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Critical care

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133 papers 1000+ followers
By Varun Shetty Critical Care fellow with background training in Internal Medicine-Pediatrics
https://read.qxmd.com/read/31078999/anti-xa-activity-by-weight-in-critically-ill-patients-receiving-unfractionated-heparin-for-venous-thromboembolism-prophylaxis
#1
Meera V Aggarwal, Andrew S Jarrell, Vi T Gilmore, Jonathan K Aboagye, Elliott R Haut, Deborah B Hobson, Brandyn D Lau, Thomas Kickler, Peggy S Kraus, Dauryne L Shaffer, Kenneth M Shermock, Michael B Streiff, Gang Zheng, Rachel M Kruer
PURPOSE: This study compared anti-Xa activity in critically ill patients receiving UFH for VTE prophylaxis between two weight groups (<100 kg vs ≥100 kg). METHODS: This prospective, observational study included critically ill patients on UFH 5000 or 7500 units every 8 h. A peak and trough anti-Xa activity assay was ordered for each patient at steady state. Goal peak anti-Xa activity was 0.1-0.3 units/mL. RESULTS: From March 2017 to June 2018, 75 patients were enrolled with 44 in the <100 kg group and 31 in the ≥100 kg group...
April 29, 2019: Journal of Critical Care
https://read.qxmd.com/read/31034248/re-appraisal-of-ventilator-free-days-in-critical-care-research
#2
Nadir Yehya, Michael O Harhay, Martha A Q Curley, David A Schoenfeld, Ron W Reeder
Ventilator-free days (VFDs) are a commonly reported composite outcome measure in acute respiratory distress syndrome (ARDS) trials. VFDs combine survival and duration of ventilation in a manner that summarizes the "net effect" of an intervention on these two outcomes. However, this combining of outcomes measures makes VFDs difficult to understand and analyze, which contributes to imprecise interpretations. We discuss the strengths and limitations of VFDs and other "failure-free days" composites, and provide a framework for when and how to use these outcome measures...
April 29, 2019: American Journal of Respiratory and Critical Care Medicine
https://read.qxmd.com/read/24794784/patient-ventilator-asynchrony-in-critically-ill-adults-frequency-and-types
#3
Karen G Mellott, Mary Jo Grap, Cindy L Munro, Curtis N Sessler, Paul A Wetzel, Jon O Nilsestuen, Jessica M Ketchum
BACKGROUND: Patient ventilator asynchrony (PVA) occurs frequently, but little is known about the types and frequency of PVA. Asynchrony is associated with significant patient discomfort, distress and poor clinical outcomes (duration of mechanical ventilation, intensive care unit and hospital stay). METHODS: Pressure-time and flow-time waveform data were collected on 27 ICU patients using the Noninvasive Cardiac Output monitor for up to 90 min per subject and blinded waveform analysis was performed...
May 2014: Heart & Lung: the Journal of Critical Care
https://read.qxmd.com/read/26627539/patient-ventilator-asynchrony
#4
REVIEW
Gaston Murias, Umberto Lucangelo, Lluis Blanch
PURPOSE OF REVIEW: The purpose of the review is to alert clinicians to the prevalent and frequently underrecognized problem of asynchrony in mechanically ventilated patients. To provide a mechanistic model of patient-ventilator asynchrony to help personnel understand how different asynchronies develop. To provide practical advice on how to recognize and solve different asynchronies in different contexts. RECENT FINDINGS: Patient-ventilator asynchrony is a serious problem that is associated with prolonged mechanical ventilation, prolonged ICU and hospital stays, and increased mortality...
February 2016: Current Opinion in Critical Care
https://read.qxmd.com/read/30920768/lived-experience-of-grieving-of-thai-buddhist-husbands-who-had-lost-their-wives-from-critical-illness
#5
Waraporn Kongsuwan, Tusanee Khaw, Manee Chaiweeradet, Rozzano Locsin
PURPOSE: To describe the meanings of the lived experiences of grieving of Thai Buddhist husbands who had lost their wives from critical illnesses. DESIGN: Hermeneutic phenomenological approach using van Manen's concepts. Seven husbands from southern Thailand who met the inclusion criteria participated in the study. METHODS: Individual in-depth interviews were conducted and recorded on tape, while the interview data were transcribed and analyzed following van Manen's phenomenological approach...
