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UNIDAD CORONARIA

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113 papers 25 to 100 followers
By Elvis Amao Internal Medicine , Cardiology and infectious diseases
https://www.readbyqxmd.com/read/28336761/impact-of-an-antimicrobial-stewardship-initiative-on-time-to-administration-of-empirical-antibiotic-therapy-in-hospitalized-patients-with-bacteremia
#1
Tiffany E Bias, William R Vincent, Nathan Trustman, Leonard B Berkowitz, Veena Venugopalan
PURPOSE: The impact of an antimicrobial stewardship initiative on time to first antibiotic dose and clinical outcomes in bacteremic patients was evaluated. METHODS: A single-center, retrospective study was conducted for adult inpatients who received antibiotics before and after implementation of a rapid administration of antimicrobials by an infectious diseases specialist (RAIDS) protocol. Patients admitted to an inpatient service from June to October 2011 (pre-RAIDS protocol) and from December 2011 to February 2012 (post-RAIDS protocol) were eligible for inclusion if (1) they were age 18 years or older, (2) their infection occurred two or more days after hospital admission, and (3) they had a blood culture growing an organism other than common skin contaminants (i...
April 1, 2017: American Journal of Health-system Pharmacy: AJHP
https://www.readbyqxmd.com/read/28320242/early-goal-directed-therapy-for-septic-shock-a-patient-level-meta-analysis
#2
(no author information available yet)
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...
March 21, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28320437/anemia-and-blood-transfusion-in-the-critically-ill-patient-with-cardiovascular-disease
#3
REVIEW
Annemarie B Docherty, Timothy S Walsh
This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency Medicine 2017. Other selected articles can be found online at http://ccforum.com/series/annualupdate2017 . Further information about the Annual Update in Intensive Care and Emergency Medicine is available from http://www.springer.com/series/8901 .
March 21, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/28284292/the-abcdef-bundle-in-critical-care
#4
REVIEW
Annachiara Marra, E Wesley Ely, Pratik P Pandharipande, Mayur B Patel
The ABCDEF bundle represents an evidence-based guide for clinicians to approach the organizational changes needed for optimizing intensive care unit patient recovery and outcomes. This article reviews the core evidence and features behind the ABCDEF bundle. The bundle has individual components that are clearly defined, flexible to implement, and help empower multidisciplinary clinicians and families in the shared care of the critically ill. The ABCDEF bundle helps guide well-rounded patient care and optimal resource utilization resulting in more interactive intensive care unit patients with better controlled pain, who can safely participate in higher-order physical and cognitive activities at the earliest point in their critical illness...
April 2017: Critical Care Clinics
https://www.readbyqxmd.com/read/28284295/ventilator-associated-pneumonia-new-definitions
#5
REVIEW
M Chance Spalding, Michael W Cripps, Christian T Minshall
The National Healthcare Safety Network's new classification characterizes all adverse ventilator-associated events (VAE) into a tiered system designed to shift the focus away from ventilator-associated pneumonia as the only important cause or morbidity in ventilated patients. This new surveillance definition of VAE eliminates subjectivity by using clearly defined criteria and facilitates the automated collection of data. This allows for easier comparison and analysis of factors affecting rates of VAE. Numerous studies have been published that demonstrate its clinical application...
April 2017: Critical Care Clinics
https://www.readbyqxmd.com/read/28284296/oxygen-therapeutics-and-mechanical-ventilation-advances
#6
REVIEW
Brian Weiss, Lewis J Kaplan
Advances in intensive care unit (ICU) therapeutics are plentiful and rooted in technological enhancements as well as recognition of patient care priorities. A plethora of new devices and modes are available for use to enhance patient safety and support liberation from mechanical ventilation while preserving oxygenation and carbon dioxide clearance. Increased penetrance of closed loop systems is one means to reduce care variation in appropriate populations. The intelligent design of the ICU space needs to integrate the footprint of that device and the data streaming from it into a coherent whole that supports patient, family, and caregivers...
April 2017: Critical Care Clinics
https://www.readbyqxmd.com/read/28284297/tracheostomy-update-when-and-how
#7
REVIEW
Bradley D Freeman
Tracheostomy remains one of the most commonly performed surgical procedures in the setting of acute respiratory failure. Tracheostomy literature focuses on 2 aspects of this procedure: when (timing) and how (technique). Recent trials have failed to demonstrate an effect of tracheostomy timing on most clinically important endpoints. Nonetheless, relative to continued translaryngeal intubation, studies suggest that tracheostomy use is associated with less need for sedation and enhanced patient comfort. Evidence likewise suggests that percutaneous dilational tracheostomy is advantageous with respect to cost and complication profile and should be considered the preferred approach in appropriately selected patients...
