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Medical Critical Care

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33 papers 25 to 100 followers
By P N University of Florida College of Pharmacy - PharmD Candidate - Class of 2017
https://www.readbyqxmd.com/read/28591533/management-of-septic-shock
#1
Rebecca E Berger, Emanuel Rivers, Mitchell M Levy
New England Journal of Medicine, Volume 376, Issue 23, Page 2282-2285, June 2017.
June 8, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28542029/the-impact-of-the-sepsis-3-septic-shock-definition-on-previously-defined-septic-shock-patients
#2
Sarah A Sterling, Michael A Puskarich, Andrew F Glass, Faheem Guirgis, Alan E Jones
OBJECTIVE: The Third International Consensus Definitions Task Force (Sepsis-3) recently recommended changes to the definitions of sepsis. The impact of these changes remains unclear. Our objective was to determine the outcomes of patients meeting Sepsis-3 septic shock criteria versus patients meeting the "old" (1991) criteria of septic shock only. DESIGN: Secondary analysis of two clinical trials of early septic shock resuscitation. SETTING: Large academic emergency departments in the United States...
September 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28351429/corticosteroids-in-septic-shock-a-systematic-review-and-network-meta-analysis
#3
Ben Gibbison, José A López-López, Julian P T Higgins, Tom Miller, Gianni D Angelini, Stafford L Lightman, Djillali Annane
BACKGROUND: Multiple corticosteroids and treatment regimens have been used as adjuncts in the treatment of septic shock. Qualitative and quantitative differences exist at cellular and tissular levels between the different drugs and their patterns of delivery. The objective of this study was to elucidate any differences between the drugs and their treatment regimens regarding outcomes for corticosteroid use in adult patients with septic shock. METHODS: Network meta-analysis of the data used for the recently conducted Cochrane review was performed...
March 28, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/28509668/norepinephrine-in-septic-shock-when-and-how-much
#4
Olfa Hamzaoui, Thomas W L Scheeren, Jean-Louis Teboul
PURPOSE OF REVIEW: Norepinephrine is the first-line agent recommended during resuscitation of septic shock to correct hypotension due to depressed vascular tone. Important clinical issues are the best timing to start norepinephrine, the optimal blood pressure target, and the best therapeutic options to face refractory hypotension when high doses of norepinephrine are required to reach the target. RECENT FINDINGS: Recent literature has reported benefits of early administration of norepinephrine because of the following reasons: profound and durable hypotension is an independent factor of increased mortality, early administration of norepinephrine increases cardiac output, improves microcirculation and avoids fluid overload...
August 2017: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/28364357/treatment-of-diabetic-ketoacidosis-dka-hyperglycemic-hyperosmolar-state-hhs-novel-advances-in-the-management-of-hyperglycemic-crises-uk-versus-usa
#5
REVIEW
Ketan K Dhatariya, Priyathama Vellanki
PURPOSE OF REVIEW: Diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS) are diabetic emergencies that cause high morbidity and mortality. Their treatment differs in the UK and USA. This review delineates the differences in diagnosis and treatment between the two countries. RECENT FINDINGS: Large-scale studies to determine optimal management of DKA and HHS are lacking. The diagnosis of DKA is based on disease severity in the USA, which differs from the UK...
May 2017: Current Diabetes Reports
https://www.readbyqxmd.com/read/28257335/serial-procalcitonin-predicts-mortality-in-severe-sepsis-patients-results-from-the-multicenter-procalcitonin-monitoring-sepsis-moses-study
#6
MULTICENTER STUDY
Philipp Schuetz, Robert Birkhahn, Robert Sherwin, Alan E Jones, Adam Singer, Jeffrey A Kline, Michael S Runyon, Wesley H Self, D Mark Courtney, Richard M Nowak, David F Gaieski, Stefan Ebmeyer, Sascha Johannes, Jan C Wiemer, Andrej Schwabe, Nathan I Shapiro
OBJECTIVES: To prospectively validate that the inability to decrease procalcitonin levels by more than 80% between baseline and day 4 is associated with increased 28-day all-cause mortality in a large sepsis patient population recruited across the United States. DESIGN: Blinded, prospective multicenter observational clinical trial following an Food and Drug Administration-approved protocol. SETTING: Thirteen U.S.-based emergency departments and ICUs...
May 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28212835/chest-ct-signs-in-pulmonary-disease-a-pictorial-review
#7
REVIEW
Shine Raju, Subha Ghosh, Atul C Mehta
CT scanning of the chest is one of the most important imaging modalities available to a pulmonologist. The advent of high-resolution CT scanning of the chest has led to its increasing use. Although chest radiographs are still useful as an initial test, their utility is limited in the diagnosis of lung diseases that depend on higher resolution images such as interstitial lung diseases and pulmonary vascular diseases. Several metaphoric chest CT scan signs have been described linking abnormal imaging patterns to lung diseases...
