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UNIDAD CORONARIA

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193 papers 25 to 100 followers
By Elvis Amao Internal Medicine , Cardiology and infectious diseases
https://www.readbyqxmd.com/read/29249905/the-inodilator-levosimendan-in-repetitive-doses-in-the-treatment-of-advanced-heart-failure
#1
Juan F Delgado, Fabrizio Oliva, Alexander Reinecke
Inotropes may be an appropriate response for some patients with advanced heart failure who remain highly symptomatic despite optimization of evidence-based therapy. These patients need to be supported waiting for a heart transplant or ventricular assist device, or may be candidates for inotropy as an intervention in its own right to maintain a patient in the best achievable circumstances. Objectives in such a situation include relieving symptoms, improving quality of life and reducing unplanned hospitalizations and the costs associated with such admissions...
March 2017: European Heart Journal Supplements: Journal of the European Society of Cardiology
https://www.readbyqxmd.com/read/29302122/rvad-support-in-the-setting-of-submassive-pulmonary-embolism
#2
Antonio Salsano, Elena Sportelli, Guido Maria Olivieri, Nicola Di Lorenzo, Silvia Borile, Francesco Santini
Patients with submassive pulmonary embolism (PE), although normotensive, are characterized by right ventricular (RV) dysfunction and elevated levels of biomarkers of cardiac damage. The best treatment option in these cases is still a subject of debate and the use of thrombolysis in submassive PE remains controversial. A 57-year-old Caucasian male with unprovoked PE, normal blood pressure, and elevated troponin I values was referred to the cardiovascular department. In view of the presence of a right atrium thrombus, the patient underwent surgical embolectomy under extracorporeal circulation, with the extraction of a huge thrombus together with fragmented thrombi from both pulmonary arteries...
December 2017: Journal of Extra-corporeal Technology
https://www.readbyqxmd.com/read/29329694/management-of-refractory-vasodilatory-shock
#3
REVIEW
Jacob C Jentzer, Saraschandra Vallabhajosyula, Ashish K Khanna, Lakhmir S Chawla, Laurence W Busse, Kianoush B Kashani
Refractory shock is a lethal manifestation of cardiovascular failure defined by an inadequate hemodynamic response to high doses of vasopressor medications. Approximately 7% of critically ill patients will develop refractory shock, with short-term mortality exceeding 50%. Refractory vasodilatory shock develops from uncontrolled vasodilation and vascular hyporesponsiveness to endogenous vasoconstrictors, causing failure of physiologic vasoregulatory mechanisms. Standard approaches to initial management of shock include fluid resuscitation and initiation of norepinephrine...
January 9, 2018: Chest
https://www.readbyqxmd.com/read/29262435/neuroprognostication-of-cardiac-arrest-patients-outcomes-of-importance
#4
Tobias Cronberg
During the last two decades, survival rates after cardiac arrest have increased while the fraction of patients surviving with a severe neurological disability or vegetative state has decreased in many countries. While improved survival is due to improvements in the whole "chain of survival," improved methods for prognostication of neurological outcome may be of major importance for the lower disability rates. Patients who are resuscitated and treated in intensive care will die mainly from the withdrawal of life-sustaining (WLST) therapy due to presumed poor chances of meaningful neurological recovery...
December 2017: Seminars in Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/29253554/heparin-induced-thrombocytopenia-in-the-critically-ill-patient
#5
REVIEW
James M East, Christine Cserti- Gazdewich, John T Granton
Heparin induced thrombocytopenia (HIT) is associated with significant morbidity and mortality. Critically ill patients are commonly thrombocytopenic and exposed to heparin. Although HIT should be considered, it is not usually the cause of thrombocytopenia in the medical-surgical ICU population. A systematic approach to the critically ill patient with thrombocytopenia using clinical features, complemented by appropriate laboratory confirmation should lead to a reduction in inappropriate laboratory testing and reduce the use of more expensive and less reliable anticoagulants...
December 15, 2017: Chest
https://www.readbyqxmd.com/read/29230392/non-invasive-monitoring-of-cardiac-output-in-critical-care-medicine
#6
REVIEW
Lee S Nguyen, Pierre Squara
Critically ill patients require close hemodynamic monitoring to titrate treatment on a regular basis. It allows administering fluid with parsimony and adjusting inotropes and vasoactive drugs when necessary. Although invasive monitoring is considered as the reference method, non-invasive monitoring presents the obvious advantage of being associated with fewer complications, at the expanse of accuracy, precision, and step-response change. A great many methods and devices are now used over the world, and this article focuses on several of them, providing with a brief review of related underlying physical principles and validation articles analysis...
