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UNIDAD CORONARIA

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67 papers 0 to 25 followers
By Elvis Amao Internal Medicine , Cardiology and infectious diseases
https://www.readbyqxmd.com/read/27908910/hospital-variation-in-time-to-epinephrine-for-non-shockable-in-hospital-cardiac-arrest
#1
Rohan Khera, Paul S Chan, Michael W Donnino, Saket Girotra
BACKGROUND: -For patients with in-hospital cardiac arrests due to non-shockable rhythms, delays in epinephrine administration beyond 5 minutes is associated with worse survival. However, the extent of hospital variation in delayed epinephrine administration and its impact on hospital-level outcomes is unknown. METHODS: -Within Get with the Guidelines-Resuscitation, we identified 103,932 adult patients (≥18 years) at 548 hospitals with an in-hospital cardiac arrest due to a non-shockable rhythm who received at least 1 dose of epinephrine between 2000 to 2014...
December 1, 2016: Circulation
https://www.readbyqxmd.com/read/27818334/neuromuscular-blockade-in-the-21-st-century-management-of-the-critically-ill-patient
#2
REVIEW
Julian deBacker, Nicholas Hart, Eddy Fan
Neuromuscular blockings agents (NMBAs) have a controversial role in the ventilatory and medical management of critical illness. The clinical concern surrounding NMBA-induced complications stems from evidence presented in the 2002 clinical practice guidelines, but new evidence from subsequent randomized trials and studies provides a more optimistic outlook about the application of NMBAs in the intensive care unit (ICU). Furthermore, changes in the delivery of critical care such as protocolized care pathways, minimizing or interrupting sedation, increased monitoring techniques, and overall improvements in reducing immobility have created a modern, 21st century ICU environment whereby NMBAs may be administered safely...
November 3, 2016: Chest
https://www.readbyqxmd.com/read/27748663/fluid-resuscitation-for-acute-kidney-injury-an-empty-promise
#3
Scott C Watkins, Andrew D Shaw
PURPOSE OF REVIEW: The past decade has seen more advances in our understanding of fluid therapy than the preceding decades combined. What was once thought to be a relatively benign panacea is increasingly being recognized as a potent pharmacological and physiological intervention that may pose as much harm as benefit. RECENT FINDINGS: Recent studies have clearly indicated that the amount, type, and timing of fluid administration have profound effects on patient morbidity and outcomes...
December 2016: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/27771302/blurred-lines-dysbiosis-and-probiotics-in-the-intensive-care-unit
#4
Lee E Morrow, Paul Wischmeyer
Clinicians have traditionally dichotomized bacteria as friendly commensals or harmful pathogens. However, the line separating the two has become blurred with the recognition that the intestinal microbiome is a complex entity wherein species can shift sides - from friend to foe and back again - based on crucial factors in their local environment. Significant disruptions in the homeostasis of the microbiome, a phenomenon called 'dysbiosis,' is increasingly associated with a host of untoward effects. Intensive care unit patients are at high risk for dysbiosis given high rates of antibiotic use, acute changes in diet, and the stress of critical illness...
October 19, 2016: Chest
https://www.readbyqxmd.com/read/24275513/the-association-between-renal-replacement-therapy-modality-and-long-term-outcomes-among-critically-ill-adults-with-acute-kidney-injury-a-retrospective-cohort-study
#5
Ron Wald, Salimah Z Shariff, Neill K J Adhikari, Sean M Bagshaw, Karen E A Burns, Jan O Friedrich, Amit X Garg, Ziv Harel, Abhijat Kitchlu, Joel G Ray
OBJECTIVE: Among critically ill patients with acute kidney injury, the impact of renal replacement therapy modality on long-term kidney function is unknown. Compared with conventional intermittent hemodialysis, continuous renal replacement therapy may promote kidney recovery by conferring greater hemodynamic stability; yet continuous renal replacement therapy may not enhance patient survival and is resource intense. Our objective was to determine whether continuous renal replacement therapy was associated with a lower risk of chronic dialysis as compared with intermittent hemodialysis, among survivors of acute kidney injury...
April 2014: Critical Care Medicine
https://www.readbyqxmd.com/read/27722111/predictors-of-dexmedetomidine-associated-hypotension-in-critically-ill-patients
#6
Anthony T Gerlach, Danielle M Blais, G Morgan Jones, Pamela K Burcham, Stanislaw P Stawicki, Charles H Cook, Claire V Murphy
BACKGROUND: Dexmedetomidine is commonly used for sedation in the Intensive Care Unit (ICU), and its use may be associated with hypotension. We sought to determine predictors of dexmedetomidine-associated hypotension. METHODS: Retrospective, single-center study of 283 ICU patients in four adults ICUs over a 12 month period. Univariate analyses were performed to determine factors associated with dexmedetomidine-related hypotension. Risk factors significant at the 0...