June 2017: Chest
https://www.readbyqxmd.com/read/28208030/intensive-care-unit-admission-and-survival-among-older-patients-with-chronic-obstructive-pulmonary-disease-heart-failure-or-myocardial-infarction
#8
Thomas S Valley, Michael W Sjoding, Andrew M Ryan, Theodore J Iwashyna, Colin R Cooke
RATIONALE: Admission to an intensive care unit (ICU) may be beneficial to patients with pneumonia with uncertain ICU needs; however, evidence regarding the association between ICU admission and mortality for other common conditions is largely unknown. OBJECTIVES: To estimate the relationship between ICU admission and outcomes for hospitalized patients with exacerbation of chronic obstructive pulmonary disease (COPD), exacerbation of heart failure (HF), or acute myocardial infarction (AMI)...
June 2017: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/28174217/diagnosis-and-treatment-of-hyponatremia-compilation-of-the-guidelines
#9
REVIEW
Ewout J Hoorn, Robert Zietse
Hyponatremia is a common water balance disorder that often poses a diagnostic or therapeutic challenge. Therefore, guidelines were developed by professional organizations, one from within the United States (2013) and one from within Europe (2014). This review discusses the diagnosis and treatment of hyponatremia, comparing the two guidelines and highlighting recent developments. Diagnostically, the initial step is to differentiate hypotonic from nonhypotonic hyponatremia. Hypotonic hyponatremia is further differentiated on the basis of urine osmolality, urine sodium level, and volume status...
May 2017: Journal of the American Society of Nephrology: JASN
https://www.readbyqxmd.com/read/28221185/antipyretic-therapy-in-critically-ill-septic-patients-a-systematic-review-and-meta-analysis
#10
REVIEW
Anne M Drewry, Enyo A Ablordeppey, Ellen T Murray, Carolyn R T Stoll, Sonya R Izadi, Catherine M Dalton, Angela C Hardi, Susan A Fowler, Brian M Fuller, Graham A Colditz
OBJECTIVE: This meta-analysis aimed to examine the impact of antipyretic therapy on mortality in critically ill septic adults. DATA SOURCES: Literature searches were implemented in Ovid Medline, Embase, Scopus, Cumulative Index of Nursing and Allied Health Literature, Cochrane Central Register of Controlled Trials, NHS Economic Evaluation Database, and ClinicalTrials.gov through February 2016. STUDY SELECTION: Inclusion criteria were observational or randomized studies of septic patients, evaluation of antipyretic treatment, mortality reported, and English-language version available...
May 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28179250/impact-of-pharmacist-management-of-pain-agitation-and-delirium-in-the-intensive-care-unit-through-participation-in-multidisciplinary-bundle-rounds
#11
Patricia Louzon, Heath Jennings, Mahmood Ali, Marijo Kraisinger
PURPOSE: A two-phase program to increase pharmacist involvement in management of pain, agitation and delirium (PAD) at a large community teaching hospital is described. SUMMARY: Florida Orlando Hospital implemented a two-phase initiative to decrease intensive care unit (ICU) length of stay (LOS), ventilator use, sedative use, and hospital expenditures while advancing pharmacists' scope of practice. Phase 1 of the initiative involved a pilot project to evaluate pharmacist management of sedative therapy for mechanically ventilated patients...
February 15, 2017: American Journal of Health-system Pharmacy: AJHP
https://www.readbyqxmd.com/read/28053053/acute-on-chronic-liver-failure-an-update
#12
REVIEW
Ruben Hernaez, Elsa Solà, Richard Moreau, Pere Ginès
Acute-on-chronic liver failure (ACLF) is a syndrome characterised by acute decompensation of chronic liver disease associated with organ failures and high short-term mortality. Alcohol and chronic viral hepatitis are the most common underlying liver diseases. Up to 40%-50% of the cases of ACLF have no identifiable trigger; in the remaining patients, sepsis, active alcoholism and relapse of chronic viral hepatitis are the most common reported precipitating factors. An excessive systemic inflammatory response seems to play a crucial role in the development of ACLF...
March 2017: Gut
https://www.readbyqxmd.com/read/28073314/safety-of-the-peripheral-administration-of-vasopressor-agents
#13
Tyler Lewis, Cristian Merchan, Diana Altshuler, John Papadopoulos
Vasopressors are an integral component of the management of septic shock and are traditionally given via a central venous catheter (CVC) due to the risk of tissue injury and necrosis if extravasated. However, the need for a CVC for the management of septic shock has been questioned, and the risk of extravasation and incidence of severe injury when vasopressors are given via a peripheral venous line (PVL) remains poorly defined. We performed a retrospective chart review of 202 patients who received vasopressors through a PVL...
January 1, 2017: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/28050897/fluid-resuscitation-in-human-sepsis-time-to-rewrite-history
#14
REVIEW
Liam Byrne, Frank Van Haren
Fluid resuscitation continues to be recommended as the first-line resuscitative therapy for all patients with severe sepsis and septic shock. The current acceptance of the therapy is based in part on long history and familiarity with its use in the resuscitation of other forms of shock, as well as on an incomplete and incorrect understanding of the pathophysiology of sepsis. Recently, the safety of intravenous fluids in patients with sepsis has been called into question with both prospective and observational data suggesting improved outcomes with less fluid or no fluid...