April 2017: Critical Care Clinics
https://www.readbyqxmd.com/read/28284299/anemia-and-red-blood-cell-transfusion-advances-in-critical-care
#8
REVIEW
Lena M Napolitano
Anemia is common in the intensive care unit (ICU), resulting in frequent administration of red blood cell (RBC) transfusions. Significant advances have been made in understanding the pathophysiology of anemia in the ICU, which is anemia of inflammation. This anemia is related to high hepcidin concentrations resulting in iron-restricted erythropoiesis, and decreased erythropoietin concentrations. A new hormone (erythroferrone) has been identified, which mediates hepcidin suppression to allow increased iron absorption and mobilization from iron stores...
April 2017: Critical Care Clinics
https://www.readbyqxmd.com/read/28265980/outcomes-in-elderly-patients-admitted-to-the-intensive-care-unit-with-solid-tumors
#9
Edouard Auclin, Anaïs Charles-Nelson, Baptiste Abbar, Emmanuel Guérot, Stéphane Oudard, Caroline Hauw-Berlemont, Constance Thibault, Alexandra Monnier, Jean-Luc Diehl, Sandrine Katsahian, Jean-Yves Fagon, Julien Taieb, Nadia Aissaoui
BACKGROUND: As the population ages and cancer therapies improve, there is an increased call for elderly cancer patients to be admitted to the intensive care unit (ICU). This study aimed to assess short-term survival and prognostic factors in critically ill patients with solid tumors aged ≥65 years. METHODS: We conducted a retrospective study. The primary endpoint was ICU mortality. Resumption of anticancer therapy in patients who survived the ICU stay and 90-day mortality were secondary endpoints...
December 2017: Annals of Intensive Care
https://www.readbyqxmd.com/read/28275619/extracorporeal-membrane-oxygenation-in-the-pre-and-post-lung-transplant-period
#10
REVIEW
Nirmal S Sharma, Mathew G Hartwig, Don Hayes
Evolution in technology has resulted in rapid increase in utilization of extracorporeal membrane oxygenation (ECMO) as a bridge to recovery and/or transplantation. Although there is limited evidence for the use of ECMO, recent improvements in ECMO technology, personnel training, ambulatory practices on ECMO and lung protective strategies have resulted in improved outcomes in patients bridged to lung transplantation. This review provides an insight into the current outcomes and best practices for utilization of ECMO in the pre- and post-lung transplantation period...
February 2017: Annals of Translational Medicine
https://www.readbyqxmd.com/read/28286833/ventilator-associated-pneumonia-and-its-responsible-germs-an-epidemiological-study
#11
Rama Bozorgmehr, Vanousheh Bahrani, Alireza Fatemi
INTRODUCTION: Ventilator-associated pneumonia (VAP) is one of the most common hospital infections and a side effect of lengthy stay in intensive care unit (ICU). Considering the ever-changing pattern of common pathogens in infectious diseases and the raise in prevalence of hospital infections, the present study was designed aiming to determine the prevalence of VAP and its bacterial causes. METHODS: In this cross-sectional study, the medical profiles of all the patients under mechanical ventilation, who had no symptoms of pneumonia at the time of intubation and developed new infiltration in chest radiography after 48 hours under mechanical ventilation along with at least 2 of the symptoms including fever, hypothermia, leukocytosis, leukopenia, or purulent discharge from the lungs, were evaluated...
2017: Emergency (Tehran, Iran)
https://www.readbyqxmd.com/read/28260911/increased-risk-of-endotracheal-intubation-and-heart-failure-following-acute-myocardial-infarction-in-patients-with-urolithiasis-a-nationwide-population-based-study
#12
Shun-Ku Lin, Jui-Ming Liu, Ying-Hsu Chang, Yuan-Tien Ting, See-Tong Pang, Ren-Jun Hsu, Po-Hung Lin
BACKGROUND: Urolithiasis is a common urinary tract disease worldwide. It has been connected to systemic diseases, including hypertension, diabetes mellitus, metabolic syndrome, and cardiovascular disease. In the current study, we aimed to evaluate the relationship between urolithiasis and the complications of acute myocardial infarction (AMI). MATERIALS AND METHODS: Data were obtained from the Longitudinal Health Insurance Database 2005 of the National Health Insurance Research Database...
2017: Therapeutics and Clinical Risk Management
https://www.readbyqxmd.com/read/28237895/anticoagulation-practices-and-the-prevalence-of-major-bleeding-thromboembolic-events-and-mortality-in-venoarterial-extracorporeal-membrane-oxygenation-a-systematic-review-and-meta-analysis
#13
Eric Sy, Michael C Sklar, Laurence Lequier, Eddy Fan, Hussein D Kanji
PURPOSE: The purpose was to evaluate the safety of anticoagulation in venoarterial extracorporeal membrane oxygenation (VA-ECMO). DESIGN: We performed a systematic review and meta-analysis using multiple electronic databases. Studies were from 1977 to September 27, 2016. We evaluated the effect of anticoagulation in VA-ECMO on outcomes including major bleeding, thromboembolic events, and in-hospital mortality using a random effects model meta-analysis. RESULTS: Twenty-six studies (1496 patients) were included...
