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Emergency Medicine Critical Care
Michael C Sklar, Laveena Munshi
The ventilatory care of patients with acute respiratory distress syndrome (ARDS) is evolving as our understanding of physiologic mechanisms of respiratory failure improves. Despite several decades of research, the mortality rate for ARDS remains high. Over the years, we continue to expand strategies to identify and mitigate ventilator-induced lung injury. This now includes a greater understanding of the benefits and harms associated with spontaneous breathing.
September 2022: Clinics in Chest Medicine
Wojciech Weigl, Jan Adamski, Dariusz Onichimowski, Piotr Nowakowski, Bodo Wagner
A growing body of evidence shows that some septic patients experience fluid overload, which leads to an increased number of serious complications and death. This is because the majority of septic patients are fluid non-responders. Therefore, a reliable distinction of which patient would benefit from fluid boluses is crucial in current sepsis mana-gement. Several methods used to assess fluid responsiveness have been developed. The principle of "dynamic" measurements (in contrast to static indices such as central venous pressure) involves the induction of a change in cardiac preload and the measurement of its effect on stroke volume...
2022: Anaesthesiology Intensive Therapy
Niels Van Regenmortel, Lynn Moers, Thomas Langer, Ella Roelant, Tim De Weerdt, Pietro Caironi, Manu L N G Malbrain, Paul Elbers, Tim Van den Wyngaert, Philippe G Jorens
PURPOSE: Iatrogenic fluid overload is a potential side effect of intravenous fluid therapy in the hospital. Little attention has been paid to sodium administration as a separate cause of harm. With this narrative review, we aim to substantiate the hypothesis that a considerable amount of fluid-induced harm is caused not only by fluid volume, but also by the sodium that is administered to hospitalized patients. METHODS: We show how a regular dietary sodium intake is easily surpassed by the substantial amounts of sodium that are administered during typical hospital stays...
May 17, 2021: Annals of Intensive Care
Jan Bakker
PURPOSE OF REVIEW: Current goals of resuscitation in septic shock are mainly a fixed volume of fluids and vasopressors to correct hypotension and improve tissue perfusion indicated by decreasing lactate levels. RECENT FINDINGS: Abnormal peripheral perfusion by objective and subjective parameters are associated with increased mortality in various phases of the treatment of critically ill patients including patients with septic shock. Ongoing resuscitation in septic shock patients with normal peripheral perfusion is not associated with improved outcome, rather with increased mortality...
June 1, 2021: Current Opinion in Critical Care
Mathieu Jozwiak, Wulfran Bougouin, Guillaume Geri, David Grimaldi, Alain Cariou
A post-resuscitation shock occurs in 50-70% of patients who had a cardiac arrest. It is an early and transient complication of the post-resuscitation phase, which frequently leads to multiple-organ failure and high mortality. The pathophysiology of post-resuscitation shock is complex and results from the whole-body ischemia-reperfusion process provoked by the sequence of circulatory arrest, resuscitation manoeuvers and return of spontaneous circulation, combining a myocardial dysfunction and sepsis features, such as vasoplegia, hypovolemia and endothelial dysfunction...
December 14, 2020: Annals of Intensive Care
Jo Ellen Wilson, Matthew F Mart, Colm Cunningham, Yahya Shehabi, Timothy D Girard, Alasdair M J MacLullich, Arjen J C Slooter, E Wesley Ely
Delirium, a syndrome characterized by an acute change in attention, awareness and cognition, is caused by a medical condition that cannot be better explained by a pre-existing neurocognitive disorder. Multiple predisposing factors (for example, pre-existing cognitive impairment) and precipitating factors (for example, urinary tract infection) for delirium have been described, with most patients having both types. Because multiple factors are implicated in the aetiology of delirium, there are likely several neurobiological processes that contribute to delirium pathogenesis, including neuroinflammation, brain vascular dysfunction, altered brain metabolism, neurotransmitter imbalance and impaired neuronal network connectivity...
November 12, 2020: Nature Reviews. Disease Primers
David C Fajgenbaum, Carl H June
New England Journal of Medicine, Volume 383, Issue 23, Page 2255-2273, December 2020.
