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UNIDAD CORONARIA

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186 papers 25 to 100 followers
By Elvis Amao Internal Medicine , Cardiology and infectious diseases
https://www.readbyqxmd.com/read/28537997/where-are-we-heading-with-fluid-responsiveness-research
#1
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
#2
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
#3
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
#4
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
#5
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
#6
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
#7
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
#8
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
#9
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
#10
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
#11
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
#12
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
#13
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
https://www.readbyqxmd.com/read/28887931/extracorporeal-membrane-oxygenation-management-techniques-to-liberate-from-extracorporeal-membrane-oxygenation-and-manage-post-intensive-care-unit-issues
#14
REVIEW
Joseph B Zwischenberger, Harrison T Pitcher
Extracorporeal membrane oxygenation (ECMO) is a life-saving technique when patients require pulmonary and/or cardiac support for days to weeks for recovery, bridge to decision, or transplantation. Due to complications associated with ECMO, it is best to stay on ECMO as little time as necessary. Foremost is weaning from ECMO, but the post-ECMO period recapitulates the entire field of critical care. Identified issues include (1) potential for systemic inflammatory response syndrome post-decannulation; (2) post-ECMO complications, such as deep vein thrombosis, wounds, renal failure, and stroke; (3) delirium; (4) posttraumatic stress disorder; (5) rehabilitation; and (6) end of life...
October 2017: Critical Care Clinics
https://www.readbyqxmd.com/read/28887932/issues-in-the-intensive-care-unit-for-patients-with-extracorporeal-membrane-oxygenation
#15
REVIEW
Hitoshi Hirose, Harrison T Pitcher, Michael Baram, Nicholas C Cavarocchi
The care of patients on extracorporeal corporeal oxygenation support takes a coordinated effort among the team of nurses, midlevel providers, perfusionists, respiratory therapists, pharmacists, and physicians. Attention on the details of the circuitry and its interactions with the patient, the resolution of the disease process and the ongoing plan of care, and unique issues in the intensive care unit are crucial for success.
October 2017: Critical Care Clinics
https://www.readbyqxmd.com/read/28887933/staffing-equipment-monitoring-considerations-for-extracorporeal-membrane-oxygenation
#16
REVIEW
David C Fitzgerald, Edward M Darling, Monika F Cardona
Although the reasons for the recent growth in adult extracorporeal membrane oxygenation (ECMO) are multifactorial, much of the success may be attributed to the development of well-trained staff and the technological innovations in equipment and monitoring devices used during extracorporeal support. In this article, the authors discuss general educational formats for the ECMO bedside provider, staffing support models, and devices designed to best meet the needs of the patient while simultaneously ensuring the proper delivery of ECMO-related care...
October 2017: Critical Care Clinics
https://www.readbyqxmd.com/read/28887934/transport-while-on-extracorporeal-membrane-oxygenation-support
#17
REVIEW
Kyle C Niziolek, Thomas J Preston, Erik C Osborn
Extracorporeal membrane oxygenation (ECMO) support for severe acute respiratory failure has been increasing. Evidence suggests that higher volume centers have better outcomes, leading to a need for specialized ECMO transport teams. The inherent nature of the prehospital environment adds an additional layer of complexity; however, the experience of multiple centers has demonstrated that cannulating and transporting a patient on ECMO can be performed safely. The purpose of this review article is to discuss the state of knowledge with respect to ECMO transport with special emphasis given to how to actually undertake such complex transports...
October 2017: Critical Care Clinics
https://www.readbyqxmd.com/read/29113815/evaluation-of-left-ventricular-diastolic-function-by-the-intensivist
#18
REVIEW
Yonatan Y Greenstein, Paul H Mayo
The assessment of left ventricular diastolic function is an important element of advanced critical care echocardiography. Standard methods of evaluating diastolic function that are routinely performed on an elective basis in the cardiology echocardiography laboratory may be difficult to apply in the critical care unit. In this article, we review methods of measuring diastolic function with echocardiography that are of relevance to the intensivist and present two options for measurement: the standard cardiology method and a simplified approach...
November 4, 2017: Chest
https://www.readbyqxmd.com/read/29137910/tamponade-hemodynamic-and-echocardiographic-diagnosis
#19
REVIEW
Mark J Kearns, Keith R Walley
Cardiac tamponade is a medical emergency that can be readily reversed with timely recognition and appropriate intervention. The clinical diagnosis of cardiac tamponade requires synthesis of a constellation of otherwise non-specific features, based on an understanding of the underlying pathophysiology. Whereas echocardiographic examination is a central component of diagnosis, alone it is insufficient to establish the physiologic diagnosis of hemodynamically significant cardiac tamponade. The hemodynamic diagnosis of cardiac tamponade requires clinical evidence of low cardiac output and stroke volume in the setting of elevated cardiac filling pressures, with evidence of increased sympathetic tone (tachycardia, peripheral vasoconstriction, etc), and exclusion of other causes of shock as the primary problem (particularly cardiogenic shock)...
November 11, 2017: Chest
https://www.readbyqxmd.com/read/29114008/2017-american-heart-association-focused-update-on-adult-basic-life-support-and-cardiopulmonary-resuscitation-quality-an-update-to-the-american-heart-association-guidelines-for-cardio-pulmonary-resuscitation-and-emergency-cardiovascular-care
#20
REVIEW
Monica E Kleinman, Zachary D Goldberger, Thomas Rea, Robert A Swor, Bentley J Bobrow, Erin E Brennan, Mark Terry, Robin Hemphill, Raúl J Gazmuri, Mary Fran Hazinski, Andrew H Travers
Cardiopulmonary resuscitation is a lifesaving technique for victims of sudden cardiac arrest. Despite advances in resuscitation science, basic life support remains a critical factor in determining outcomes. The American Heart Association recommendations for adult basic life support incorporate the most recently published evidence and serve as the basis for education and training for laypeople and healthcare providers who perform cardiopulmonary resuscitation.
November 6, 2017: Circulation
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