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ICU Excellence

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754 papers 100 to 500 followers Clínica Fundadores Bogotá Colombia
Christopher W Goodman, Allan S Brett
Treatment of chronic noncancer pain during the opioid epidemic has become challenging for clinicians. Patients want their pain to be adequately managed, and clinicians are searching for safe, effective alternatives to opioids. Recent guidelines from the Centers for Disease Control and Prevention..
August 3, 2017: New England Journal of Medicine
Thomas R Frieden
A core principle of good public health practice is to base all policy decisions on the highest-quality scientific data, openly and objectively derived. Determining whether data meet these conditions is difficult; uncertainty can lead to inaction by clinicians and public health decision makers...
August 3, 2017: New England Journal of Medicine
Ranjana Srivastava
"Hospice. It’s where people go to die," she says, surprising me with her sudden lucidity. "And also for symptom management," I add gently. "Like my headache," she notes. And your homelessness, I think — the fact that your one-bedroom, upstairs council flat just won’t do anymore. "I could go home,"..
August 31, 2017: New England Journal of Medicine
Sanjay Divakaran, Paul Dellaripa, Lester Kobzik, Bruce Levy, Joseph Loscalzo
Foreword. In this Journal feature, information about a real patient is presented in stages (boldface type) to an expert clinician, who responds to the information, sharing his or her reasoning with the reader (regular type). The authors’ commentary follows. Stage. A 20-year-old woman presented to..
August 3, 2017: New England Journal of Medicine
Douglas E Drachman, David M Dudzinski, Matthew P Moy, Carlos Fernandez-Del Castillo, Jonathan H Chen
Presentation of Case. Dr. David M. Dudzinski: A 32-year-old man was evaluated in the emergency department of this hospital for the abrupt onset of postprandial chest pain. Several hours before presentation, the patient had eaten pizza in his apartment. Less than 1 hour later, while he was at rest..
August 31, 2017: New England Journal of Medicine
Alyssa R Letourneau, Melissa C Price, Marwan M Azar
Presentation of Case. Dr. Robert H. Goldstein (Medicine): A 63-year-old woman was admitted to the intensive care unit (ICU) of this hospital because of fever, hypotension, and hypoxemia. Five months before the current admission, weakness of the proximal muscles of the arms and dyspnea on exertion..
August 24, 2017: New England Journal of Medicine
Michael Klompas
No abstract text is available yet for this article.
November 2017: Critical Care Medicine
Saskia Rijkenberg, Willemke Stilma, Robert J Bosman, Nardo J van der Meer, Peter H J van der Voort
OBJECTIVES: The Behavioral Pain Scale (BPS) and Critical-Care Pain Observation Tool (CPOT) are behavioral pain assessment tools for sedated and unconscious critically ill patients. The aim of this study was to compare the reliability, internal consistency, and discriminant validation of the BPS and the CPOT simultaneously in mechanically ventilated patients after cardiac surgery. DESIGN: A prospective, observational cohort study. SETTING: A 20-bed closed-format intensive care unit with mixed medical, surgical, and cardiac surgery patients in a teaching hospital in Amsterdam, The Netherlands...
August 2017: Journal of Cardiothoracic and Vascular Anesthesia
Josie Dixon, Maria Karagiannidou, Martin Knapp
CONTEXT: End of life care for people with dementia can be poor, involving emergency hospital admissions, burdensome treatments of uncertain value and under-treatment of pain and other symptoms. Advance care planning (ACP) is identified, in England and elsewhere, as a means of improving end of life outcomes for people with dementia and their carers. OBJECTIVE: To systematically and critically review empirical evidence concerning the effectiveness of ACP in improving end of life outcomes for people with dementia and their carers...
August 4, 2017: Journal of Pain and Symptom Management
D Montgomery Bissell, Karl E Anderson, Herbert L Bonkovsky
New England Journal of Medicine, Volume 377, Issue 9, Page 862-872, August 2017.
August 31, 2017: New England Journal of Medicine
Charles L Sprung, Djillali Annane, Didier Keh, Rui Moreno, Mervyn Singer, Klaus Freivogel, Yoram G Weiss, Julie Benbenishty, Armin Kalenka, Helmuth Forst, Pierre-Francois Laterre, Konrad Reinhart, Brian H Cuthbertson, Didier Payen, Josef Briegel
BACKGROUND: Hydrocortisone is widely used in patients with septic shock even though a survival benefit has been reported only in patients who remained hypotensive after fluid and vasopressor resuscitation and whose plasma cortisol levels did not rise appropriately after the administration of corticotropin. METHODS: In this multicenter, randomized, double-blind, placebo-controlled trial, we assigned 251 patients to receive 50 mg of intravenous hydrocortisone and 248 patients to receive placebo every 6 hours for 5 days; the dose was then tapered during a 6-day period...
