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Critical care

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64 papers 25 to 100 followers
By M KKhan Pediatric Intensivist
https://www.readbyqxmd.com/read/28816851/clinical-practice-guideline-safe-medication-use-in-the-icu
#1
Sandra L Kane-Gill, Joseph F Dasta, Mitchell S Buckley, Sandeep Devabhakthuni, Michael Liu, Henry Cohen, Elisabeth L George, Anne S Pohlman, Swati Agarwal, Elizabeth A Henneman, Sharon M Bejian, Sean M Berenholtz, Jodie L Pepin, Mathew C Scanlon, Brian S Smith
OBJECTIVE: To provide ICU clinicians with evidence-based guidance on safe medication use practices for the critically ill. DATA SOURCES: PubMed, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, CINAHL, Scopus, and ISI Web of Science for relevant material to December 2015. STUDY SELECTION: Based on three key components: 1) environment and patients, 2) the medication use process, and 3) the patient safety surveillance system...
September 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28284292/the-abcdef-bundle-in-critical-care
#2
REVIEW
Annachiara Marra, E Wesley Ely, Pratik P Pandharipande, Mayur B Patel
The ABCDEF bundle represents an evidence-based guide for clinicians to approach the organizational changes needed for optimizing intensive care unit patient recovery and outcomes. This article reviews the core evidence and features behind the ABCDEF bundle. The bundle has individual components that are clearly defined, flexible to implement, and help empower multidisciplinary clinicians and families in the shared care of the critically ill. The ABCDEF bundle helps guide well-rounded patient care and optimal resource utilization resulting in more interactive intensive care unit patients with better controlled pain, who can safely participate in higher-order physical and cognitive activities at the earliest point in their critical illness...
April 2017: Critical Care Clinics
https://www.readbyqxmd.com/read/28224102/practical-strategies-for-increasing-efficiency-and-effectiveness-in-critical-care-education
#3
REVIEW
Maurice F Joyce, Sheri Berg, Edward A Bittner
Technological advances and evolving demands in medical care have led to challenges in ensuring adequate training for providers of critical care. Reliance on the traditional experience-based training model alone is insufficient for ensuring quality and safety in patient care. This article provides a brief overview of the existing educational practice within the critical care environment. Challenges to education within common daily activities of critical care practice are reviewed. Some practical evidence-based educational approaches are then described which can be incorporated into the daily practice of critical care without disrupting workflow or compromising the quality of patient care...
February 4, 2017: World Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/28442312/expert-statements-on-the-standard-of-care-in-critically-ill-adult-patients-with-atypical-hemolytic-uremic-syndrome
#4
REVIEW
Elie Azoulay, Paul Knoebl, José Garnacho-Montero, Katerina Rusinova, Gennadii Galstian, Philippe Eggimann, Fekri Abroug, Dominique Benoit, Michael von Bergwelt-Baildon, Julia Wendon, Marie Scully
A typical hemolytic uremic syndrome (aHUS) presents similarly to thrombotic thrombocytopenic purpura (TTP) and other causes or conditions with thrombotic microangiopathy (TMA), such as disseminated intravascular coagulation or sepsis. Similarity in clinical presentation may hinder diagnosis and optimal treatment selection in the urgent setting in the ICU. However, there is currently no consensus on the diagnosis or treatment of aHUS for ICU specialists. This review aims to summarize available data on the diagnosis and treatment strategies of aHUS in the ICU to enhance the understanding of aHUS diagnosis and outcomes in patients managed in the ICU...
August 2017: Chest
https://www.readbyqxmd.com/read/28527880/intensive-monitoring-of-urine-output-is-associated-with-increased-detection-of-acute-kidney-injury-and-improved-outcomes
#5
Kui Jin, Raghavan Murugan, Florentina E Sileanu, Emily Foldes, Priyanka Priyanka, Gilles Clermont, John A Kellum
BACKGROUND: Urine output (UO) is a vital sign for critically ill patients, but standards for monitoring and reporting vary widely between ICUs. Careful monitoring of UO could lead to earlier recognition of acute kidney injury (AKI) and better fluid management. We sought to determine if the intensity of UO monitoring is associated with outcomes in patients with and those without AKI. METHODS: This was a retrospective cohort study including 15,724 adults admitted to ICUs from 2000 to 2008...
May 17, 2017: Chest
https://www.readbyqxmd.com/read/28454664/end-of-life-and-bereavement-care-in-the-intensive-care-unit-a-need-for-more-quality-empirical-research
#6
EDITORIAL
Tom Buckley
No abstract text is available yet for this article.
