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https://read.qxmd.com/read/30747682/variability-in-critical-care-related-charge-markups-in-medicare-patients
#1
Joshua Tseng, Harry C Sax, Rodrigo F Alban
Charge markups for health care are variable and inflated several times beyond cost. Using the 2015 Medicare Provider Fee-For-Service Utilization and Payment Data file, we identified providers who billed for critical care hours and related procedures, including CPR, EKG interpretation, central line placement, arterial line placement, chest tube/thoracentesis, and emergent endotracheal intubation. Markup ratios (MRs), defined as the amount charged divided by the amount allowable, were calculated and compared; 42...
October 1, 2018: American Surgeon
https://read.qxmd.com/read/30732522/current-use-and-impact-on-30-day-mortality-of-pulmonary-artery-catheter-in-cardiogenic-shock-patients-results-from-the-cardshock-study
#2
Alessandro Sionis, Mercedes Rivas-Lasarte, Alexandre Mebazaa, Tuukka Tarvasmäki, Jordi Sans-Roselló, Heli Tolppanen, Marjut Varpula, Raija Jurkko, Marek Banaszewski, Jose Silva-Cardoso, Valentina Carubelli, Matias Greve Lindholm, John Parissis, Jindrich Spinar, Johan Lassus, Veli-Pekka Harjola, Josep Masip
BACKGROUND: Cardiogenic shock (CS) is the most life-threatening manifestation of acute heart failure. Its complexity and high in-hospital mortality may justify the need for invasive monitoring with a pulmonary artery catheter (PAC). METHODS: Patients with CS included in the CardShock Study, an observational, prospective, multicenter, European registry, were analyzed, aiming to describe the real-world use of PAC, evaluate its impact on 30-day mortality, and the ability of different hemodynamic parameters to predict outcomes...
February 7, 2019: Journal of Intensive Care Medicine
https://read.qxmd.com/read/30720690/intraoperative-hemodynamic-parameters-and-acute-kidney-injury-after-living-donor-liver-transplantation
#3
Won Ho Kim, Hye-Won Oh, Seong-Mi Yang, Je Hyuk Yu, Hyung-Chul Lee, Chul-Woo Jung, Kyung-Suk Suh, Kook Hyun Lee
BACKGROUND: Acute kidney injury (AKI) after living donor liver transplantation (LDLT) is associated with increased mortality. We sought to identify associations between intraoperative hemodynamic variables and postoperative AKI. METHODS: We retrospectively reviewed 734 cases of LDLT. Intraoperative hemodynamic variables of systemic and pulmonary arterial pressure, central venous pressure (CVP), and pulmonary artery catheter-derived parameters including mixed venous oxygen saturation (SvO2), right ventricular end-diastolic volume (RVEDV), stroke volume, systemic vascular resistance, right ventricular ejection fraction, and stroke work index were collected...
January 30, 2019: Transplantation
https://read.qxmd.com/read/30720647/monitoring-gas-exchange-during-hypothermia-for-hypoxic-ischemic-encephalopathy
#4
Bushra Afzal, Praveen Chandrasekharan, Daniel J Tancredi, James Russell, Robin H Steinhorn, Satyan Lakshminrusimha
OBJECTIVES: Therapeutic hypothermia is standard of care in management of moderate/severe hypoxic-ischemic encephalopathy. Persistent pulmonary hypertension of the newborn is associated with hypoxic-ischemic encephalopathy and is exacerbated by hypoxemia and hypercarbia. Gas exchange is assessed by arterial blood gas analysis (with/without correction for body temperature), pulse oximetry, and end-tidal CO2. DESIGN: A retrospective chart review. SETTINGS: Regional perinatal center in Western New York...
February 2019: Pediatric Critical Care Medicine
https://read.qxmd.com/read/30698825/selective-versus-standard-cerebro-myocardial-perfusion-in-neonates-undergoing-aortic-arch-repair-a-multi-center-study
#5
Giovanni Battista Luciani, Stiljan Hoxha, Emanuela Angeli, Francesco Petridis, Lucio Careddu, Alessio Rungatscher, Massimo Caputo, Gaetano Gargiulo
BACKGROUND: The results of neonatal aortic arch surgery using cerebro-myocardial perfusion were analyzed. Selective cerebral and myocardial perfusion, using two separate pump rotors, was compared with standard, using a single pump rotor with an arterial line Y-connector. METHODS: Between 5/2008-5/2016, 69 consecutive neonates underwent arch repair using either selective cerebro-myocardial perfusion (Group A, n=34) or standard (Group B, n=35). The groups were similar for age, weight, BSA, prevalence of one-stage or staged repair and single ventricle palliation; male gender was more frequent in Group A...