January 10, 2008: New England Journal of Medicine
Paul M Palevsky, Jane Hongyuan Zhang, Theresa Z O'Connor, Glenn M Chertow, Susan T Crowley, Devasmita Choudhury, Kevin Finkel, John A Kellum, Emil Paganini, Roland M H Schein, Mark W Smith, Kathleen M Swanson, B Taylor Thompson, Anitha Vijayan, Suzanne Watnick, Robert A Star, Peter Peduzzi
BACKGROUND: The optimal intensity of renal-replacement therapy in critically ill patients with acute kidney injury is controversial. METHODS: We randomly assigned critically ill patients with acute kidney injury and failure of at least one nonrenal organ or sepsis to receive intensive or less intensive renal-replacement therapy. The primary end point was death from any cause by day 60. In both study groups, hemodynamically stable patients underwent intermittent hemodialysis, and hemodynamically unstable patients underwent continuous venovenous hemodiafiltration or sustained low-efficiency dialysis...
July 3, 2008: New England Journal of Medicine
John C Sakles
No abstract text is available yet for this article.
November 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Michele Umbrello, Antonella Marino, Davide Chiumello
Mechanical ventilation is the type of organ support most widely provided in the intensive care unit. However, this form of support does not constitute a cure for acute respiratory distress syndrome (ARDS), as it mainly works by buying time for the lungs to heal while contributing to the maintenance of vital gas exchange. Moreover, it can further damage the lung, leading to the development of a particular form of lung injury named ventilator-induced lung injury (VILI). Experimental evidence accumulated over the last 30 years highlighted the factors associated with an injurious form of mechanical ventilation...
July 2017: Annals of Translational Medicine
Hilary P Grocott
No abstract text is available yet for this article.
November 2017: Journal of Thoracic and Cardiovascular Surgery
Michael P Casaer, Dieter Mesotten, Greet Hermans, Pieter J Wouters, Miet Schetz, Geert Meyfroidt, Sophie Van Cromphaut, Catherine Ingels, Philippe Meersseman, Jan Muller, Dirk Vlasselaers, Yves Debaveye, Lars Desmet, Jasperina Dubois, Aime Van Assche, Simon Vanderheyden, Alexander Wilmer, Greet Van den Berghe
BACKGROUND: Controversy exists about the timing of the initiation of parenteral nutrition in critically ill adults in whom caloric targets cannot be met by enteral nutrition alone. METHODS: In this randomized, multicenter trial, we compared early initiation of parenteral nutrition (European guidelines) with late initiation (American and Canadian guidelines) in adults in the intensive care unit (ICU) to supplement insufficient enteral nutrition. In 2312 patients, parenteral nutrition was initiated within 48 hours after ICU admission (early-initiation group), whereas in 2328 patients, parenteral nutrition was not initiated before day 8 (late-initiation group)...
August 11, 2011: New England Journal of Medicine
Andrew H Limper, Antoine Adenis, Thuy Le, Thomas S Harrison
Fungi are major contributors to the opportunistic infections that affect patients with HIV/AIDS. Systemic infections are mainly with Pneumocystis jirovecii (pneumocystosis), Cryptococcus neoformans (cryptococcosis), Histoplasma capsulatum (histoplasmosis), and Talaromyces (Penicillium) marneffei (talaromycosis). The incidence of systemic fungal infections has decreased in people with HIV in high-income countries because of the widespread availability of antiretroviral drugs and early testing for HIV. However, in many areas with high HIV prevalence, patients present to care with advanced HIV infection and with a low CD4 cell count or re-present with persistent low CD4 cell counts because of poor adherence, resistance to antiretroviral drugs, or both...
November 2017: Lancet Infectious Diseases
Ryan D Aycock, Lauren M Westafer, Jennifer L Boxen, Nima Majlesi, Elizabeth M Schoenfeld, Raveendhara R Bannuru
STUDY OBJECTIVE: Computed tomography (CT) is an important imaging modality used in the diagnosis of a variety of disorders. Imaging quality may be improved if intravenous contrast is added, but there is a concern for potential renal injury. Our goal is to perform a meta-analysis to compare the risk of acute kidney injury, need for renal replacement, and total mortality after contrast-enhanced CT versus noncontrast CT. METHODS: We searched MEDLINE (PubMed), the Cochrane Library, CINAHL, Web of Science, ProQuest, and Academic Search Premier for relevant articles...
August 12, 2017: Annals of Emergency Medicine
Andre C Kalil
No abstract text is available yet for this article.
November 2017: Critical Care Medicine
M Najafzadeh, C A Marra, M Sadatsafavi, S D Aaron, S D Sullivan, K L Vandemheen, P W Jones, J M Fitzgerald
BACKGROUND: Little is known about the combination of different medications in chronic obstructive pulmonary disease (COPD). This study determined the cost effectiveness of adding salmeterol (S) or fluticasone/salmeterol (FS) to tiotropium (T) for COPD. METHODS: This concurrent, prospective, economic analysis was based on costs and health outcomes from a 52 week randomised study comparing: (1) T 18 microg once daily + placebo twice daily (TP group); (2) T 18 microg once daily + S 25 microg/puff, 2 puffs twice daily (TS group); and (3) T 18 microg once daily + FS 250/25 microg/puff, 2 puffs twice daily (TFS group)...
November 2008: Thorax
2017-09-02 03:13:16
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