anti-coagulated patients are at risk for VTE and may benefit from further treatment...
September 2017: Burns: Journal of the International Society for Burn Injuries
Ben Gibbison, José A López-López, Julian P T Higgins, Tom Miller, Gianni D Angelini, Stafford L Lightman, Djillali Annane
BACKGROUND: Multiple corticosteroids and treatment regimens have been used as adjuncts in the treatment of septic shock. Qualitative and quantitative differences exist at cellular and tissular levels between the different drugs and their patterns of delivery. The objective of this study was to elucidate any differences between the drugs and their treatment regimens regarding outcomes for corticosteroid use in adult patients with septic shock. METHODS: Network meta-analysis of the data used for the recently conducted Cochrane review was performed...
March 28, 2017: Critical Care: the Official Journal of the Critical Care Forum
Tat Ming Ng, Wendy X Khong, Patrick N A Harris, Partha P De, Angela Chow, Paul A Tambyah, David C Lye
Extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae are a common cause of bacteraemia in endemic countries and may be associated with high mortality; carbapenems are considered the drug of choice. Limited data suggest piperacillin-tazobactam could be equally effective. We aimed to compare 30-day mortality of patients treated empirically with piperacillin-tazobactam versus a carbapenem in a multi-centre retrospective cohort study in Singapore. Only patients with active empiric monotherapy with piperacillin-tazobactam or a carbapenem were included...
2016: PloS One
Arved Weimann, Marco Braga, Franco Carli, Takashi Higashiguchi, Martin Hübner, Stanislaw Klek, Alessandro Laviano, Olle Ljungqvist, Dileep N Lobo, Robert Martindale, Dan L Waitzberg, Stephan C Bischoff, Pierre Singer
Early oral feeding is the preferred mode of nutrition for surgical patients. Avoidance of any nutritional therapy bears the risk of underfeeding during the postoperative course after major surgery. Considering that malnutrition and underfeeding are risk factors for postoperative complications, early enteral feeding is especially relevant for any surgical patient at nutritional risk, especially for those undergoing upper gastrointestinal surgery. The focus of this guideline is to cover nutritional aspects of the Enhanced Recovery After Surgery (ERAS) concept and the special nutritional needs of patients undergoing major surgery, e...
June 2017: Clinical Nutrition: Official Journal of the European Society of Parenteral and Enteral Nutrition
Ana L Huerta-Alardín, Joseph Varon, Paul E Marik
Rhabdomyolysis ranges from an asymptomatic illness with elevation in the creatine kinase level to a life-threatening condition associated with extreme elevations in creatine kinase, electrolyte imbalances, acute renal failure and disseminated intravascular coagulation. Muscular trauma is the most common cause of rhabdomyolysis. Less common causes include muscle enzyme deficiencies, electrolyte abnormalities, infectious causes, drugs, toxins and endocrinopathies. Weakness, myalgia and tea-colored urine are the main clinical manifestations...
April 2005: Critical Care: the Official Journal of the Critical Care Forum
Lindsay Lief, John Arbo, David A Berlin
In 2001, Rivers and colleagues published a randomized controlled trial of early goal-directed therapy (EGDT) for the treatment of sepsis. More than a decade later, it remains a landmark achievement. The study proved the benefits of early aggressive treatment of sepsis. However, many questions remain about specific aspects of the complex EGDT algorithm. Recently, 3 large trials attempted to replicate these results. None of the studies demonstrated a benefit of an EGDT protocol for sepsis. This review explores the physiologic basis of goal-directed therapy, including the hemodynamic targets and the therapeutic interventions...
December 2017: Journal of Intensive Care Medicine
Young-Jae Cho, Jae Young Moon, Ein-Soon Shin, Je Hyeong Kim, Hoon Jung, So Young Park, Ho Cheol Kim, Yun Su Sim, Chin Kook Rhee, Jaemin Lim, Seok Jeong Lee, Won-Yeon Lee, Hyun Jeong Lee, Sang Hyun Kwak, Eun Kyeong Kang, Kyung Soo Chung, Won-Il Choi
There is no well-stated practical guideline for mechanically ventilated patients with or without acute respiratory distress syndrome (ARDS). We generate strong (1) and weak (2) grade of recommendations based on high (A), moderate (B) and low (C) grade in the quality of evidence. In patients with ARDS, we recommend low tidal volume ventilation (1A) and prone position if it is not contraindicated (1B) to reduce their mortality. However, we did not support high-frequency oscillatory ventilation (1B) and inhaled nitric oxide (1A) as a standard treatment...
October 2016: Tuberculosis and Respiratory Diseases
K G Kreymann, M M Berger, N E P Deutz, M Hiesmayr, P Jolliet, G Kazandjiev, G Nitenberg, G van den Berghe, J Wernerman, C Ebner, W Hartl, C Heymann, C Spies
Enteral nutrition (EN) via tube feeding is, today, the preferred way of feeding the critically ill patient and an important means of counteracting for the catabolic state induced by severe diseases. These guidelines are intended to give evidence-based recommendations for the use of EN in patients who have a complicated course during their ICU stay, focusing particularly on those who develop a severe inflammatory response, i.e. patients who have failure of at least one organ during their ICU stay. These guidelines were developed by an interdisciplinary expert group in accordance with officially accepted standards and are based on all relevant publications since 1985...
April 2006: Clinical Nutrition: Official Journal of the European Society of Parenteral and Enteral Nutrition
Marinos Pericleous, Alexander Sarnowski, Alice Moore, Rik Fijten, Murtaza Zaman
Several pathogenic processes have been implicated in the development of abdominal ascites. Portal hypertension, most usually in the context of liver cirrhosis, can explain about 75% of the cases, whereas infective, inflammatory and infiltrative aetiologies can account for the rest. In this article, we discuss the consensus best practice as published by three professional bodies for the management of ascites, spontaneous bacterial peritonitis (SBP) and hepatorenal syndrome (HRS). The aim of this study was to compare available clinical guidelines and identify areas of agreement and conflict...
March 2016: European Journal of Gastroenterology & Hepatology
Eric L Scholten, Jeremy R Beitler, G Kim Prisk, Atul Malhotra
Prone positioning was first proposed in the 1970s as a method to improve gas exchange in ARDS. Subsequent observations of dramatic improvement in oxygenation with simple patient rotation motivated the next several decades of research. This work elucidated the physiological mechanisms underlying changes in gas exchange and respiratory mechanics with prone ventilation. However, translating physiological improvements into a clinical benefit has proved challenging; several contemporary trials showed no major clinical benefits with prone positioning...
January 2017: Chest
Andre Coetzee, Pieter Fourie
No abstract text is available yet for this article.
December 2015: Journal of Cardiothoracic and Vascular Anesthesia
Daniel Bolliger, Manfred D Seeberger, Kenichi A Tanaka
In the recent years, thromboelastography has become a popular monitoring device for hemostasis and transfusion management in major surgery, trauma, and hemophilia. Thromboelastography is performed in whole blood and assesses the viscoelastic property of clot formation under low shear condition. Thromboelastography can be performed with a variety of activator and inhibitors at different concentrations representing the most important factors for different intervals and clot formation variables reported in multiple studies and algorithms...
January 2012: Transfusion Medicine Reviews
2016-07-18 18:30:11
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