January 30, 2019: Artificial Organs
https://read.qxmd.com/read/30685151/sildenafil-for-pulmonary-hypertension-in-the-early-postoperative-period-after-mitral-valve-surgery
#6
Eilon Ram, Leonid Sternik, Robert Klempfner, Michael Eldar, Ilan Goldenberg, Yael Peled, Ehud Raanani, Alexander Kogan
OBJECTIVES: The phosphodiesterase-5 inhibitor sildenafil was developed for the treatment of pulmonary hypertension. The authors investigated the efficacy and safety of sildenafil in the early postoperative period after mitral valve surgery in patients with pulmonary hypertension. DESIGN: A double-blind, placebo-controlled randomized trial was performed. SETTING: The trial was performed in a single tertiary referral center. PARTICIPANTS: Fifty consecutive patients who experienced pulmonary hypertension and underwent mitral valve surgery...
December 25, 2018: Journal of Cardiothoracic and Vascular Anesthesia
https://read.qxmd.com/read/30681152/blood-transfusions-blood-storage-and-correlation-with-elevated-pulmonary-arterial-pressures
#7
Marilynn Cullison, Richard Mahon, Gerald McGwin, Richard McCarron, Robert Browning, Charles Auker
BACKGROUND: The aim of this study was to determine if transfusion with RBCs is associated with a rise in mean pulmonary artery pressure (MPAP) and whether such a rise is influenced by the duration of RBC storage. STUDY DESIGN AND METHODS: A retrospective chart review of intensive care unit patients with pulmonary artery catheters was conducted at two military medical centers. RESULTS: RBC transfusion is associated with a sustained (≥4 hours) statistically significant 2- to 3-mm Hg rise in MPAP relative to both pretransfusion levels (p < 0...
January 25, 2019: Transfusion
https://read.qxmd.com/read/30673628/systemic-but-not-local-low-grade-endotoxinemia-increases-plasma-scd163-independently-of-the-cortisol-response
#8
Ermina Bach, Niels Møller, Jens Otto Lunde Jørgensen, Mads Buhl, Holger Jon Møller
AIMS/HYPOTHESIS: The macrophage-specific glycoprotein sCD163 has emerged as a biomarker of low grade inflammation in the metabolic syndrome and related disorders. High sCD163 levels are seen in acute sepsis as result of direct lipopolysaccharide-mediated shedding of the protein from macrophage surfaces including Kupffer cells. The aims of this study were to investigate if low grade endotoxinemia in human subjects results in increasing levels of sCD163 in a cortisol-dependent manner. METHODS: We studied eight male hypopituitary patients and eight age and gender matched healthy controls during intravenous low dose LPS or placebo infusion administered continuously over 360 min...
January 1, 2019: Endocrine Connections
https://read.qxmd.com/read/30661506/fetal-hemodynamics-and-cardiac-streaming-assessed-by-4d-flow-cardiovascular-magnetic-resonance-in-fetal-sheep
#9
Eric M Schrauben, Brahmdeep Singh Saini, Jack R T Darby, Jia Yin Soo, Mitchell C Lock, Elaine Stirrat, Greg Stortz, John G Sled, Janna L Morrison, Mike Seed, Christopher K Macgowan
BACKGROUND: To date it has not been possible to obtain a comprehensive 3D assessment of fetal hemodynamics because of the technical challenges inherent in imaging small cardiac structures, movement of the fetus during data acquisition, and the difficulty of fusing data from multiple cardiac cycles when a cardiac gating signal is absent. Here we propose the combination of volumetric velocity-sensitive cardiovascular magnetic resonance imaging ("4D flow" CMR) and a specialized animal preparation (catheters to monitor fetal heart rate, anesthesia to immobilize mother and fetus) to examine fetal sheep cardiac hemodynamics in utero...
January 21, 2019: Journal of Cardiovascular Magnetic Resonance
https://read.qxmd.com/read/30658228/skin-complications-associated-with-vascular-access-devices-a-secondary-analysis-of-13-studies-involving-10-859-devices
#10
Amanda J Ullman, Gabor Mihala, Kate O'Leary, Nicole Marsh, Christine Woods, Simon Bugden, Mark Scott, Claire M Rickard
BACKGROUND: Vascular access devices are widely used in healthcare settings worldwide. The insertion of a vascular access device creates a wound, vulnerable to irritation, injury and infection. Vascular access-associated skin complications are frequently reported in the literature, however very little evidence is available regarding the incidence and risk factors of these conditions to inform practice and technology development. OBJECTIVES: To estimate the incidence of vascular access-associated skin complications, and to identify patient, catheter and healthcare-related characteristics associated with skin complication development...