December 3, 2020: New England Journal of Medicine
Alain Combes, Susanna Price, Arthur S Slutsky, Daniel Brodie
Cardiogenic shock can occur due to acute ischaemic or non-ischaemic cardiac events, or from progression of long-standing underlying heart disease. When addressing the cause of underlying disease, the management of cardiogenic shock consists of vasopressors and inotropes; however, these agents can increase myocardial oxygen consumption, impair tissue perfusion, and are frequently ineffective. An alternative approach is to temporarily augment cardiac output using mechanical devices. The use of these devices-known as temporary circulatory support systems-has increased substantially in recent years, despite being expensive, resource intensive, associated with major complications, and lacking high-quality evidence to support their use...
July 18, 2020: Lancet
François Dépret, W Frank Peacock, Kathleen D Liu, Zubaid Rafique, Patrick Rossignol, Matthieu Legrand
PURPOSE: To review the mechanisms of action, expected efficacy and side effects of strategies to control hyperkalemia in acutely ill patients. METHODS: We searched MEDLINE and EMBASE for relevant papers published in English between Jan 1, 1938, and July 1, 2018, in accordance with the PRISMA Statement using the following terms: "hyperkalemia," "intensive care," "acute kidney injury," "acute kidney failure," "hyperkalemia treatment," "renal replacement therapy," "dialysis," "sodium bicarbonate," "emergency," "acute...
February 28, 2019: Annals of Intensive Care
Siamak Moayedi, Michael Witting, Matthew Pirotte
BACKGROUND: The easy internal jugular (Easy IJ) technique involves placement of a single-lumen catheter in the internal jugular vein using ultrasound guidance. This technique is used in patients who do not have suitable peripheral or external jugular venous access. The efficacy and safety of this procedure are unknown. OBJECTIVE: We aimed to estimate efficacy and safety parameters for the Easy IJ when used in emergency department (ED) settings. METHODS: We conducted a prospective study of the Easy IJ in stable ED patients with severe intravenous access difficulty...
December 2016: Journal of Emergency Medicine
Bruno Levy, Caroline Fritz, Elsa Tahon, Audrey Jacquot, Thomas Auchet, Antoine Kimmoun
Vasoplegia is a ubiquitous phenomenon in all advanced shock states, including septic, cardiogenic, hemorrhagic, and anaphylactic shock. Its pathophysiology is complex, involving various mechanisms in vascular smooth muscle cells such as G protein-coupled receptor desensitization (adrenoceptors, vasopressin 1 receptors, angiotensin type 1 receptors), alteration of second messenger pathways, critical illness-related corticosteroid insufficiency, and increased production of nitric oxide. This review, based on a critical appraisal of the literature, discusses the main current treatments and future approaches...
February 27, 2018: Critical Care: the Official Journal of the Critical Care Forum
Daniele Masarone, Fabio Valente, Marta Rubino, Rossella Vastarella, Rita Gravino, Alessandra Rea, Maria Giovanna Russo, Giuseppe Pacileo, Giuseppe Limongelli
Pediatric heart failure represents an important cause of morbidity and mortality in childhood. Currently, there are well-established guidelines for the management of heart failure in the adult population, but an equivalent consensus in children is lacking. In the clinical setting, ensuring an accurate diagnosis and defining etiology is essential to optimal treatment. Diuretics and angiotensin-converting enzyme inhibition are the first-line therapies, whereas beta-blockers and devices for electric therapy are less used in children than in adults...
August 2017: Pediatrics and Neonatology
Tài Pham, Laurent J Brochard, Arthur S Slutsky
Mechanical ventilation is the most used short-term life support technique worldwide and is applied daily for a diverse spectrum of indications, from scheduled surgical procedures to acute organ failure. This state-of-the-art review provides an update on the basic physiology of respiratory mechanics, the working principles, and the main ventilatory settings, as well as the potential complications of mechanical ventilation. Specific ventilatory approaches in particular situations such as acute respiratory distress syndrome and chronic obstructive pulmonary disease are detailed along with protective ventilation in patients with normal lungs...