July 2016: International Journal of Critical Illness and Injury Science
https://www.readbyqxmd.com/read/27707496/early-goal-directed-mobilisation-in-the-surgical-intensive-care-unit-a-randomised-controlled-trial
#7
RANDOMIZED CONTROLLED TRIAL
Stefan J Schaller, Matthew Anstey, Manfred Blobner, Thomas Edrich, Stephanie D Grabitz, Ilse Gradwohl-Matis, Markus Heim, Timothy Houle, Tobias Kurth, Nicola Latronico, Jarone Lee, Matthew J Meyer, Thomas Peponis, Daniel Talmor, George C Velmahos, Karen Waak, J Matthias Walz, Ross Zafonte, Matthias Eikermann
BACKGROUND: Immobilisation predicts adverse outcomes in patients in the surgical intensive care unit (SICU). Attempts to mobilise critically ill patients early after surgery are frequently restricted, but we tested whether early mobilisation leads to improved mobility, decreased SICU length of stay, and increased functional independence of patients at hospital discharge. METHODS: We did a multicentre, international, parallel-group, assessor-blinded, randomised controlled trial in SICUs of five university hospitals in Austria (n=1), Germany (n=1), and the USA (n=3)...
October 1, 2016: Lancet
https://www.readbyqxmd.com/read/27706464/effect-of-postextubation-high-flow-nasal-cannula-vs-noninvasive-ventilation-on-reintubation-and-postextubation-respiratory-failure-in-high-risk-patients-a-randomized-clinical-trial
#8
RANDOMIZED CONTROLLED TRIAL
Gonzalo Hernández, Concepción Vaquero, Laura Colinas, Rafael Cuena, Paloma González, Alfonso Canabal, Susana Sanchez, Maria Luisa Rodriguez, Ana Villasclaras, Rafael Fernández
Importance: High-flow conditioned oxygen therapy delivered through nasal cannulae and noninvasive mechanical ventilation (NIV) may reduce the need for reintubation. Among the advantages of high-flow oxygen therapy are comfort, availability, lower costs, and additional physiopathological mechanisms. Objective: To test if high-flow conditioned oxygen therapy is noninferior to NIV for preventing postextubation respiratory failure and reintubation in patients at high risk of reintubation...
October 18, 2016: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/27692704/sevoflurane-and-isoflurane-pharmacokinetics-hemodynamic-stability-and-cardioprotective-effects-during-cardiopulmonary-bypass
#9
David Freiermuth, Berend Mets, Daniel Bolliger, Oliver Reuthebuch, Thomas Doebele, Markus Scholz, Michael Gregor, Matthias Haschke, Manfred Daniel Seeberger, Jens Fassl
OBJECTIVES: This study aimed to evaluate the pharmacokinetic profiles of sevoflurane and isoflurane during use of minimized extracorporeal circulation to perform coronary artery bypass graft surgery. Furthermore, cardiovascular stability during bypass and the postoperative release of troponins were evaluated. DESIGN: Prospective, randomized study. SETTING: University hospital. PARTICIPANTS: The study comprised 31 adult patients undergoing coronary artery bypass grafting...
December 2016: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/27687720/prevention-of-critical-care-complications-in-the-coronary-intensive-care-unit-protocols-bundles-and-insights-from-intensive-care-studies
#10
Sean van Diepen, Wendy I Sligl, Jeffrey B Washam, Ian C Gilchrist, Rakesh C Arora, Jason N Katz
Over the past half century, coronary care units have expanded from specialized ischemia arrhythmia monitoring units into intensive care units (ICUs) for acutely ill and medically complex patients with a primary cardiac diagnosis. Patients admitted to contemporary coronary intensive care units (CICUs) are at risk for common and preventable critical care complications, yet many CICUs have not adopted standard-of-care prevention protocols and practices from general ICUs. In this article, we (1) review evidence-based interventions and care bundles that reduce the incidence of ventilator-associated pneumonia, excess sedation during mechanical ventilation, central line infections, stress ulcers, malnutrition, delirium, and medication errors and (2) recommend pragmatic adaptations for common conditions in critically ill patients with cardiac disease, and (3) provide example order sets and practical CICU protocol implementation strategies...
