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UNIDAD CORONARIA

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97 papers 25 to 100 followers
By Elvis Amao Internal Medicine , Cardiology and infectious diseases
https://www.readbyqxmd.com/read/28067677/the-microbiome-in-mechanically-ventilated-patients
#1
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
#2
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...
January 23, 2017: Current Opinion in Infectious Diseases
https://www.readbyqxmd.com/read/27906708/acute-respiratory-distress-syndrome-mimics-the-role-of-lung-biopsy
#3
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
#4
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
https://www.readbyqxmd.com/read/28079708/parenteral-nutrition-in-the-critically-ill
#5
Jan Gunst, Greet Van den Berghe
PURPOSE OF REVIEW: Feeding guidelines have recommended early, full nutritional support in critically ill patients to prevent hypercatabolism and muscle weakness. Early enteral nutrition was suggested to be superior to early parenteral nutrition. When enteral nutrition fails to meet nutritional target, it was recommended to administer supplemental parenteral nutrition, albeit with a varying starting point. Sufficient amounts of amino acids were recommended, with addition of glutamine in subgroups...
January 11, 2017: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/28040989/n-terminal-pro-brain-natriuretic-peptide-concentrations-after-hypertensive-intracerebral-hemorrhage
#6
Fei Li, Qian-Xue Chen, Shou-Gui Xiang, Shi-Zhun Yuan, Xi-Zhen Xu
INTRODUCTION: The role of N-terminal pro-brain natriuretic peptide (NT-proBNP) in patients with hypertensive intracerebral hemorrhage (HICH) is poorly understood. This study aimed to investigate the secretion pattern of NT-proBNP in patients with HICH and to assess its relationship with hematoma size, hyponatremia, and intracranial pressure (ICP). METHODS: This prospective study enrolled 147 isolated patients with HICH. Blood samples were obtained from each patient, and values of serum NT-proBNP, hematoma size, blood sodium, and ICP were collected for each patient...
January 1, 2017: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/28110612/efficacy-of-high-flow-nasal-cannula-therapy-in-intensive-care-units
#7
Timothy N Liesching, Yuxiu Lei
PURPOSE: We conducted a meta-analysis to compare the physiological and clinical outcomes of high-flow nasal cannula (HFNC) with standard oxygen (O2) or conventional noninvasive ventilation (NIV) in intensive care units (ICUs). PROCEDURES: We selected the full-text prospective studies comparing HFNC with standard O2 or NIV in ICU. The continuous variables were analyzed with sample size-adjusted pooled t test. The categorical variables were extracted and combined for recalculating odds ratio...
January 1, 2017: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/28173733/practice-of-intubation-of-the-critically-ill-at-mayo-clinic
#8
Nathan J Smischney, Mohamed O Seisa, Katherine J Heise, Kyle D Busack, Theodore O Loftsgard, Darrell R Schroeder, Daniel A Diedrich
OBJECTIVE: To describe the practice of intubation of the critically ill at a single academic institution, Mayo Clinic's campus in Rochester, Minnesota, and to report the incidence of immediate postintubation complications. PATIENTS AND METHODS: Critically ill adult (≥18 years) patients admitted to a medical-surgical intensive care unit from January 1, 2013, to December 31, 2014, who required endotracheal intubation included. RESULTS: The final cohort included 420 patients...
January 1, 2017: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/28203417/clinical-factors-associated-with-weaning-failure-in-patients-requiring-prolonged-mechanical-ventilation
#9
Hong-Joon Shin, Jin-Sun Chang, Seong Ahn, Tae-Ok Kim, Cheol-Kyu Park, Jung-Hwan Lim, In-Jae Oh, Yu-Il Kim, Sung-Chul Lim, Young-Chul Kim, Yong-Soo Kwon
BACKGROUND: For patients requiring prolonged mechanical ventilation (PMV), weaning is difficult and mortality is very high. PMV has been defined recently, by consensus, as constituting ≥21 consecutive days of mechanical ventilation (MV) for ≥6 hours per day. This study aimed to evaluate the clinical factors predicting weaning failure in patients undergoing PMV in medical intensive care unit (ICU). METHODS: We retrospectively reviewed the clinical and laboratory characteristics of 127 patients who received MV for more than 21 days in the medical ICU at Chonnam National University Hospital in South Korea between January 2005 and December 2014...