March 28, 2019: Journal of Nursing Scholarship
https://read.qxmd.com/read/30815378/neutrophil-lymphocyte-ratio-a-prognostic-tool-in-patients-with-in-hospital-cardiac-arrest
#6
Vishal H Patel, Philip Vendittelli, Rajat Garg, Susan Szpunar, Thomas LaLonde, John Lee, Howard Rosman, Rajendra H Mehta, Hussein Othman
BACKGROUND: In-hospital cardiac arrest (IHCA) portends a poor prognosis and survival to discharge rate. Prognostic markers such as interleukin-6, S-100 protein and high sensitivity C reactive protein have been studied as predictors of adverse outcomes after return of spontaneous circulation (ROSC); however; these variables are not routine laboratory tests and incur additional cost making them difficult to incorporate and less attractive in assessing patient's prognosis. The neutrophil-lymphocyte ratio (NLR) is a marker of adverse prognosis for many cardiovascular conditions and certain types of cancers and sepsis...
February 21, 2019: World Journal of Critical Care Medicine
https://read.qxmd.com/read/30785784/timing-of-renal-replacement-therapy-for-severe-acute-kidney-injury-in-critically-ill-patients
#7
Stéphane Gaudry, Jean-Pierre Quenot, Alexandre Hertig, Saber Davide Barbar, David Hajage, Jean-Damien Ricard, Didier Dreyfuss
Acute kidney injury (AKI) affects many intensive care unit patients and is responsible for increased morbidity and mortality. Although life-saving in many situations, renal replacement therapy (RRT) may be associated with complications and the appropriate timing of its initiation is still the subject of intense debate. An early initiation strategy can prevent some metabolic complications whereas a delayed one may allow for renal function recovery in some patients without need for this costly and potentially dangerous technique...
February 20, 2019: American Journal of Respiratory and Critical Care Medicine
https://read.qxmd.com/read/30701448/current-use-of-vasopressors-in-septic-shock
#8
Thomas W L Scheeren, Jan Bakker, Daniel De Backer, Djillali Annane, Pierre Asfar, E Christiaan Boerma, Maurizio Cecconi, Arnaldo Dubin, Martin W Dünser, Jacques Duranteau, Anthony C Gordon, Olfa Hamzaoui, Glenn Hernández, Marc Leone, Bruno Levy, Claude Martin, Alexandre Mebazaa, Xavier Monnet, Andrea Morelli, Didier Payen, Rupert Pearse, Michael R Pinsky, Peter Radermacher, Daniel Reuter, Bernd Saugel, Yasser Sakr, Mervyn Singer, Pierre Squara, Antoine Vieillard-Baron, Philippe Vignon, Simon T Vistisen, Iwan C C van der Horst, Jean-Louis Vincent, Jean-Louis Teboul
BACKGROUND: Vasopressors are commonly applied to restore and maintain blood pressure in patients with sepsis. We aimed to evaluate the current practice and therapeutic goals regarding vasopressor use in septic shock as a basis for future studies and to provide some recommendations on their use. METHODS: From November 2016 to April 2017, an anonymous web-based survey on the use of vasoactive drugs was accessible to members of the European Society of Intensive Care Medicine (ESICM)...
January 30, 2019: Annals of Intensive Care
https://read.qxmd.com/read/30762325/patient-ventilator-asynchrony-in-adult-critically-ill-patients
#9
Andrea Bruni, Eugenio Garofalo, Corrado Pelaia, Antonio Messina, Gianmaria Cammarota, Paolo Murabito, Silvia Corrado, Luigi Vetrugno, Federico Longhini, Paolo Navalesi
Patient-ventilator asynchrony is considered as a major clinical problem for mechanically ventilated patients. It occurs during partial ventilatory support, when the respiratory muscles and the ventilator interact to contribute generating the volume output. In this review article, we consider all studies published on patient-ventilator asynchrony in the last 25 years. We selected 62 studies. The different forms of asynchrony are first defined and classified. We also describe the methods used for detecting and quantifying asynchronies...
February 13, 2019: Minerva Anestesiologica
https://read.qxmd.com/read/30500905/ciprofloxacin-in-critically-ill-subjects-considering-hepatic-function-age-and-sex-to-choose-the-optimal-dose
#10
Xia Li, Michael Zoller, Uwe Fuhr, Mikayil Huseyn-Zada, Barbara Maier, Michael Vogeser, Johannes Zander, Max Taubert
Background: Pathophysiological changes often result in altered pharmacokinetics of ciprofloxacin in critically ill patients. Although ciprofloxacin clearance (CLCIP) substantially depends on kidney function in healthy volunteers, its relationship to measured creatinine clearance (CLCRM) is weak in critically ill patients. Objectives: To assess the need for dose reductions in isolated or combined kidney and liver dysfunction in critically ill patients and to re-evaluate relationships between kidney parameters, demographics and ciprofloxacin pharmacokinetics...
