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vasopressor use

Youichi Yanagawa, Kei Jitsuiki, Hiroki Nagasawa, Ikuto Takeuchi, Shunsuke Madokoro, Hiromichi Ohsaka, Kouhei Ishikawa, Kazuhiko Omori, Satoru Suwa
A physician-staffed helicopter emergency medical service called a doctor helicopter (DH) in Eastern Shizuoka was equipped with a smartphone video transmission system in April 2018. We herein report on the introduction of this system for the verification of transfusion in the DH. A 51-year-old man visited a local hospital after cutting his left neck himself. He was diagnosed with jugular vein injury and underwent compressive hemostasis. As he entered profound hemorrhagic shock, he underwent tracheal intubation, massive fluid resuscitation, and administration of 3 vasopressor agents to maintain circulation...
March 2019: Air Medical Journal
Ana Martins, Maria Lurdes Castro, Isabel Fragata
INTRODUCTION: Transcatheter aortic valve implantation is a less invasive option for aortic valve replacement. The number of transcatheter aortic valve implantations under local anesthesia with sedation has been increasing as the team's experience increases and less invasive accesses are used. The aim of this study is to describe the evolution of the anesthetic technique in patients undergoing transcatheter aortic valve implantation at our center over the years, as which was compared. MATERIAL AND METHODS: Retrospective study in 149 consecutive patients undergoing transcatheter aortic valve implantation in Hospital Santa Marta (January 2010 to December 2016)...
February 28, 2019: Acta Médica Portuguesa
Jatinder Grewal, Anna-Liisa Sutt, George Cornmell, Kiran Shekar, John Fraser
PURPOSE: Patients supported with extracorporeal membrane oxygenation (ECMO) have been reported to have increased sedation requirements. Tracheostomies are performed in intensive care to facilitate longer term mechanical ventilation, reduce sedation, improve patient comfort, secretion clearance, and ability to speak and swallow. We aimed to investigate the safety of tracheostomy (TT) placement on ECMO, its impact on fluid intake, and the use of sedative, analgesic, and vasoactive drugs...
March 21, 2019: Journal of Intensive Care Medicine
Stephanie Reichert, Stefanie Scheid, Tina Roth, Marius Herkel, Diana Petrova, Alexandra Linden, Miki Weberbauer, Jennifer Esser, Philipp Diehl, Sebastian Grundmann, Hans-Jörg Busch, Katrin Fink, Christoph Bode, Martin Moser, Thomas Helbing
Leukocyte transmigration through the blood vessel wall is a fundamental step of the inflammatory response and requires expression of adhesion molecule PECAM-1. Accumulating evidence implicates that semaphorin (Sema) 3F and its receptor neuropilin (NRP) 2 are central regulators in vascular biology. Herein, we assess the role of Sema3F in leukocyte migration in vitro and in vivo. To determine the impact of Sema3F on leukocyte recruitment in vivo, we used the thioglycollate-induced peritonitis model. After the induction of peritonitis, C57BL/6 mice were intraperitoneally (i...
March 15, 2019: Inflammation
Francis Xavier Guyette, Christian Martin-Gill, Gabriela Galli, Neal McQuaid, Jonathan Elmer
INTRODUCTION: Hypotension in the prehospital environment is common and linked to dose-dependent mortality. Bolus dose epinephrine (BDE) may reverse hypotension. We tested if BDE use to treat profound hypotension is associated with 24-hour survival. METHODS: We performed a retrospective case-cohort study of critical care transport patients with systolic blood pressure (SBP) <70 mmHg from January 2011 to January 2017. To account for baseline differences between treated and untreated patients, we used nearest neighbor matching to estimate the average treatment effect of BDE on 24-hour survival...
March 15, 2019: Prehospital Emergency Care
Min-Yu Lai, Wei-Chih Kan, Ya-Ting Huang, John Chen, Chih-Chung Shiao
Plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) is an excellent prognostic⁻predictive tool in heart failure (HF) patients, but its plasma level changes following therapy. The comparison of prognosis⁻predictivity of a single measurement of plasma NT-pro BNP in different follow-up periods in acute HF patients has been less studied. This study aimed to evaluate whether the association between initial plasma NT-proBNP levels and all-cause mortality would decrease along with an increased follow-up period in patients with acute HF...