December 12, 2018: International Journal of Nursing Studies
https://read.qxmd.com/read/30655330/automatic-extraction-of-a-reference-region-for-the-noninvasive-quantification-of-translocator-protein-in-brain-using-11-c-pbr28
#11
Paolo Zanotti Fregonara, William Charles Kreisl, Robert B Innis, Chul Hyoung Lyoo
Brain inflammation is associated with various types of neurodegenerative diseases, including Alzheimer's disease. Quantifying inflammation with PET is a challenging and invasive procedure, especially in frail patients, because it requires blood sampling from an arterial catheter. A widely used alternative to arterial sampling is a supervised clustering algorithm (SVCA), which identifies the voxels with minimal specific binding in the PET images, thus extracting a reference region for noninvasive kinetic modeling...
January 17, 2019: Journal of Nuclear Medicine: Official Publication, Society of Nuclear Medicine
https://read.qxmd.com/read/30653055/renin-as-a-marker-of-tissue-perfusion-and-prognosis-in-critically-ill-patients
#12
Patrick J Gleeson, Ilaria Alice Crippa, Wasineenart Mongkolpun, Federica Zama Cavicchi, Tess Van Meerhaeghe, Serge Brimioulle, Fabio Silvio Taccone, Jean-Louis Vincent, Jacques Creteur
OBJECTIVES: To characterize renin in critically ill patients. Renin is fundamental to circulatory homeostasis and could be a useful marker of tissue-perfusion. However, diurnal variation, continuous renal replacement therapy and drug-interference could confound its use in critical care practice. DESIGN: Prospective observational study. SETTING: Single-center, mixed medical-surgical ICU in Europe. PATIENTS: Patients over 18 years old with a baseline estimated glomerular filtration rate greater than 30 mL/min/1...
February 2019: Critical Care Medicine
https://read.qxmd.com/read/30649073/continuous-noninvasive-arterial-pressure-monitoring-in-obese-patients-during-bariatric-surgery-an-evaluation-of-the-vascular-unloading-technique-clearsight-system
#13
Dorothea E Rogge, Julia Y Nicklas, Gerhard Schön, Oliver Grothe, Sebastian A Haas, Daniel A Reuter, Bernd Saugel
BACKGROUND: Continuous monitoring of arterial pressure is important in severely obese patients who are at particular risk for cardiovascular complications. Innovative technologies for continuous noninvasive arterial pressure monitoring are now available. In this study, we compared noninvasive arterial pressure measurements using the vascular unloading technique (Clearsight system; Edwards Lifesciences Corp, Irvine, CA) with invasive arterial pressure measurements (radial arterial catheter) in severely obese patients during laparoscopic bariatric surgery...
January 14, 2019: Anesthesia and Analgesia
https://read.qxmd.com/read/30648673/cardiac-output-monitoring-technology-and-choice
#14
REVIEW
Jeff Kobe, Nitasha Mishra, Virendra K Arya, Waiel Al-Moustadi, Wayne Nates, Bhupesh Kumar
The accurate quantification of cardiac output (CO) is given vital importance in modern medical practice, especially in high-risk surgical and critically ill patients. CO monitoring together with perioperative protocols to guide intravenous fluid therapy and inotropic support with the aim of improving CO and oxygen delivery has shown to improve perioperative outcomes in high-risk surgical patients. Understanding of the underlying principles of CO measuring devices helps in knowing the limitations of their use and allows more effective and safer utilization...
January 2019: Annals of Cardiac Anaesthesia
https://read.qxmd.com/read/30648262/the-stop-flow-arm-equilibrium-pressure-in-preoperative-patients-stressed-volume-and-correlations-with-echocardiography
#15
Konstantin Yastrebov, Anders Aneman, Michel Slama, Vladimir Kokhno, Vsevolod Luchansky, Sam Orde, Andrew Hilton, Dmitriy Lukiyanov, Irina Volobueva, Svetlana Sidelnikova, Evgeniy Polovnikov
BACKGROUND: The distending intravascular pressure at no flow conditions reflects the stressed volume. While this haemodynamic variable is recognised as clinically important, there is a paucity of reports of its range and responsiveness to volume expansion in patients without cardiovascular disease and no reports of correlations to echocardiographic assessments of left ventricular filling. METHODS: Twenty-seven awake (13 male), spontaneously breathing patients without any history of cardiopulmonary, vascular or renal disease were studied prior to induction of anaesthesia...