February 12, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/28236098/use-of-extracorporeal-membrane-oxygenation-in-complicated-transcatheter-aortic-valve-replacement
#14
Kyokun Uehara, Kenji Minakata, Naritatsu Saito, Masao Imai, Hiroki Daijo, Taro Nakatsu, Kazuhisa Sakamoto, Kazuhiro Yamazaki, Takeshi Kimura, Ryuzo Sakata
OBJECTIVES: Although transcatheter aortic valve replacement (TAVR) is an excellent alternative procedure for high-risk patients with severe symptomatic aortic stenosis, it is often associated with life-threatening complications. We report on the emergency or elective use of veno-arterial extracorporeal membrane oxygenation (ECMO) to manage these complications. METHODS: Between December 2013 and February 2016, 46 patients underwent TAVR at our institution. Of these, 4 patients required emergency ECMO support and another 3 patients were electively placed on ECMO support at the start of the procedure...
February 24, 2017: General Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/28224105/nutrient-stimulation-of-mesenteric-blood-flow-implications-for-older-critically-ill-patients
#15
REVIEW
Thu An Nguyen, Yasmine Ali Abdelhamid, Liza K Phillips, Leeanne S Chapple, Michael Horowitz, Karen L Jones, Adam M Deane
Nutrient ingestion induces a substantial increase in mesenteric blood flow. In older persons (aged ≥ 65 years), particularly those with chronic medical conditions, the cardiovascular compensatory response may be inadequate to maintain systemic blood pressure during mesenteric blood pooling, leading to postprandial hypotension. In older ambulatory persons, postprandial hypotension is an important pathophysiological condition associated with an increased propensity for syncope, falls, coronary vascular events, stroke and death...
February 4, 2017: World Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/28242147/veno-venous-extracorporeal-membrane-oxygenation-for-acute-respiratory-distress-syndrome-in-a-patient-with-acute-right-heart-failure
#16
Silvia Mongodi, Anita Orlando, Guido Tavazzi, Marco Pozzi, Giuseppe Maggio, Antonio Braschi, Giorgio Antonio Iotti, Francesco Mojoli
No abstract text is available yet for this article.
December 7, 2016: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/28067677/the-microbiome-in-mechanically-ventilated-patients
#17
Yudong Yin, Peter Hountras, Richard G Wunderink
PURPOSE OF REVIEW: Discovery of a normal lung microbiome requires reassessment of our concepts of HAP/VAP pathogenesis and has important implications for clinical diagnosis and management. RECENT FINDINGS: Changes in the microbiome of dental plaque are associated with increased risk of HAP/VAP. A transition to a lung microbiome enriched with gut flora is found in ARDS with an increased inflammatory response in patients with this change in microbial flora. A characteristic microbiome pattern of higher amounts of bacterial DNA, lower community diversity, and greater relative abundance of a single species characterize pneumonia and occasionally identify bacteria not found in culture...
April 2017: Current Opinion in Infectious Diseases
https://www.readbyqxmd.com/read/28118221/prevention-of-ventilator-associated-pneumonia
#18
Gianluigi Li Bassi, Tarek Senussi, Eli Aguilera Xiol
PURPOSE OF REVIEW: Ventilator-associated pneumonia (VAP) is an iatrogenic disease. Here we appraise recent advancements in the development and testing of strategies to prevent VAP. We also provide recommendations on the most promising interventions that should be applied. RECENT FINDINGS: In the last year, preventive bundles have consistently let to a reduction of VAP. A few trials on endotracheal tubes (ETTs) with novel cuffs failed to translate positive bench findings into clinical settings...
April 2017: Current Opinion in Infectious Diseases
https://www.readbyqxmd.com/read/27906708/acute-respiratory-distress-syndrome-mimics-the-role-of-lung-biopsy
#19
Mylène Aublanc, Sophie Perinel, Claude Guérin
PURPOSE OF REVIEW: Acute respiratory distress syndrome (ARDS) mimics is a condition looking like ARDS but that does not fulfill every criterion according to the recent Berlin definition. The purpose of this review is to better delineate ARDS mimics, to discuss why the complete diagnosis of ARDS is important, and to make a brief overview on the role of open lung biopsy in this setting. RECENT FINDINGS: Recent autopsy and lung biopsy data from ARDS patients compared lung histologic findings with the new Berlin definition of ARDS...
February 2017: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/27906709/looking-closer-at-acute-respiratory-distress-syndrome-the-role-of-advanced-imaging-techniques
#20
Giacomo Bellani, Jean-Jaques Rouby, Jean-Michel Constantin, Antonio Pesenti
PURPOSE OF REVIEW: Advanced imaging techniques have provided invaluable insights in understanding of acute respiratory distress syndrome (ARDS) and the effect of therapeutic strategies, thanks to the possibility of gaining regional information and moving from simple 'anatomical' information to in-vivo functional imaging. RECENT FINDINGS: Computed tomography (CT) led to the understanding of several ARDS mechanisms and interaction with mechanical ventilation. It is nowadays frequently part of routine diagnostic workup, often leading to treatment changes...
February 2017: Current Opinion in Critical Care
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