March 13, 2019: Journal of Clinical Medicine
Lisa Q Rong, Mohamed K Kamel, Mohamed Rahouma, Ajita Naik, Kritika Mehta, Ahmed A Abouarab, Antonino Di Franco, Michelle Demetres, Taylor L Mustapich, Meghann M Fitzgerald, Kane O Pryor, Mario Gaudino
STUDY OBJECTIVE: We performed a systematic comparison of high-dose and low-dose opioid anesthesia in cardiac surgery. DESIGN: Systematic review and meta-analysis of randomized controlled trials (RCTs). SETTING: Operating room. PATIENTS: 1400 adult patients undergoing cardiac surgery using general anesthesia. INTERVENTIONS: All RCTs comparing the effects of various doses of intravenous opioids (morphine, fentanyl, sufentanil, and remifentanil) during adult cardiac surgery using general anesthesia published until May 2018 (full-text English articles reporting data from human subjects) were included...
March 11, 2019: Journal of Clinical Anesthesia
Renske Wiersema, Jacqueline Koeze, Bart Hiemstra, Ville Pettilä, Anders Perner, Frederik Keus, Iwan C C van der Horst
BACKGROUND: Acute kidney injury (AKI) occurs in up to 50% of all critically ill patients and hemodynamic abnormalities are assumed to contribute, but their nature and share is still unclear. We explored the associations between hemodynamic variables, including cardiac index and right ventricular function, and the occurrence of AKI in critically ill patients. METHODS: In this prospective cohort study, we included all patients acutely admitted to an intensive care unit (ICU)...
March 13, 2019: Annals of Intensive Care
Christopher El Khuri, Gilbert Abou Dagher, Ali Chami, Ralph Bou Chebl, Tarek Amoun, Rana Bachir, Batoul Jaafar, Nesrine Rizk
Background: EGDT (Early Goal Directed Therapy) or some portion of EGDT has been shown to decrease mortality secondary to sepsis and septic shock. Objective: Our study aims to assess the effect of adopting this approach in the emergency department on in-hospital mortality secondary to sepsis/septic shock in Lebanon. Hypothesis: Implementation of the EGDT protocol of sepsis in ED will decrease in-hospital mortality. Methods: Our retrospective study included 290 adult patients presenting to the ED of a tertiary center in Lebanon with severe sepsis and/or septic shock...
2019: Emergency Medicine International
Aurora Vincent, Raja Sawhney, Yadranko Ducic
Microvascular free tissue transfer is an indispensable reconstructive option in head and neck reconstruction. Flap failure is relatively rare, but it is nonetheless very morbid and psychologically devastating to patients when it does occur. Further, complications after free tissue transfer to the head and neck remain common. There are numerous ongoing debates about various facets of preoperative, intraoperative, and postoperative care of patients undergoing free flap reconstruction of the head and neck, all ultimately searching for the optimal treatment algorithm to further improve flap success, minimize complications, and maximize patient outcomes...
February 2019: Seminars in Plastic Surgery
Türkay Akbaş
OBJECTIVE: This study aimed to evaluate epidemiology and outcome among critically ill patients under a restrictive transfusion practice. METHODS: One hundred sixty-nine patients who were admitted to the intensive care unit (ICU) between March 2016 to December 2017 and remained in the ICU > 24 hours were retrospectively included. RESULTS: Hemoglobin levels on admission were <12 g/dL in 85% and <9 g/dL in 37.9% of patients. The median admission hemoglobin level was decreased on the last day of the ICU stay...
March 12, 2019: Journal of International Medical Research
Nicholas S Cormier, Michael J Stein, Tinghua Zhang, Haemi Lee, Jing Zhang
Background: Epidural nerve blocks (EA) have been widely used in abdominal and thoracic surgery as an adjunct to general anesthesia (GA). The role for EA in microsurgical free flap breast reconstruction remains unclear with concerns regarding its impact on flap survival and operating room efficiency. The purpose of this study was to examine the effectiveness of epidural blocks in patients undergoing deep inferior epigastric perforator (DIEP) flap breast reconstruction. Methods: A retrospective analysis of patients undergoing DIEP breast reconstruction under GA alone was compared with those receiving EA/GA...
January 2019: Plastic and Reconstructive Surgery. Global Open
Kenji Watanabe, Nobuko Ito, Takuya Ohata, Taro Kariya, Hiroshi Inui, Yoshitsugu Yamada
RATIONALE: Chronic thromboembolic pulmonary hypertension (CTEPH) is a disease with a poor prognosis, characterized by chronic thromboembolic obstruction of the pulmonary arteries and pulmonary hypertension. Balloon pulmonary angioplasty (BPA) is a newly emergent treatment for CTEPH, which may substitute pulmonary endarterectomy, the standard but more invasive treatment for CTEPH. Here, we report the case of a CTEPH patient who underwent 2 noncardiac surgeries without complications after preoperative intervention of BPA...