2017: Frontiers in Medicine
https://www.readbyqxmd.com/read/29168046/procalcitonin-guided-antibiotic-therapy-in-intensive-care-unit-patients-a-systematic-review-and-meta-analysis
#7
Hui-Bin Huang, Jin-Min Peng, Li Weng, Chun-Yao Wang, Wei Jiang, Bin Du
BACKGROUND: Serum procalcitonin (PCT) concentration is used to guide antibiotic decisions in choice, timing, and duration of anti-infection therapy to avoid antibiotic overuse. Thus, we performed a systematic review and meta-analysis to seek evidence of different PCT-guided antimicrobial strategies for critically ill patients in terms of predefined clinical outcomes. METHODS: We searched for relevant studies in PubMed, Embase, Web of Knowledge, and the Cochrane Library up to 25 February 2017...
November 22, 2017: Annals of Intensive Care
https://www.readbyqxmd.com/read/28537997/where-are-we-heading-with-fluid-responsiveness-research
#8
Simon T Vistisen, Peter Juhl-Olsen
PURPOSE OF REVIEW: Fluid responsiveness prediction is not always possible with well established dynamic approaches such as passive leg raising or pulse pressure variation in the ICU. The purpose of the present review is to summarize emerging alternative techniques for fluid responsiveness prediction in adult critically ill patients and discuss their methodology and applicability. In addition, the future role of fluid responsiveness prediction in the ICU is discussed. RECENT FINDINGS: Several new dynamic techniques have been investigated and they all contribute to the applicability of fluid responsiveness techniques...
August 2017: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/28537998/lactate-and-microcirculation-as-suitable-targets-for-hemodynamic-optimization-in-resuscitation-of-circulatory-shock
#9
Michael E Kiyatkin, Jan Bakker
PURPOSE OF REVIEW: A discussion of recent research exploring the feasibility of perfusion-guided resuscitation of acute circulatory failure with a focus on lactate and microcirculation. RECENT FINDINGS: Upon diagnosis of shock, hyperlactemia is associated with poor outcome and, under appropriate clinical circumstances, may reflect inadequate tissue perfusion. Persistent hyperlactemia despite resuscitation is even more strongly correlated with morbidity and mortality...
August 2017: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/28548991/protein-nutrition-and-exercise-survival-kit-for-critically-ill
#10
Peter J M Weijs
PURPOSE OF REVIEW: Protein delivery as well as exercise of critically ill in clinical practice is still a highly debated issue. Here we discuss only the most recent updates in the literature concerning protein nutrition and exercise of the critically ill. RECENT FINDINGS: By lack of randomized controlled trial (RCTs) in protein nutrition we discuss four post-hoc analyses of nutrition studies and one experimental study in mice. Studies mainly confirm some insights that protein and energy effects are separate and that the trajectory of the patient in the ICU might change these effects...
August 2017: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/28538248/minimally-invasive-cardiac-output-technologies-in-the-icu-putting-it-all-together
#11
Ramon P Clement, Jaap J Vos, Thomas W L Scheeren
PURPOSE OF REVIEW: Haemodynamic monitoring is a cornerstone in the diagnosis and evaluation of treatment in critically ill patients in circulatory distress. The interest in using minimally invasive cardiac output monitors is growing. The purpose of this review is to discuss the currently available devices to provide an overview of their validation studies in order to answer the question whether these devices are ready for implementation in clinical practice. RECENT FINDINGS: Current evidence shows that minimally invasive cardiac output monitoring devices are not yet interchangeable with (trans)pulmonary thermodilution in measuring cardiac output...
August 2017: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/28562384/personalized-hemodynamic-management
#12
Bernd Saugel, Jean-Louis Vincent, Julia Y Wagner
PURPOSE OF REVIEW: To describe personalized hemodynamic management of critically ill patients in the operating room and the ICU. RECENT FINDINGS: Several recent clinical studies have investigated different strategies for optimizing blood pressure (BP) and flow in the operating room and in the ICU. In the past, (early) goal-directed hemodynamic treatment strategies often used predefined fixed population-based 'normal' values as hemodynamic targets. Most hemodynamic variables, however, have large interindividual variability and are dependent on several biometric factors...
August 2017: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/28570301/clinical-examination-for-diagnosing-circulatory-shock
#13
Bart Hiemstra, Ruben J Eck, Frederik Keus, Iwan C C van der Horst
PURPOSE OF REVIEW: In the acute setting of circulatory shock, physicians largely depend on clinical examination and basic laboratory values. The daily use of clinical examination for diagnostic purposes contrasts sharp with the limited number of studies. We aim to provide an overview of the diagnostic accuracy of clinical examination in estimating circulatory shock reflected by an inadequate cardiac output (CO). RECENT FINDINGS: Recent studies showed poor correlations between CO and mottling, capillary refill time or central-to-peripheral temperature gradients in univariable analyses...
August 2017: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/28793300/the-burden-of-malignancy-in-a-tertiary-hospital-intensive-cardiovascular-care-unit
#14
Israel Mazin, Shlomi Matetzky, Linor Shemer, Dana Fourey, Paul Fefer, Amit Segev, Arsalan Abu-Much, Roy Beigel, Elad Asher
OBJECTIVES: During the past decade, the most common causes of mortality and morbidity were cardiovascular diseases and malignancies. The aim of the current study was to describe the incidence, course of admission, and short-term (30-day) prognosis of patients with and without malignancy, admitted to a tertiary center intensive cardiovascular care unit (ICCU). METHODS: A prospective observational study of 2,259 patients admitted to the ICCU was conducted between January 2014 and December 2015...
