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"Intensive Care" OR "ICU"

Aušra Čiginskienė, Asta Dambrauskienė, Jordi Rello, Dalia Adukauskienė
Background and objectives: High mortality and healthcare costs area associated with ventilator-associated pneumonia (VAP) due to Acinetobacter baumannii ( A. baumannii ). The data concerning the link between multidrug-resistance of A. baumannii strains and outcomes remains controversial. Therefore, we aimed to identify the relation of risk factors for ventilator-associated pneumonia (VAP) and mortality with the drug resistance profiles of Acinetobacter baumannii ( A. baumannii ) and independent predictors of in-hospital mortality...
February 13, 2019: Medicina
Yaseen M Arabi, Waleed Tamimi, Gwynne Jones, Dunia Jawdat, Hani Tamim, Hasan M Al-Dorzi, Musharaf Sadat, Lara Afesh, Maram Sakhija, Abdulaziz Al-Dawood
OBJECTIVES: The objectives of this study were to evaluate the clinical and nutritional correlates of high free fatty acids (FFAs) level in critically ill patients and the association with outcomes, and to study the effect of short-term caloric restriction (permissive underfeeding) on FFAs level during critical illness. PATIENTS/METHOD: In this pre-planned sub-study of the PermiT (Permissive Underfeeding vs. Target Enteral Feeding in Adult Critically Ill Patients) trial, we included critically ill patients who were expected to stay for ≥14 days in the intensive care unit...
February 13, 2019: Nutrients
Osayame A Ekhaguere, Michael A Padula, Erik A Jensen
OBJECTIVE:  The use of acid suppression therapies in newborns lacks efficacy and is associated with adverse effects. Point-of-care (POC) assessment of gastric aspirate pH may provide an objective, noninvasive measure of gastric acidity in tube fed infants. We conducted the present study to characterize the POC gastric pH levels in gastric tube fed infants before and after initiation of enteral omeprazole or ranitidine. STUDY DESIGN:  Retrospective cohort study of infants with gastric aspirate pH levels determined by POC pH strips...
February 19, 2019: American Journal of Perinatology
Yaseen M Arabi, Fahad Al-Hameed, Karen E A Burns, Sangeeta Mehta, Sami J Alsolamy, Mohammed S Alshahrani, Yasser Mandourah, Ghaleb A Almekhlafi, Mohammed Almaani, Ali Al Bshabshe, Simon Finfer, Zia Arshad, Imran Khalid, Yatin Mehta, Atul Gaur, Hassan Hawa, Hergen Buscher, Hani Lababidi, Abdulsalam Al Aithan, Sheryl A I Abdukahil, Jesna Jose, Lara Y Afesh, Abdulaziz Al-Dawood
BACKGROUND: Whether adjunctive intermittent pneumatic compression in critically ill patients receiving pharmacologic thromboprophylaxis would result in a lower incidence of deep-vein thrombosis than pharmacologic thromboprophylaxis alone is uncertain. METHODS: We randomly assigned patients who were considered adults according to the local standards at the participating sites (≥14, ≥16, or ≥18 years of age) within 48 hours after admission to an intensive care unit (ICU) to receive either intermittent pneumatic compression for at least 18 hours each day in addition to pharmacologic thromboprophylaxis with unfractionated or low-molecular-weight heparin (pneumatic compression group) or pharmacologic thromboprophylaxis alone (control group)...
February 18, 2019: New England Journal of Medicine
Jonathan D Casey, David R Janz, Derek W Russell, Derek J Vonderhaar, Aaron M Joffe, Kevin M Dischert, Ryan M Brown, Aline N Zouk, Swati Gulati, Brent E Heideman, Michael G Lester, Alexandra H Toporek, Itay Bentov, Wesley H Self, Todd W Rice, Matthew W Semler
BACKGROUND: Hypoxemia is the most common complication during tracheal intubation of critically ill adults and may increase the risk of cardiac arrest and death. Whether positive-pressure ventilation with a bag-mask device (bag-mask ventilation) during tracheal intubation of critically ill adults prevents hypoxemia without increasing the risk of aspiration remains controversial. METHODS: In a multicenter, randomized trial conducted in seven intensive care units in the United States, we randomly assigned adults undergoing tracheal intubation to receive either ventilation with a bag-mask device or no ventilation between induction and laryngoscopy...
February 18, 2019: New England Journal of Medicine
Patrick Starlinger, Hubert Hackl, David Pereyra, Susanna Skalicky, Elisabeth Geiger, Michaela Finsterbusch, Dietmar Tamandl, Christine Brostjan, Thomas Grünberger, Matthias Hackl, Alice Assinger
There is an urgent need for an easily assessable preoperative test to predict postoperative liver function recovery and thereby determine the optimal time point of liver resection, specifically as current markers are often expensive, time consuming and invasive. Emerging evidence suggests that microRNA (miRNA) signatures represent potent diagnostic, prognostic and treatment response biomarkers for several diseases. Using next-generation sequencing as an unbiased systematic approach 554 miRNAs were detected in preoperative plasma of 21 patients suffering from postoperative liver dysfunction (LD) after liver resection and 27 matched controls...