January 2017: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/28184952/sudden-dysfunction-of-veno-venous-extracorporeal-membrane-oxygenation-caused-by-intermittent-cannula-obstruction-the-key-role-of-echocardiography
#10
Cristina Ruisanchez, J Aurelio Sarralde, Camilo Gonzalez-Fernandez, M Jose Dominguez
No abstract text is available yet for this article.
February 9, 2017: Intensive Care Medicine
https://www.readbyqxmd.com/read/28188062/mechanical-ventilation-in-patients-subjected-to-extracorporeal-membrane-oxygenation-ecmo
#11
M L Sánchez
Mechanical ventilation (MV) is a crucial element in the management of acute respiratory distress syndrome (ARDS), because there is high level evidence that a low tidal volume of 6ml/kg (protective ventilation) improves survival. In these patients with refractory respiratory insufficiency, venovenous extracorporeal membrane oxygenation (ECMO) can be used. This salvage technique improves oxygenation, promotes CO2 clearance, and facilitates protective and ultraprotective MV, potentially minimizing ventilation-induced lung injury...
February 7, 2017: Medicina Intensiva
https://www.readbyqxmd.com/read/28190548/venovenous-versus-venoarterial-extracorporeal-membrane-oxygenation-for-adult-patients-with-acute-respiratory-distress-syndrome-requiring-precannulation-hemodynamic-support-a-review-of-the-elso-registry
#12
Zachary N Kon, Gregory J Bittle, Chetan Pasrija, Si M Pham, Michael A Mazzeffi, Daniel L Herr, Pablo G Sanchez, Bartley P Griffith
BACKGROUND: In addition to severe hypoxia and hypercapnia, acute respiratory distress syndrome (ARDS) can present with substantial hemodynamic compromise, requiring inotropic or vasopressor support or both. Either venovenous (VV) or venoarterial (VA) extracorporeal membrane oxygenation (ECMO) can be offered in this situation. However, a contemporary comparison of these two cannulation strategies has yet to be well described. METHODS: The Extracorporeal Life Support Organization Registry was reviewed for all cases of adult ARDS in patients that required inotropic agents or vasopressors or both before ECMO initiation (2009 to 2013)...
February 9, 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/27965226/preventing-delirium-in-critically-ill-patients
#13
REVIEW
Sarah A Delgado
No abstract text is available yet for this article.
December 2016: American Journal of Critical Care: An Official Publication, American Association of Critical-Care Nurses
https://www.readbyqxmd.com/read/28166435/adverse-events-during-inter-hospital-transports-on-extracorporeal-membrane-oxygenation
#14
Anders Ericsson, Björn Frenckner, L Mikael Broman
BACKGROUND: Extracorporeal membrane oxygenation (ECMO) may be a lifesaving rescue therapy in refractory, severe respiratory, and/or circulatory failure. To provide the best cost efficiency to the population served and patient outcome, ECMO therapy should be provided by specialized high volume ECMO centers. This requires dedicated transport teams to organize and perform these complex transports. Concerning adverse events and complications during these transfers, only a minimal amount of data has been published...
February 6, 2017: Prehospital Emergency Care
https://www.readbyqxmd.com/read/28176385/financial-and-clinical-outcomes-of-extracorporeal-mechanical-support
#15
Ryan Chiu, Eric Pillado, Sohail Sareh, Kim De La Cruz, Richard J Shemin, Peyman Benharash
BACKGROUND: Over the past decade, extracorporeal mechanical support (ECMO) has been increasingly utilized in respiratory failure and cardiogenic shock. There is a need for assessing clinical and financial outcomes of ECMO use. This study presents our institution's experience with veno-arterial ECMO (VA-ECMO) over a 9-year period. METHODS: A retrospective review of our institution's ECMO database identified patients undergoing VA-ECMO between 2005 and 2013 (N = 150)...