2017: Cardiology
https://www.readbyqxmd.com/read/29116464/venovenous-extracorporeal-membrane-oxygenation-devices-related-colonisations-and-infections
#15
Guillemette Thomas, Sami Hraiech, Nadim Cassir, Samuel Lehingue, Romain Rambaud, Sandrine Wiramus, Christophe Guervilly, Fanny Klasen, Mélanie Adda, Stéphanie Dizier, Antoine Roch, Laurent Papazian, Jean-Marie Forel
BACKGROUND: Nosocomial infections occurring during extracorporeal membrane oxygenation (ECMO) support have already been reported, but few studied infections directly related to ECMO devices. This study aims to evaluate the rate of both colonisations and infections related to ECMO devices at the time of ECMO removal. RESULTS: We included all consecutive adult patients treated with venovenous ECMO (VV-ECMO) for at least 48 h during a 34-month study. At the time of ECMO removal, blood cultures, swab cultures on insertion cannula site and intravascular cannula extremity cultures were systematically performed...
November 7, 2017: Annals of Intensive Care
https://www.readbyqxmd.com/read/28284300/renal-replacement-therapy-in-acute-kidney-injury-controversies-and-consensus
#16
REVIEW
Michael Heung, Lenar Yessayan
Acute kidney injury (AKI) is a common complication among critically ill patents, and 5% of intensive care unit (ICU) patients require initiation of renal replacement therapy (RRT). In recent years, clinical trials have provided evidence-based guidance for some important aspects of RRT management in patients with AKI, such as dialysis dosing and approaches to anticoagulation in patients undergoing continuous RRT. However, there remain many areas of uncertainty, and delivery of RRT in the ICU requires clinical judgment, flexibility, and an understanding of dialysis principles...
April 2017: Critical Care Clinics
https://www.readbyqxmd.com/read/28887925/introduction-to-extracorporeal-membrane-oxygenation
#17
REVIEW
Nicholas C Cavarocchi
Renewed interest in extracorporeal membrane oxygenation (ECMO) support of critically ill patients has led to a large expansion of its use across the world. This article reviews the long history of ECMO and introduces the early pioneers. The idea of team planning and team work is introduced in this article. There is an emphasis on understanding that ECMO care varies across institutions but is slowly growing to more uniform protocols.
October 2017: Critical Care Clinics
https://www.readbyqxmd.com/read/28887927/cardiac-support-emphasis-on-venoarterial-ecmo
#18
REVIEW
Christopher S King, Aviral Roy, Liam Ryan, Ramesh Singh
Major advances have been made in mechanical circulatory support in recent years. Venoarterial (VA) extracorporeal membrane oxygenation (ECMO) provides both pulmonary and circulatory support for critically ill patients with hemodynamic compromise, serving as a bridge to recovery or definitive therapy in the form of transplant or a durable ventricular assist device. In the past, VA ECMO support was used in cases of cardiogenic shock or failure to wean from cardiopulmonary bypass; however, the technology is now being applied to an ever-expanding list of conditions, including massive pulmonary embolism, cardiac arrest, drug overdose, and hypothermia...
October 2017: Critical Care Clinics
https://www.readbyqxmd.com/read/28887928/management-strategies-for-severe-respiratory-failure-as-extracorporeal-membrane-oxygenation-is-being-considered
#19
REVIEW
Bharat Awsare, Justin Herman, Michael Baram
Pulmonary and critical care physicians must be facile in recognition and management of patients with acute respiratory distress syndrome (ARDS). Part of the current critical care knowledge base must include an understanding of how extracorporeal membrane oxygenation fits into the paradigm of ARDS management without using it as a "salvage therapy." This article provides a basic understanding of the evolution of ARDS to multiple organ dysfunction syndrome, recognizing benefits and limits of rescue therapies, indications and contraindications of extracorporeal membrane oxygenation, and coordination of care for severe respiratory failure...
October 2017: Critical Care Clinics
https://www.readbyqxmd.com/read/28887929/vascular-complications-in-extracoporeal-membrane-oxygenation
#20
REVIEW
Kathleen M Lamb, Hitoshi Hirose
Venoarterial extracorporeal membrane oxygenation is a rescue therapy in patients with severe cardiopulmonary failure. Often, cannulation is done emergently and the femoral vessels are most readily accessible for venous and arterial access. Unfortunately, complications with arterial femoral access can lead to devastating complications, primarily related to limb ischemia. A coordinated protocol of diligent limb examination by trained intensive care unit staff, near infrared spectroscopy monitoring of limbs, and placement of a distal perfusion catheter at the time of femoral cannulation or when signs of ischemia develop, can lead to successful limb salvage...
October 2017: Critical Care Clinics
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2017-11-17 10:11:38
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