February 19, 2019: Hepatology: Official Journal of the American Association for the Study of Liver Diseases
Tatjana Van Der Heggen, Evelyn Dhont, Harlinde Peperstraete, Joris R Delanghe, Johan Vande Walle, Peter De Paepe, Pieter A De Cock
BACKGROUND: Augmented renal clearance (ARC), an increase in kidney function with enhanced elimination of circulating solute, has been increasingly recognized in critically ill adults. In a pediatric intensive care setting, data are scarce. The primary objective of this study was to investigate the prevalence of ARC in critically ill children. Secondary objectives included a risk factor analysis for the development of ARC and a comparison of two methods for assessment of renal function...
February 18, 2019: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
Gerald Chi, C Michael Gibson, Arzu Kalayci, Alexander T Cohen, Adrian F Hernandez, Russell D Hull, Farima Kahe, Mehrian Jafarizade, Sadaf Sharfaei, Yuyin Liu, Robert A Harrington, Samuel Z Goldhaber
PURPOSE: To assess the efficacy and safety of betrixaban for venous thromboembolism (VTE) prophylaxis among critically ill patients. METHODS: The APEX trial randomized 7513 acutely ill hospitalized patients to betrixaban for 35-42 days or enoxaparin for 10 ± 4 days. Among those, 703 critically ill patients admitted to the intensive care unit were included in the analysis, and 547 patients who had no severe renal insufficiency or P-glycoprotein inhibitor use were included in the full-dose stratum...
February 18, 2019: Intensive Care Medicine
J E Möhlmann, M van Luin, E M Mascini, H J van Leeuwen, M R de Maat
INTRODUCTION: Selective decontamination of the digestive tract (SDD) is a strategy in mechanically ventilated patients to reduce mortality. Treatment consists of enterally administered non-absorbable antibiotics, i.e., tobramycin. However, most intensive care unit (ICU) patients with SDD appear to have detectable tobramycin serum concentrations. The Rijnstate Hospital implemented a protocol for therapeutic drug monitoring (TDM) of tobramycin in patients at risk. The aim of this study was to evaluate the necessity of TDM in these patients and to optimize the current protocol...
February 18, 2019: European Journal of Clinical Pharmacology
Qingqing Liu, Jin Yang, Jun Zhang, Fanfan Zhao, Xiaojie Feng, Xue Wang, Jun Lyu
Background: Ventilator-associated pneumonia (VAP) is a common and serious nosocomial infection of intensive-care units (ICUs). Accurate, timely diagnosis enables early VAP patients to receive appropriate therapies and reduce the occurrence of complication. However, so far clinical datas regarding the epidemiology and mortality of VAP are still limited. Medical Information Mart for Intensive Care (MIMIC) database is a free, open and public resource about ICU research database. MIMIC database is a free, open, public database that collects information on more than 40,000 ICU patients who are predominantly white people...
2019: Frontiers in Pharmacology
Patrick Canning, Wael Tawfick, Nicola Whelan, Niamh Hynes, Sherif Sultan
OBJECTIVE: Endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms (AAAs) is the standard treatment for anatomically suitable patients. EVAR has been associated with a lower perioperative morbidity and mortality compared with open surgical repair (OSR) at the expense of increased reinterventions and costs. We aimed to compare the outcomes of EVAR and OSR for elective AAA repair. The primary end point was cost per QALY at 3 years. Secondary end points were perioperative morbidity and mortality; freedom from reintervention; length of hospital, high-dependency unit, and intensive care unit stay; and freedom from all-cause mortality...
February 15, 2019: Journal of Vascular Surgery
Josefine Thomsen, Ulrik Sprogøe
In this case report, we present a 28-year-old woman who was admitted to a neuro-intensive care unit with sub-arachnoid haemorrhage. She was intubated and haemodynamically unstable. Over five days the need for norepinephrine reached the level of 1.2 µg/kg/min to insure a sufficient cerebral perfusion pressure. Epinephrine and vasopressin were without effect in raising the blood pressure. On suspicion of tachyphylaxis the norepinephrine infusion was stopped, and no decline in blood pressure was observed. After two days without use of any vasopressor agents, the efficacy of norepinephrine returned to normal...
February 11, 2019: Ugeskrift for Laeger
H Eylül Bozkurt Yılmaz, Elif Küpeli, Nazan Şen, İlker Arer, Kenan Çalışkan, Şule Akçay, Mehmet Haberal
OBJECTIVES: We evaluated the frequency and cause of acute respiratory failure in renal transplant recipients. MATERIALS AND METHODS: Our single-center retrospective observational study included consecutive renal transplant recipients who were admitted to an intensive care unit for acute respiratory failure between 2011 and 2017. Acute respiratory failure was defined as oxygen saturation < 92% or partial pressure of oxygen in arterial blood < 60 mm Hg on room air and/or requirement of noninvasive or invasive mechanical ventilation...