September 2017: Mayo Clinic Proceedings
John H Boyd, Demetrios Sirounis, Julien Maizel, Michel Slama
BACKGROUND: In critically ill patients at risk for organ failure, the administration of intravenous fluids has equal chances of resulting in benefit or harm. While the intent of intravenous fluid is to increase cardiac output and oxygen delivery, unwelcome results in those patients who do not increase their cardiac output are tissue edema, hypoxemia, and excess mortality. Here we briefly review bedside methods to assess fluid responsiveness, focusing upon the strengths and pitfalls of echocardiography in spontaneously breathing mechanically ventilated patients as a means to guide fluid management...
September 4, 2016: Critical Care: the Official Journal of the Critical Care Forum
Mervyn Singer, Clifford S Deutschman, Christopher Warren Seymour, Manu Shankar-Hari, Djillali Annane, Michael Bauer, Rinaldo Bellomo, Gordon R Bernard, Jean-Daniel Chiche, Craig M Coopersmith, Richard S Hotchkiss, Mitchell M Levy, John C Marshall, Greg S Martin, Steven M Opal, Gordon D Rubenfeld, Tom van der Poll, Jean-Louis Vincent, Derek C Angus
IMPORTANCE: Definitions of sepsis and septic shock were last revised in 2001. Considerable advances have since been made into the pathobiology (changes in organ function, morphology, cell biology, biochemistry, immunology, and circulation), management, and epidemiology of sepsis, suggesting the need for reexamination. OBJECTIVE: To evaluate and, as needed, update definitions for sepsis and septic shock. PROCESS: A task force (n = 19) with expertise in sepsis pathobiology, clinical trials, and epidemiology was convened by the Society of Critical Care Medicine and the European Society of Intensive Care Medicine...
February 23, 2016: JAMA
Michael Gottlieb, John Bailitz
No abstract text is available yet for this article.
December 2015: Annals of Emergency Medicine
Kenrick Berend, Aiko P J de Vries, Rijk O B Gans
New England Journal of Medicine, Volume 371, Issue 15, Page 1434-1445, October 2014.
October 9, 2014: New England Journal of Medicine
Jean-Jacques Parienti, Damien du Cheyron, Jean-François Timsit, Ousmane Traoré, Pierre Kalfon, Olivier Mimoz, Leonard A Mermel
OBJECTIVE: Catheter-associated infections are common, costly, and potentially lethal. The impact of catheter insertion site on infection risk remains controversial. We aimed to establish whether nontunneled central venous catheters inserted in the subclavian vein are associated with lower risk of catheter-associated infection compared to femoral or internal jugular vein insertion. DATA SOURCES: We searched MEDLINE (2000-2011), EMBASE (2000-2011), and Cochrane Library plus meta-analyses, gray literature, reference lists, and articles recommended by experts...
May 2012: Critical Care Medicine
Leonardo Cordeiro de Souza, Fernando Silva Guimarães, Jocemir Ronaldo Lugon
PURPOSE: The performance of most indices used to predict ventilator weaning outcomes remains below expectation. The purpose of this study was to evaluate a new weaning index, the timed inspiratory effort (TIE) index, which is based on the maximal inspiratory pressure and the occlusion time required to reach it. METHODS: This observational prospective study included patients undergoing mechanical ventilation. Patients ready to be weaned had their TIE index and 6 previously reported indices recorded...
January 2015: Journal of Intensive Care Medicine
Bram Rochwerg, Waleed Alhazzani, Anees Sindi, Diane Heels-Ansdell, Lehana Thabane, Alison Fox-Robichaud, Lawrence Mbuagbaw, Wojciech Szczeklik, Fayez Alshamsi, Sultan Altayyar, Wang-Chun Ip, Guowei Li, Michael Wang, Anna Wludarczyk, Qi Zhou, Gordon H Guyatt, Deborah J Cook, Roman Jaeschke, Djillali Annane
BACKGROUND: Fluid resuscitation is the cornerstone of sepsis treatment. However, whether balanced or unbalanced crystalloids or natural or synthetic colloids confer a survival advantage is unclear. PURPOSE: To examine the effect of different resuscitative fluids on mortality in patients with sepsis. DATA SOURCES: MEDLINE, EMBASE, ACP Journal Club, CINAHL, HealthSTAR, the Allied and Complementary Medicine Database, and the Cochrane Central Register of Controlled Trials through March 2014...
September 2, 2014: Annals of Internal Medicine
2014-12-20 17:39:10
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