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Critical care

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57 papers 25 to 100 followers
By M KKhan Pediatric Intensivist
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
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
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
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
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
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
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
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
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
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
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
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
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
Melissa P Knauert, Jeffrey A Haspel, Margaret A Pisani
Critical illness is associated with profound sleep disruption. Causality is diverse and includes physiologic, psychological, and environmental factors. There are limited pharmacologic interventions available to treat sleep disturbances in critical illness; however, multidisciplinary strategies that alter the intensive care unit (ICU) environment and cluster care delivery have shown promise in sleep and circadian promotion and delirium reduction. With the appropriate administrative support and involvement of diverse ICU stakeholders, effective strategies could be created, implemented, and maintained to improve sleep disruption in critically ill patients...
September 2015: Clinics in Chest Medicine
Shyoko Honiden, Geoffrey R Connors
ICU-acquired weakness is a common problem and carries significant morbidity. Despite evidence that early mobility can mitigate this, implementation outside of the research setting is lagging. Understanding barriers at the systems as well as individual level is a crucial step in successful implementation of an ICU mobility program. This includes taking inventory of waste, overburden and inconsistencies in the work environment. Appreciating regulative, normative as well as cultural forces at work is critical...
September 2015: Clinics in Chest Medicine
Mary Baker, Jim Luce, Gabriel T Bosslet
Clinicians working in the intensive care unit (ICU) confront death and dying daily. ICU care can be inconsistent with a patient's values, preferences, and previously expressed goals of care. Current evidence promotes the integration of palliative care services within the ICU setting. Palliative care bridges the gap between comfort and cure, and these services are growing in the United States. This article discusses the benefits and barriers to integration of ICU and palliative care services, and a stepwise approach to implementation of palliative care services...
September 2015: Clinics in Chest Medicine
Geoffrey R Connors, Jonathan M Siner
Clinical reasoning in medicine describes the process whereby a clinician gathers, assimilates, and assesses information about a person and their illness to assign a diagnosis and institute therapy. Care of patients in the intensive care unit involves managing a substantial quantity of incomplete, novel, and rapidly changing data. A modified nine-step bayesian approach to clinical reasoning comports well with this complex environment and is useful for assisting and educating novice learners to apply clinical reasoning accurately and consistently...
September 2015: Clinics in Chest Medicine
Jason J Heavner, Jonathan M Siner
Patients in the intensive care unit are at high risk for experiencing adverse events and errors. The high-acuity health care needs of these vulnerable patients expose them to numerous medications, procedures, and health care providers. The occurrence of adverse events is associated with detriments to patient outcomes including increased mortality. Adverse event reporting is the most commonly used event-detection tool, but it should also be complimented with other tools such as trigger tools, chart review, and direct observation...
September 2015: Clinics in Chest Medicine
Dominique Piquette, Vicki R LeBlanc
Simulation is now commonly used in health care education, and a growing body of evidence supports its positive impact on learning. However, simulation-based medical education (SBME) involves a range of modalities, instructional methods, and presentations associated with different advantages and limitations. This review aims at better understanding the nature of SBME, its theoretic and proven benefits, its delivery, and the challenges posed by SBME. Areas requiring further research and development are also discussed...
September 2015: Clinics in Chest Medicine
Neil A Halpern
Successfully designing a new ICU requires clarity of vision and purpose and the recognition that the patient room is the core of the ICU experience for patients, staff, and visitors. The ICU can be conceptualized into three components: the patient room, central areas, and universal support services. Each patient room should be designed for single patient use and be similarly configured and equipped. The design of the room should focus upon functionality, ease of use, healing, safety, infection control, communications, and connectivity...
March 2014: Chest
2016-11-17 20:29:31
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