December 2017: Annals of Intensive Care
https://www.readbyqxmd.com/read/27741949/hydrocortisone-treatment-in-early-sepsis-associated-acute-respiratory-distress-syndrome-results-of-a-randomized-controlled-trial
#15
Surat Tongyoo, Chairat Permpikul, Wasineenart Mongkolpun, Veerapong Vattanavanit, Suthipol Udompanturak, Mehmet Kocak, G Umberto Meduri
BACKGROUND: Authors of recent meta-analyses have reported that prolonged glucocorticoid treatment is associated with significant improvements in patients with severe pneumonia or acute respiratory distress syndrome (ARDS) of multifactorial etiology. A prospective randomized trial limited to patients with sepsis-associated ARDS is lacking. The objective of our study was to evaluate the efficacy of hydrocortisone treatment in sepsis-associated ARDS. METHODS: In this double-blind, single-center (Siriraj Hospital, Bangkok), randomized, placebo-controlled trial, we recruited adult patients with severe sepsis within 12 h of their meeting ARDS criteria...
October 15, 2016: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/26573630/personalizing-blood-pressure-management-in-septic-shock
#16
Ryotaro Kato, Michael R Pinsky
This review examines the available evidence for targeting a specific mean arterial pressure (MAP) in sepsis resuscitation. The clinical data suggest that targeting an MAP of 65-70 mmHg in patients with septic shock who do not have chronic hypertension is a reasonable first approximation. Whereas in patients with chronic hypertension, targeting a higher MAP of 80-85 mmHg minimizes renal injury, but it comes with increased risk of arrhythmias. Importantly, MAP alone should not be used as a surrogate of organ perfusion pressure, especially under conditions in which intracranial, intra-abdominal or tissue pressures may be elevated...
December 2015: Annals of Intensive Care
https://www.readbyqxmd.com/read/27995597/acute-heart-failure-in-patients-admitted-to-the-emergency-department-with-acute-myocardial-infarction
#17
Justyna M Krzysztofik, Mateusz Sokolski, Michał Kosowski, Wojciech Zimoch, Adrian Lis, Maciej Klepuszewski, Michał Kasperczak, Marcin Proniak, Krzysztof Reczuch, Waldemar Banasiak, Ewa A Jankowska, Piotr Ponikowski
BACKGROUND: Acute heart failure (AHF), occurring as a complication of ongoing acute myocardial infarction (AMI), is a common predictor of worse clinical outcome. Much less is known about the unique subpopulation of patients who present these two life-threatening conditions in the emergency department (ED). AIM: The aim of the study was to establish the prevalence of coexistence of AHF with AMI in the ED, to identify clinical factors associated with the higher prevalence of AHF at very early onset of AMI, and to assess the prognostic impact of the presence of AHF with AMI...
2017: Kardiologia Polska
https://www.readbyqxmd.com/read/27998289/effects-of-low-doses-of-esmolol-on-cardiac-and-vascular-function-in-experimental-septic-shock
#18
Chaojie Wei, Huguette Louis, Margaux Schmitt, Eliane Albuisson, Sophie Orlowski, Bruno Levy, Antoine Kimmoun
BACKGROUND: Administration of a selective β1-blocker, such as esmolol, in human septic shock has demonstrated cardiovascular protective effects related to heart rate reduction. Certain experimental data also indicate that esmolol exerts systemic anti-inflammatory and beneficial effects on vascular tone. Thus, the present study aimed to determine whether a non-chronotropic dose of esmolol maintains its protective cardiovascular and anti-inflammatory effects in experimental septic shock...
December 21, 2016: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/27858374/prediction-of-fluid-responsiveness-an-update
#19
REVIEW
Xavier Monnet, Paul E Marik, Jean-Louis Teboul
In patients with acute circulatory failure, the decision to give fluids or not should not be taken lightly. The risk of overzealous fluid administration has been clearly established. Moreover, volume expansion does not always increase cardiac output as one expects. Thus, after the very initial phase and/or if fluid losses are not obvious, predicting fluid responsiveness should be the first step of fluid strategy. For this purpose, the central venous pressure as well as other "static" markers of preload has been used for decades, but they are not reliable...
December 2016: Annals of Intensive Care
https://www.readbyqxmd.com/read/27875032/management-of-renal-failure-in-end-stage-liver-disease-a-critical-appraisal
#20
REVIEW
Xingxing S Cheng, Jane C Tan, W Ray Kim
Renal failure is a late consequence of end-stage liver disease (ESLD). Even with liver transplantation, pretransplant renal impairment remains a strong predictor of posttransplant mortality. This review seeks to summarize and critically appraise common therapies used in this setting, including pharmacologic agents, procedures (transjugular intrahepatic portosystemic shunt, renal replacement therapy), and simultaneous liver-kidney transplantation. More experimental extracorporal modalities, eg, albumin dialysis or bioartificial livers, will not be discussed...
December 2016: Liver Transplantation
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