July 1, 2016: Canadian Journal of Cardiology
https://www.readbyqxmd.com/read/27669729/age-specific-prognostication-after-out-of-hospital-cardiac-arrest-the-ethical-dilemma-between-life-sustaining-treatment-and-the-right-to-die-in-the-elderly
#11
Patrick Sulzgruber, Fritz Sterz, Michael Poppe, Andreas Schober, Elisabeth Lobmeyr, Philip Datler, Markus Keferböck, Sebastian Zeiner, Alexander Nürnberger, Pia Hubner, Peter Stratil, Christian Wallmueller, Christoph Weiser, Alexandra-Maria Warenits, Raphael van Tulder, Andreas Zajicek, Angelika Buchinger, Christoph Testori
BACKGROUND: While prognostic values on survival after out-of-hospital cardiac arrest have been well investigated, less attention has been paid to their age-specific relevance. Therefore, we aimed to identify suitable age-specific early prognostication in elderly patients suffering out-of-hospital cardiac arrest in order to reduce the burden of unnecessary treatment and harm. METHODS: In a prospective population-based observational trial on individuals suffering out-of-hospital cardiac arrest, a total of 2223 patients receiving resuscitation attempts by the local emergency medical service in Vienna, Austria, were enrolled...
September 26, 2016: European Heart Journal. Acute Cardiovascular Care
https://www.readbyqxmd.com/read/27653798/comparison-of-echocardiographic-indices-used-to-predict-fluid-responsiveness-in-ventilated-patients
#12
Philippe Vignon, Xavier Repessé, Emmanuelle Bégot, Julie Léger, Christophe Jacob, Koceila Bouferrache, Michel Slama, Gwenaël Prat, Antoine Vieillard-Baron
RATIONALE: Assessment of fluid responsiveness relies on dynamic echocardiographic parameters which have not yet been compared in large cohorts. OBJECTIVES: To determine the diagnostic accuracy of dynamic parameters used to predict fluid responsiveness in ventilated patients with a circulatory failure of any cause. METHODS: In this multicenter prospective study, respiratory variations of superior vena cava diameter (∆SVC) measured using transesophageal echocardiography, of inferior vena cava diameter (∆IVC) measured using transthoracic echocardiography, of the maximal Doppler velocity in left ventricular outflow tract (∆VmaxAo) measured using either approach, and pulse pressure variations (∆PP) were recorded with the patient in the semi-recumbent position...
September 21, 2016: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/27245700/emergency-transcatheter-aortic-valve-implantation-in-patients-with-severe-aortic-regurgitation-and-a-left-ventricle-assist-device-a-case-report-and-systematic-review
#13
Hindrik W van der Werf, Remco Aj Schurer, Ton E Vonck, Janny E Poelman, Aafke A Klungel, Vladimir Cernak, Ad Fm van den Heuvel, Pim van der Harst
BACKGROUND: Cardiogenic shock due to severe aortic regurgitation in patients with left ventricle assist devices is a life threatening condition. Here, we consider transcatheter aortic valve implantation as a treatment option. METHODS AND RESULTS: A patient with a left ventricle assist device was presented to us with cardiogenic shock due to severe aortic regurgitation. We successfully implanted a transcatheter aortic valve in emergency setting. The patient recovered and underwent cardiac transplantation three months afterwards...
May 31, 2016: European Heart Journal. Acute Cardiovascular Care
https://www.readbyqxmd.com/read/27279127/percutaneous-coronary-intervention-under-temporary-peripheral-veno-arterial-extracorporeal-membrane-oxygenation
#14
Jawad Chaara, Mustafa Cikirikcioglu, Marco Roffi
We describe the case of a 68-year old female presenting with subacute ST-elevation myocardial infarction and severe depressed left ventricular ejection fraction (15%) in the presence of severe three-vessel coronary artery disease. The patient was haemodynamically stable. After heart team discussion, a percutaneous coronary intervention was performed under peripheral veno-arterial extracorporeal membrane oxygenation without complications.
June 8, 2016: European Heart Journal. Acute Cardiovascular Care
https://www.readbyqxmd.com/read/27625341/diagnosis-of-type-2-diabetes-and-prediabetes-among-patients-with-acute-coronary-syndromes
#15
Thorarinn A Bjarnason, Linda B Kristinsdottir, Erna S Oskarsdottir, Steinar O Hafthorsson, Isleifur Olafsson, Sigrun H Lund, Karl Andersen
BACKGROUND: Previously undetected dysglycaemia is common among patients with acute coronary syndromes (ACSs). The aim of this study was to identify the most reliable method of diagnosing type 2 diabetes mellitus (T2DM) and prediabetes in ACS patients. METHODS: Patients admitted to the coronary care unit with ACSs and no previous history of T2DM were consecutively included in the study. Glucose metabolism was measured by glycated haemoglobin (HbA1c), fasting plasma glucose (FPG) and 2-hour plasma glucose (2hPG) with a standard oral glucose tolerance test during hospital admission, and this process was repeated 3 months later...