January 2019: Experimental and Clinical Transplantation
Meysam Mojtabaee, Shagin Shahryari, Farahnaz Sadegh Beigee
OBJECTIVES: Deceased lung donation requires optimum donor care, with lung viability greatly affected by the progress of the disease leading to brain death. In this study, we searched for causes of lung unsuitability for transplant in both primary and secondary evaluations. MATERIALS AND METHODS: Primary lung evaluations included chest radiography, oxygen challenge test, and donor clinical and history examination. Secondary evaluations for lungs that passed the first step included fiberoptic bronchoscopy and donor-recipient matching...
January 2019: Experimental and Clinical Transplantation
Julio Miranda-Bacallado, María Manuela Izquierdo-Gómez, Javier García-Niebla, Juan José Jiménez, José Luis Iribarren, Ignacio Laynez-Cerdeña, Juan Lacalzada-Almeida
BACKGROUND: Approximately half of pulmonary embolism cases are diagnosed in an emergency context. The classic symptoms of pulmonary embolism are absent in intensive care unit patients who are under sedation and on mechanical ventilation. In this scenario, after the development of sudden, severe hypotension, pulmonary embolism must be considered and included in a differential diagnosis according to the cause of admission. Echocardiography may be of further help in a differential diagnosis of the cause of shock...
February 19, 2019: Journal of Medical Case Reports
Sheling Xie, Peng Yan, Chen Yao, Xiaoyan Yan, Yuliang Huo, Junhua Zhang, Si Liu, Zhiqiao Feng, Hongcai Shang, Lixin Xie
BACKGROUND: Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is the leading cause of mortality in chronic obstructive pulmonary disease (COPD). Traditional Chinese medicine (TCM) has been widely used in Asia as an adjunct treatment for AECOPD to improve the patients' symptoms. Xuebijing (XBJ) injection is one of the major herbal medicines used in TCM. Previous small-sample clinical trials have proven its efficacy and safety in the treatment of AECOPD; however, the current data on XBJ as an adjunct therapy are insufficient...
February 18, 2019: Trials
Shichao Zhu, Yan Kang, Wen Wang, Lin Cai, Xin Sun, Zhiyong Zong
BACKGROUND: Most of the previous studies focused on central line-associated bloodstream infection (CLABSI), while non-central line-associated bloodstream infection (N-CLABSI) was poorly studied. This study was performed to investigate the clinical impacts and risk factors for N-CLABSI in intensive care unit (ICU) patients. METHODS: An observational study was conducted in an adult general ICU. The electronic medical records from 2013 to 2017 of all patients aged ≥ 18 years admitted to the ICU > 2 days were analyzed retrospectively...
February 18, 2019: Critical Care: the Official Journal of the Critical Care Forum
I-Ying Kuo, Yu-Lin Huang, Chien-Yu Lin, Chien-Hsun Lin, Wei-Lun Chang, Wu-Wei Lai, Yi-Ching Wang
BACKGROUND: Prognosis of esophageal squamous cell carcinoma (ESCC) patients is poor and the concurrent chemoradiation therapy (CCRT) provided to ESCC patients often failed due to resistance. Therefore, development of biomarkers for predicting CCRT response is immensely important. In this study, we evaluated the predicting value of SRY (sex determining region Y)-box 17 (SOX17) protein during CCRT and its dysregulation of transcriptional targets in CCRT resistance in ESCC. METHODS: Pyrosequencing methylation, RT-qPCR and immunohistochemistry assays were performed to examine the DNA methylation, mRNA expression and protein expression levels of SOX17 in endoscopic biopsy from a total of 70 ESCC patients received CCRT...
February 18, 2019: Journal of Biomedical Science
B Costa Rodrigues, M Ignacchiti Lacerda, G R Ramires de Jesús, Flávia Cunha Dos Santos, N Ramires de Jesús, R A Levy, E Mendes Klumb
OBJECTIVE: To analyze the impact of different classes of lupus nephritis as risk variables for maternal and fetal adverse outcomes in a cohort of pregnant lupus patients. METHODS: This is a cohort study with retrospective and prospective data collection, conducted at the University Hospital of State University of Rio de Janeiro, Brazil, from 2011 to 2016. A total of 147 pregnancies of 137 systemic lupus erythematosus patients of whom 66 had lupus nephritis were included...
February 18, 2019: Lupus
Elias Wagner, Georg Marckmann, Ralf J Jox
AIMS: In the case of acute brain injury, decision-making uncertainties can arise when both an advance decision to refuse treatment and a prior consent to post-mortem organ donation are present. It is yet unknown how the persons concerned view this potential conflict. The present study aims to investigate how frequent this situation is, whether the persons concerned are aware of the potential conflict and what they would prioritize. METHODS: Semi-quantitative cross-sectional survey of senior citizens of a metropolitan region in Germany using a literature-based questionnaire...
February 18, 2019: Das Gesundheitswesen
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