May 2017: Australian Critical Care: Official Journal of the Confederation of Australian Critical Care Nurses
https://www.readbyqxmd.com/read/28506741/evaluation-of-a-sound-environment-intervention-in-an-icu-a-feasibility-study
#7
Lotta Johansson, Berit Lindahl, Susanne Knutsson, Mikael Ögren, Kerstin Persson Waye, Mona Ringdal
BACKGROUND: Currently, it is well known that the sound environment in intensive care units (ICU) is substandard. Therefore, there is a need of interventions investigating possible improvements. Unfortunately, there are many challenges to consider in the design and performance of clinical intervention studies including sound measurements and clinical outcomes. OBJECTIVES: (1) explore whether it is possible to implement a full-scale intervention study in the ICU concerning sound levels and their impact on the development of ICU delirium; (2) discuss methodological challenges and solutions for the forthcoming study; (3) conduct an analysis of the presence of ICU delirium in the study group; and (4) describe the sound pattern in the intervention rooms...
May 12, 2017: Australian Critical Care: Official Journal of the Confederation of Australian Critical Care Nurses
https://www.readbyqxmd.com/read/28251580/experimental-assessment-of-oxygen-homeostasis-during-acute-hemodilution-the-integrated-role-of-hemoglobin-concentration-and-blood-pressure
#8
Tiffanie Kei, Nikhil Mistry, Albert K Y Tsui, Elaine Liu, Stephen Rogers, Allan Doctor, David F Wilson, Jean-Francois Desjardins, Kim Connelly, C David Mazer, Gregory M T Hare
BACKGROUND: Low hemoglobin concentration (Hb) and low mean arterial blood pressure (MAP) impact outcomes in critically ill patients. We utilized an experimental model of "normotensive" vs. "hypotensive" acute hemodilutional anemia to test whether optimal tissue perfusion is dependent on both Hb and MAP during acute blood loss and fluid resuscitation, and to assess the value of direct measurements of the partial pressure of oxygen in tissue (PtO2). METHODS: Twenty-nine anesthetized rats underwent 40% isovolemic hemodilution (1:1) (or sham-hemodilution control, n = 4) with either hydroxyethyl starch (HES) (n = 14, normotensive anemia) or saline (n = 11, hypotensive anemia) to reach a target Hb value near 70 g/L...
December 2017: Intensive Care Medicine Experimental
https://www.readbyqxmd.com/read/28186222/postoperative-pulmonary-complications
#9
A Miskovic, A B Lumb
Postoperative pulmonary complications (PPCs) are common, costly, and increase patient mortality. Changes to the respiratory system occur immediately on induction of general anaesthesia: respiratory drive and muscle function are altered, lung volumes reduced, and atelectasis develops in > 75% of patients receiving a neuromuscular blocking drug. The respiratory system may take 6 weeks to return to its preoperative state after general anaesthesia for major surgery. Risk factors for PPC development are numerous, and clinicians should be aware of non-modifiable and modifiable factors in order to recognize those at risk and optimize their care...
March 1, 2017: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/28127133/right-atrial-thrombus-and-its-causes-complications-and-therapy
#10
Mina M Benjamin, Aasim Afzal, Themistokles Chamogeorgakis, Georges A Feghali
A 70-year-old man who presented with dyspnea and intermittent chest pain was found to have a large free-floating right atrial thrombus on two-dimensional echocardiogram. Atriotomy was performed, and an 18-cm-long thrombus was removed from the right atrium and inferior vena cava. Postoperatively, the patient developed cardiogenic shock treated by intravenous vasopressor agents and extracorporeal membrane oxygenation. The postoperative course was also complicated by bilateral pulmonary emboli requiring pulmonary artery thrombectomy...
January 2017: Proceedings of the Baylor University Medical Center
https://www.readbyqxmd.com/read/25910673/the-critical-care-literature-2014
#11
REVIEW
Michael E Winters, Joseph P Martinez, Haney Mallemat, William J Brady
No abstract text is available yet for this article.
June 2015: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28112704/evaluation-and-treatment-of-hyperglycemia-in-critically-ill-patients
#12
Andrea Balloni, Federico Lari, Fabrizio Giostra
The hyperglycemic reaction to stress is part of adaptive metabolic response to critical illness, especially hypoxia, hemorrhage and sepsis. It involves neuro-endocrine and immune pathways leading to the development of insulin resistance and hepatic glucose production by gluconeogenesis and glycogenolysis. Over the last years the concept of stress related hyperglycemia has been replaced by the concept of dysglycemia and its three domains: hyperglycemia, hypoglycemia and glycemic variability. Each of the three domains is independently associated with increased risk of mortality in patients admitted in intensive care unit and non critically ill patients, both medical and surgical...