March 2019: Medicine (Baltimore)
Chantalle E Menard, Anand Kumar, Donald S Houston, Alexis F Turgeon, Emily Rimmer, Brett L Houston, Steven Doucette, Ryan Zarychanski
OBJECTIVES: To characterize the prevalence, incidence, and temporal evolution of thrombocytopenia (platelets < 100 × 10/L) in septic shock and to investigate the independent association of thrombocytopenia on clinical outcomes. DESIGN: Retrospective, propensity-matched, cohort study. SETTING: Two academic ICUs in Winnipeg, Canada. PATIENTS: Nine-hundred eighty adult patients diagnosed with septic shock between 2007 and 2012...
January 11, 2019: Critical Care Medicine
Luzius A Steiner, Martin Siegemund
PURPOSE OF REVIEW: This review highlights the aspects of pathophysiology that make it difficult to predict the effects of any attempt to improve brain perfusion and reviews the options to improve brain perfusion according to the needs of an individual patient, focusing on the choice of a suitable threshold for cerebral perfusion pressure. RECENT FINDINGS: Typically, vasopressors or vasodilators that do not directly influence the cerebral vascular bed are used to improve cerebral perfusion...
April 2019: Current Opinion in Critical Care
Michael M Koerner, Michael D Harper, Christopher K Gordon, Douglas Horstmanshof, James W Long, Michael J Sasevich, James D Neel, Aly El Banayosy
Background: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has been shown to be a viable and effective treatment for patients suffering from refractory cardiogenic shock (rCS), which is associated with high mortality rates. Although ECMO therapy used as short-term mechanical circulatory support (MCS) has shown tremendous growth in its application over the past decade, the complication and mortality rates remain high. This retrospective study analyzes complications associated with VA-ECMO support, evaluates the use of defined protocols at a single center, and examines factors that may contribute to patient complication and mortality...
January 2019: Annals of Cardiothoracic Surgery
Steven M Lemieux, Alexander R Levine
PURPOSE: The utility of low-dose corticosteroids in septic shock is reviewed. SUMMARY: Low-dose corticosteroids are suggested as treatment for septic shock patients who remain hemodynamically unstable despite adequate fluid resuscitation and vasopressor therapy. However, the risks and benefits of corticosteroids are unclear in this patient population. Previous multicenter trials have yielded conflicting results on the survival benefits of corticosteroids. The recently published Adjunctive Corticosteroid Treatment in Critically Ill Patients with Septic Shock (ADRENAL) and Activated Protein C and Corticosteroids for Human Septic Shock (APROCCHSS) trials provide valuable but opposing insight into this ongoing debate...
March 9, 2019: American Journal of Health-system Pharmacy: AJHP
Andrej Paľa, Julia Schick, Moritz Klein, Benjamin Mayer, Bernd Schmitz, Christian Rainer Wirtz, Ralph König, Thomas Kapapa
OBJECTIVEDelayed cerebral ischemia (DCI) is a major factor contributing to the inferior outcome of patients with spontaneous subarachnoid hemorrhage (SAH). Nimodipine and induced hypertension using vasopressors are an integral part of standard therapy. Consequences of the opposite effect of nimodipine and vasopressors on blood pressure on patient outcome remain unclear. The authors report the detailed general characteristics and influence of nimodipine and vasopressors on outcome in patients with SAH.METHODSThe authors performed a 2-center, retrospective, clinical database analysis of 732 SAH patients treated between 2008 and 2016...
March 8, 2019: Journal of Neurosurgery
Young R Lee, Michael Sadanand Seth, Dylan Soney, Hanyu Dai
BACKGROUND: Sepsis and septic shock are inflammatory disorders associated with high rates of mortality. Patients with sepsis and septic shock frequently become tachycardic as a result of the utilization of vasopressor therapy and cardiac overcompensation owing to hypotension, predisposing patients to an increased risk of atrial fibrillation. Previously, it was thought that beta-blocker therapy in patients with sepsis would exacerbate hypotension; however, recent studies have shown that may not be the case...
March 8, 2019: Clinical Drug Investigation
Chih-Hung Wang, Wei-Tien Chang, Chien-Hua Huang, Min-Shan Tsai, Ping-Hsun Yu, Yen-Wen Wu, Wen-Jone Chen
BACKGROUND: We attempted to identify factors associated with physicians' decisions to terminate CPR and to explore the role of family in the decision-making process. METHODS: We conducted a retrospective observational study in a single center in Taiwan. Patients who experienced in-hospital cardiac arrest (IHCA) between 2006 and 2014 were screened for study inclusion. Multivariate survival analysis was conducted to identify independent variables associated with IHCA outcomes using the Cox proportional hazards model...
2019: PloS One
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