February 8, 2017: Journal of Cardiac Surgery
https://www.readbyqxmd.com/read/28169848/efficacy-of-flow-monitoring-during-ecmo
#16
Aditya Badheka, Sara E Stucker, Joseph W Turek, Madhavan L Raghavan
The hypothesis that blood flow monitoring could serve as an effective early indicator of distal obstruction during ECMO was tested under controlled experimental conditions. The ECMO circuit typically includes (or could be easily modified to include) a shunt that bifurcates from the main line returning a small amount of blood back to the pump with access points for drug infusions. Distal circuit obstructions in the oxygenator and beyond will result in an increased diversion of flow from the distal line to the shunt...
February 6, 2017: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
https://www.readbyqxmd.com/read/28176223/transportation-of-patients-on-extracorporeal-membrane-oxygenation-a-tertiary-medical-center-experience-and-systematic-review-of-the-literature
#17
Pedro Vitale Mendes, Cesar de Albuquerque Gallo, Bruno Adler Maccagnan Pinheiro Besen, Adriana Sayuri Hirota, Raquel de Oliveira Nardi, Edzangela Vasconcelos Dos Santos, Ho Yeh Li, Daniel Joelsons, Eduardo Leite Vieira Costa, Flavia Krepel Foronda, Luciano Cesar Pontes Azevedo, Marcelo Park
BACKGROUND: Utilization of extracorporeal membrane oxygenation (ECMO) has increased worldwide, but its use remains restricted to severely ill patients, and few referral centers are properly structured to offer this support. Inter-hospital transfer of patients on ECMO support can be life-threatening. In this study, we report a single-center experience and a systematic review of the available published data on complications and mortality associated with ECMO transportation. METHODS: We reported single-center data regarding complications and mortality associated with the transportation of patients on ECMO support...
December 2017: Annals of Intensive Care
https://www.readbyqxmd.com/read/28168038/echocardiography-for-patients-undergoing-extracorporeal-cardiopulmonary-resuscitation-a-primer-for-intensive-care-physicians
#18
REVIEW
Zhongheng Zhang
Echocardiography is an invaluable tool in the management of patients with extracorporeal cardiopulmonary resuscitation (ECPR) and subsequent extracorporeal membrane oxygenation (ECMO) support and weaning. At the very beginning, echocardiography can identify the etiology of cardiac arrest, such as massive pulmonary embolism and cardiac tamponade. Eliminating these culprits saves life and may avoid the initiation of extracorporeal cardiopulmonary resuscitation. If the underlying causes are not identified or intrinsic to the heart (e...
2017: Journal of Intensive Care
https://www.readbyqxmd.com/read/28153356/mechanical-circulatory-support-for-end-stage-heart-failure
#19
Alain Combes
Mechanical circulatory assistance has become a frequent therapeutic option for patients with advanced heart failure. For patients with acute cardiogenic shock and impaired organ function, short-term assistance with venoarterial extracorporeal membrane oxygenation is the leading therapeutic option. It enables a "bridge to decision-making" i.e. withdrawal of the device after myocardial recovery or after recognition of therapeutic futility, or as a bridge-to-transplantation or to long-term mechanical support. For Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) class 2-6 patients, implantation of a long-term ventricular assist-device (VAD) should be considered before progression to multiple organ failure if heart transplantation is not a first-line option...
January 11, 2017: Metabolism: Clinical and Experimental
https://www.readbyqxmd.com/read/28131429/venoarterial-extracorporeal-membrane-oxygenation-for-refractory-cardiogenic-shock-in-elderly-patients-trends-in-application-and-outcome-from-the-extracorporeal-life-support-organization-elso-registry
#20
Roberto Lorusso, Sandro Gelsomino, Orlando Parise, Priya Mendiratta, Parthak Prodhan, Peter Rycus, Graeme MacLaren, Thomas V Brogan, Yih-Sharng Chen, Jos Maessen, Xiaotong Hou, Ravi R Thiagarajan
BACKGROUND: Venoarterial extracorporeal membrane oxygenation (VA-ECMO) for refractory cardiogenic shock (RCS) is increasingly used in adult patients, but age represents a controversial factor in this setting. METHODS: Data from the Extracorporeal Life Support Organization registry was analyzed to assess in-hospital survival of elderly patients (≥70 years of age) undergoing VA-ECMO for RCS from 1992 to 2015. In-hospital survival and complications for elderly patients were compared with data in younger adults (≥18 to <70 years of age) supported with VA-ECMO during the same time period for similar indications...
January 25, 2017: Annals of Thoracic Surgery
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