January 16, 2017: Acta Bio-medica: Atenei Parmensis
https://www.readbyqxmd.com/read/27992852/paracetamol-in-fever-in-critically-ill-patients-an-update
#13
REVIEW
D Chiumello, M Gotti, G Vergani
Fever, which is arbitrary defined as an increase in body temperature above 38.3°C, can affect up to 90% of patients admitted in intensive care unit. Induction of fever is mediated by the release of pyrogenic cytokines (tumor necrosis factor α, interleukin 1, interleukin 6, and interferons). Fever is associated with increased length of stay in intensive care unit and with a worse outcome in some subgroups of patients (mainly neurocritically ill patients). Although fever can increase oxygen consumption in unstable patients, on the contrary, it can activate physiologic systems that are involved in pathogens clearance...
April 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/28044135/effects-of-early-continuous-venovenous-hemofiltration-on-e-selectin-hemodynamic-stability-and-ventilatory-function-in-patients-with-septic-shock-induced-acute-respiratory-distress-syndrome
#14
RANDOMIZED CONTROLLED TRIAL
Jian-Biao Meng, Zhi-Zhen Lai, Xiu-Juan Xu, Chun-Lian Ji, Ma-Hong Hu, Geng Zhang
Objective. To investigate the effects of 72-hour early-initiated continuous venovenous hemofiltration (ECVVH) treatment in patients with septic-shock-induced acute respiratory distress syndrome (ARDS) (not acute kidney injury, AKI) with regard to serum E-selectin and measurements of lung function and hemodynamic stability. Methods. This prospective nonblinded single institutional randomized study involved 51 patients who were randomly assigned to receive or not receive ECVVH, an ECVVH group (n = 24) and a non-ECVVH group (n = 27)...
2016: BioMed Research International
https://www.readbyqxmd.com/read/27965225/evidence-based-review-and-discussion-points
#15
REVIEW
Ronald L Hickman
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/27965226/preventing-delirium-in-critically-ill-patients
#16
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/27853091/tetanus-in-the-elderly-the-management-of-intensive-care-and-prolonged-hospitalization
#17
Hiroki Isono, Taiju Miyagami, Kohta Katayama, Momoko Isono, Ryuichi Hasegawa, Harumi Gomi, Hiroyuki Kobayashi
Tetanus is a potentially fatal infection. Approximately 100 cases are reported in Japan each year; however, little is known about its clinical course and outcomes in the current era of treatment. We herein report three cases of tetanus in elderly patients who survived after mechanical ventilation and intensive care. These patients, together with six other similar cases, had a median weaning period of 31 days and median length of stay of 77 days. In elderly patients, severe systemic forms of tetanus require prolonged mechanical ventilation and hospitalization...
2016: Internal Medicine
https://www.readbyqxmd.com/read/26304276/novel-uses-of-targeted-temperature-management
#18
REVIEW
John McGinniss, Peter Marshall, Shyoko Honiden
Targeted temperature management has an established role in treating the post-cardiac arrest syndrome after out-of-hospital cardiac arrest with an initial rhythm of ventricular tachycardia/ventricular fibrillation. There is less certain benefit if the initial rhythm is pulseless electrical activity/asystole or for in-hospital cardiac arrest. Targeted temperature management may have a role as salvage modality for conditions causing intracranial hypertension, such as traumatic brain injury, hepatic encephalopathy, intracerebral hemorrhage, and acute stroke...
September 2015: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/26304277/icu-telemedicine-solutions
#19
REVIEW
Steven A Fuhrman, Craig M Lilly
During the last 15 years, critical care services provided via telemedicine have expanded to now be incorporated into the care of 13% of patients in intensive care units (ICUs) in the United States. A response to shortfalls in the availability of critical care-trained providers has evolved into integrated programs of ICU care with contributions to improved outcomes through proactive management, population oversight, and standardization of care processes. The most impactful characteristics of successful ICU telemedicine programs are now better understood with more than a decade of national experience and the accrued benefits to health care systems...
September 2015: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/26304278/controversies-and-misconceptions-in-intensive-care-unit-nutrition
#20
REVIEW
Michael H Hooper, Paul E Marik
The early initiation of enteral nutrition remains a fundamental component of the management of critically ill and injured patients in the intensive care unit. Trophic feeding is equivalent, if not superior, to full-dose feeding. Parenteral nutrition has no proved benefit over enteral nutrition, which is the preferred route of nutritional support in intensive care unit patients with a functional gastrointestinal tract. Continuous enteral and parental nutrition inhibits the release of important enterohormones...
September 2015: Clinics in Chest Medicine
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