September 13, 2016: European Heart Journal. Acute Cardiovascular Care
https://www.readbyqxmd.com/read/27639509/-non-invasive-mechanical-ventilation-after-the-successful-weaning-a-comparison-with-the-venturi-mask
#16
Esra Adıyeke, Asu Ozgultekin, Guldem Turan, Altay Iskender, Gamze Canpolat, Abdullah Pektaş, Osman Ekinci
BACKGROUND AND OBJECTIVES: This study compared the rates of acute respiratory failure, reintubation, length of intensive care stay and mortality in patients in whom the non-invasive mechanical ventilation (NIMV) was applied instead of the routine venturi face mask (VM) application after a successful weaning. METHODS: Following the approval of the hospital ethics committee, 62 patients who were under mechanical ventilation for at least 48hours were scheduled for this study...
September 14, 2016: Revista Brasileira de Anestesiologia
https://www.readbyqxmd.com/read/27639872/association-of-serum-magnesium-on-mortality-in-patients-admitted-to-the-intensive-cardiac-care-unit
#17
Niyada Naksuk, Tiffany Hu, Chayakrit Krittanawong, Charat Thongprayoon, Sunita Sharma, Jae Yoon Park, Andrew N Rosenbaum, Prakriti Gaba, Ammar M Killu, Alan M Sugrue, Thoetchai Peeraphatdit, Vitaly Herasevich, Malcolm R Bell, Peter A Brady, Suraj Kapa, Samuel J Asirvatham
BACKGROUND: Although electrolyte disturbances may affect cardiac action potential, little is known about the association between serum magnesium and QTc interval as well as clinical outcomes. METHODS: A consecutive 8,498 patients admitted to the Mayo Clinic Hospital - Rochester cardiac care unit (CCU), from January 1, 2004 through December 31, 2013, with two or more documented serum magnesium levels, was studied in order to test the hypothesis that serum magnesium levels are associated with in-hospital mortality, sudden cardiac death and corrected QT interval (QTc) interval...
September 14, 2016: American Journal of Medicine
https://www.readbyqxmd.com/read/27618681/early-identification-of-patients-with-out-of-hospital-cardiac-arrest-with-no-chance-of-survival-and-consideration-for-organ-donation
#18
Patricia Jabre, Wulfran Bougouin, Florence Dumas, Pierre Carli, Corinne Antoine, Laurent Jacob, Benjamin Dahan, Frankie Beganton, Jean-Philippe Empana, Eloi Marijon, Nicole Karam, Alexandre Loupy, Carmen Lefaucheur, Daniel Jost, Alain Cariou, Frédéric Adnet, Thomas D Rea, Xavier Jouven
Background: In patients with out-of-hospital cardiac arrest (OHCA), care requirements can conflict with the need to promptly focus efforts on organ donation in patients who are pronounced dead. Objective: To evaluate objective criteria for identifying patients with OHCA with no chance of survival during the first minutes of cardiopulmonary resuscitation to enable prompt orientation toward organ donation. Design: Retrospective assessment using OHCA data from 2 registries and 1 trial...
September 13, 2016: Annals of Internal Medicine
https://www.readbyqxmd.com/read/27634596/early-extracorporeal-membrane-oxygenation-for-cardiovascular-failure-in-a-patient-with-massive-chloroquine-poisoning
#19
François Bagate, Costin Radu, Armand Mekontso Dessap, Nicolas de Prost
No abstract text is available yet for this article.
August 30, 2016: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27592289/echocardiography-as-a-guide-for-fluid-management
#20
REVIEW
John H Boyd, Demetrios Sirounis, Julien Maizel, Michel Slama
BACKGROUND: In critically ill patients at risk for organ failure, the administration of intravenous fluids has equal chances of resulting in benefit or harm. While the intent of intravenous fluid is to increase cardiac output and oxygen delivery, unwelcome results in those patients who do not increase their cardiac output are tissue edema, hypoxemia, and excess mortality. Here we briefly review bedside methods to assess fluid responsiveness, focusing upon the strengths and pitfalls of echocardiography in spontaneously breathing mechanically ventilated patients as a means to guide fluid management...
September 4, 2016: Critical Care: the Official Journal of the Critical Care Forum
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