January 15, 2019: Acta Anaesthesiologica Scandinavica
https://read.qxmd.com/read/30644649/effect-of-vasopressin-on-a-porcine-model-of-persistent-pulmonary-hypertension-of-the-newborn
#16
Reem Amer, Yasser N Elsayed, Marjory Ruth Graham, Anurag S Sikarwar, Martha Hinton, Shyamala Dakshinamurti
BACKGROUND: Persistent pulmonary hypertension of the newborn (PPHN) is due to a failure of pulmonary vascular relaxation. Vasopressin, a systemic vasoconstrictor acting on smooth muscle AVPR1a receptors, is used in treatment of PPHN. We sought to determine acute effects of vasopressin infusion on pulmonary hemodynamics in a large animal model of hypoxic PPHN. METHODS: PPHN was induced in 6 newborn piglets by 72 h normobaric hypoxia (FiO2 = 0.10); controls were 7 age-matched 3-day-old piglets...
January 15, 2019: Pediatric Pulmonology
https://read.qxmd.com/read/30644561/doppler-and-oscillometric-mean-blood-pressure-best-represent-direct-blood-pressure-measurements-in-anesthetized-rhesus-macaques-macaca-mulatta
#17
Stacey Carol Kang, Katechan Jampachaisri, Cholawat Pacharinsak
BACKGROUND: Indirect blood pressure measurements are often used to guide clinical decisions, but few studies have verified their agreement with direct arterial blood pressure in nonhuman primates. Here, the accuracy and precision of Doppler (DOP) and oscillometric (OS) [systolic (OSsys), mean (OSmean), and diastolic (OSdias)] blood pressure readings were assessed in rhesus macaques. METHODS: DOP and OS were utilized to measure blood pressure values in nine anesthetized rhesus macaques, which were compared to direct measurements via a saphenous arterial catheter...
January 14, 2019: Journal of Medical Primatology
https://read.qxmd.com/read/30642679/evaluation-of-dynamic-ultrasound-for-arterial-access-in-children-undergoing-cardiac-surgery
#18
Genevieve E Staudt, Susan S Eagle, Alexander K Hughes, Brian S Donahue
OBJECTIVE: To evaluate the effect of dynamic ultrasound (US) on the need for surgical intervention to achieve successful arterial cannulation in the pediatric cardiac surgery population. DESIGN: Retrospective, observational study. SETTING: Single, academic, pediatric hospital in the United States. PARTICIPANTS: The study comprised 3,569 consecutive patients who had an arterial catheter placed in the operating room before undergoing congenital heart surgery between January 2004 and September 2016...
December 1, 2018: Journal of Cardiothoracic and Vascular Anesthesia
https://read.qxmd.com/read/30641324/totally-endoscopic-ventricular-septal-defect-repair-using-bilateral-femoral-arterial-cannulation-in-an-8-year-old-girl
#19
Huy Q Dang, Huong T Le
INTRODUCTION: There are few reports on applying totally endoscopic surgery (TES) for repairing ventricular septal defect (VSD), especially in children. CASE PRESENTATION: We described an 8-year-old girl, weighing 17 kg, who was diagnosed with peri-membranous VSD and patent ductus arteriosus (PDA). The patient had undergone trans-catheter PDA closure first, and 3 weeks later, TES was performed for VSD repair through 4 small trocars (one 12 mm trocar and three 5 mm trocars) without robotic assistance...
January 9, 2019: International Journal of Surgery Case Reports
https://read.qxmd.com/read/30624291/monitoring-haemodynamic-response-to-fluid-challenge-in-icu-comparison-of-pressure-recording-analytical-method-and-oesophageal-doppler-a-prospective-observational-study
#20
Romain Barthélémy, Arthur Neuschwander, Fatou Dramé, Maximilien Redouté, David Ditchi, Jules Stern, Alexandre Mebazaa, Romain Pirracchio, Benjamin G Chousterman
BACKGROUND: The ability of the pressure recording analytical method (PRAM) in tracking change in cardiac output (ΔCO) after a fluid challenge in ICU needs to be evaluated with the most contemporary comparison methods recommended by experts. OBJECTIVE: Our objective was to report the trending ability of PRAM in tracking ΔCO after a fluid challenge in ICU and to compare this with oesophageal Doppler monitoring (ODM). DESIGN: Prospective, observational study...
February 2019: European Journal of Anaesthesiology
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