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Practice: CCU

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8 papers 25 to 100 followers
Dion Stub, Karen Smith, Stephen Bernard, Ziad Nehme, Michael Stephenson, Janet E Bray, Peter Cameron, Bill Barger, Andris H Ellims, Andrew J Taylor, Ian T Meredith, David M Kaye
BACKGROUND: Oxygen is commonly administered to patients with ST-elevation-myocardial infarction despite previous studies suggesting a possible increase in myocardial injury as a result of coronary vasoconstriction and heightened oxidative stress. METHODS AND RESULTS: We conducted a multicenter, prospective, randomized, controlled trial comparing oxygen (8 L/min) with no supplemental oxygen in patients with ST-elevation-myocardial infarction diagnosed on paramedic 12-lead ECG...
June 16, 2015: Circulation
Andrea Morelli, Christian Ertmer, Martin Westphal, Sebastian Rehberg, Tim Kampmeier, Sandra Ligges, Alessandra Orecchioni, Annalia D'Egidio, Fiorella D'Ippoliti, Cristina Raffone, Mario Venditti, Fabio Guarracino, Massimo Girardis, Luigi Tritapepe, Paolo Pietropaoli, Alexander Mebazaa, Mervyn Singer
IMPORTANCE: β-Blocker therapy may control heart rate and attenuate the deleterious effects of β-adrenergic receptor stimulation in septic shock. However, β-Blockers are not traditionally used for this condition and may worsen cardiovascular decompensation related through negative inotropic and hypotensive effects. OBJECTIVE: To investigate the effect of the short-acting β-blocker esmolol in patients with severe septic shock. DESIGN, SETTING, AND PATIENTS: Open-label, randomized phase 2 study, conducted in a university hospital intensive care unit (ICU) between November 2010 and July 2012, involving patients in septic shock with a heart rate of 95/min or higher requiring high-dose norepinephrine to maintain a mean arterial pressure of 65 mm Hg or higher...
October 23, 2013: JAMA: the Journal of the American Medical Association
Chris P H Lexis, Iwan C C van der Horst, Erik Lipsic, Wouter G Wieringa, Rudolf A de Boer, Ad F M van den Heuvel, Hindrik W van der Werf, Remco A J Schurer, Gabija Pundziute, Eng S Tan, Wybe Nieuwland, Hendrik M Willemsen, Bernard Dorhout, Barbara H W Molmans, Anouk N A van der Horst-Schrivers, Bruce H R Wolffenbuttel, Gert J ter Horst, Albert C van Rossum, Jan G P Tijssen, Hans L Hillege, Bart J G L de Smet, Pim van der Harst, Dirk J van Veldhuisen
IMPORTANCE: Metformin treatment is associated with improved outcome after myocardial infarction in patients with diabetes. In animal experimental studies metformin preserves left ventricular function. OBJECTIVE: To evaluate the effect of metformin treatment on preservation of left ventricular function in patients without diabetes presenting with ST-segment elevation myocardial infarction (STEMI). DESIGN, SETTING, AND PARTICIPANTS: Double-blind, placebo-controlled study conducted among 380 patients who underwent primary percutaneous coronary intervention (PCI) for STEMI at the University Medical Center Groningen, The Netherlands, between January 1, 2011, and May 26, 2013...
April 16, 2014: JAMA: the Journal of the American Medical Association
Saurav Chatterjee, Jørn Wetterslev, Abhishek Sharma, Edgar Lichstein, Debabrata Mukherjee
BACKGROUND: The benefit of blood transfusion in patients with myocardial infarction is controversial, and a possibility of harm exists. METHODS: A systematic search of studies published between January 1, 1966, and March 31, 2012, was conducted using MEDLINE, EMBASE, CINAHL, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials databases. English-language studies comparing blood transfusion with no blood transfusion or a liberal vs restricted blood transfusion strategy were identified...
January 28, 2013: JAMA Internal Medicine
Bradley A Bart, Steven R Goldsmith, Kerry L Lee, Michael M Givertz, Christopher M O'Connor, David A Bull, Margaret M Redfield, Anita Deswal, Jean L Rouleau, Martin M LeWinter, Elizabeth O Ofili, Lynne W Stevenson, Marc J Semigran, G Michael Felker, Horng H Chen, Adrian F Hernandez, Kevin J Anstrom, Steven E McNulty, Eric J Velazquez, Jenny C Ibarra, Alice M Mascette, Eugene Braunwald
BACKGROUND: Ultrafiltration is an alternative strategy to diuretic therapy for the treatment of patients with acute decompensated heart failure. Little is known about the efficacy and safety of ultrafiltration in patients with acute decompensated heart failure complicated by persistent congestion and worsened renal function. METHODS: We randomly assigned a total of 188 patients with acute decompensated heart failure, worsened renal function, and persistent congestion to a strategy of stepped pharmacologic therapy (94 patients) or ultrafiltration (94 patients)...
December 13, 2012: New England Journal of Medicine
P Michael Ho, Thomas M Maddox, Li Wang, Stephan D Fihn, Robert L Jesse, Eric D Peterson, John S Rumsfeld
CONTEXT: Prior mechanistic studies reported that omeprazole decreases the platelet inhibitory effects of clopidogrel, yet the clinical significance of these findings is not clear. OBJECTIVE: To assess outcomes of patients taking clopidogrel with or without a proton pump inhibitor (PPI) after hospitalization for acute coronary syndrome (ACS). DESIGN, SETTING, AND PATIENTS: Retrospective cohort study of 8205 patients with ACS taking clopidogrel after discharge from 127 Veterans Affairs hospitals between October 1, 2003, and January 31, 2006...
March 4, 2009: JAMA: the Journal of the American Medical Association
Francis Kim, Graham Nichol, Charles Maynard, Al Hallstrom, Peter J Kudenchuk, Thomas Rea, Michael K Copass, David Carlbom, Steven Deem, W T Longstreth, Michele Olsufka, Leonard A Cobb
IMPORTANCE: Hospital cooling improves outcome after cardiac arrest, but prehospital cooling immediately after return of spontaneous circulation may result in better outcomes. OBJECTIVE: To determine whether prehospital cooling improves outcomes after resuscitation from cardiac arrest in patients with ventricular fibrillation (VF) and without VF. DESIGN, SETTING, AND PARTICIPANTS: A randomized clinical trial that assigned adults with prehospital cardiac arrest to standard care with or without prehospital cooling, accomplished by infusing up to 2 L of 4°C normal saline as soon as possible following return of spontaneous circulation...
January 1, 2014: JAMA: the Journal of the American Medical Association
Daniel De Backer, Patrick Biston, Jacques Devriendt, Christian Madl, Didier Chochrad, Cesar Aldecoa, Alexandre Brasseur, Pierre Defrance, Philippe Gottignies, Jean-Louis Vincent
BACKGROUND: Both dopamine and norepinephrine are recommended as first-line vasopressor agents in the treatment of shock. There is a continuing controversy about whether one agent is superior to the other. METHODS: In this multicenter, randomized trial, we assigned patients with shock to receive either dopamine or norepinephrine as first-line vasopressor therapy to restore and maintain blood pressure. When blood pressure could not be maintained with a dose of 20 microg per kilogram of body weight per minute for dopamine or a dose of 0...
March 4, 2010: New England Journal of Medicine
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