November 29, 2018: Journal of Antimicrobial Chemotherapy
https://read.qxmd.com/read/30516866/management-of-sepsis-in-patients-with-cirrhosis-current-evidence-and-practical-approach
#11
REVIEW
Douglas A Simonetto, Laura Piccolo Serafim, Alice Gallo de Moraes, Ognjen Gajic, Patrick S Kamath
Sepsis in patients with cirrhosis is associated with high mortality. An impaired immune response accounts for the increased infection risk observed in these patients. Hemodynamic and systemic changes suggestive of sepsis may be seen in patients with cirrhosis in the absence of infection, therefore diagnosis and treatment of sepsis may be delayed. The optimal management of the critically-ill septic patient with cirrhosis has not been well established and is generally extrapolated from consensus guidelines and expert recommendations made for management of non-cirrhotic patients with sepsis...
December 5, 2018: Hepatology: Official Journal of the American Association for the Study of Liver Diseases
https://read.qxmd.com/read/30478708/caring-for-the-critically-ill-patients-over-80-a-narrative-review
#12
REVIEW
Bertrand Guidet, Helene Vallet, Jacques Boddaert, Dylan W de Lange, Alessandro Morandi, Guillaume Leblanc, Antonio Artigas, Hans Flaatten
BACKGROUND: There is currently no international recommendation for the admission or treatment of the critically ill older patients over 80 years of age in the intensive care unit (ICU), and there is no valid prognostic severity score that includes specific geriatric assessments. MAIN BODY: In this review, we report recent literature focusing on older critically ill patients in order to help physicians in the multiple-step decision-making process. It is unclear under what conditions older patients may benefit from ICU admission...
November 26, 2018: Annals of Intensive Care
https://read.qxmd.com/read/30570162/bolus-vs-continuous-nasogastric-feeds-in-mechanically-ventilated-pediatric-patients-a-pilot-study
#13
Ann-Marie Brown, Elaine Fisher, Michael L Forbes
BACKGROUND: Malnutrition increases the risk of mortality and morbidity in the pediatric intensive care unit (PICU). Barriers to adequate delivery of enteral nutrition (EN) include hemodynamic instability, feeding interruptions and intolerance, and lack of standardized feeding protocols. The most recent guidelines on nutrition support for the critically ill child describe a paucity of evidence around the best method to deliver EN. There is an untested clinical assumption that bolus gastric feeding (B-GF) in intubated patients is associated with aspiration events, lung injury, and associated morbidity compared with continuous gastric feeding (C-GF)...
December 20, 2018: JPEN. Journal of Parenteral and Enteral Nutrition
https://read.qxmd.com/read/20472939/early-cpap-versus-surfactant-in-extremely-preterm-infants
#14
RANDOMIZED CONTROLLED TRIAL
Neil N Finer, Waldemar A Carlo, Michele C Walsh, Wade Rich, Marie G Gantz, Abbot R Laptook, Bradley A Yoder, Roger G Faix, Abhik Das, W Kenneth Poole, Edward F Donovan, Nancy S Newman, Namasivayam Ambalavanan, Ivan D Frantz, Susie Buchter, Pablo J Sánchez, Kathleen A Kennedy, Nirupama Laroia, Brenda B Poindexter, C Michael Cotten, Krisa P Van Meurs, Shahnaz Duara, Vivek Narendran, Beena G Sood, T Michael O'Shea, Edward F Bell, Vineet Bhandari, Kristi L Watterberg, Rosemary D Higgins
BACKGROUND: There are limited data to inform the choice between early treatment with continuous positive airway pressure (CPAP) and early surfactant treatment as the initial support for extremely-low-birth-weight infants. METHODS: We performed a randomized, multicenter trial, with a 2-by-2 factorial design, involving infants who were born between 24 weeks 0 days and 27 weeks 6 days of gestation. Infants were randomly assigned to intubation and surfactant treatment (within 1 hour after birth) or to CPAP treatment initiated in the delivery room, with subsequent use of a protocol-driven limited ventilation strategy...
May 27, 2010: New England Journal of Medicine
https://read.qxmd.com/read/30409433/2018-international-consensus-on-cardiopulmonary-resuscitation-and-emergency-cardiovascular-care-science-with-treatment-recommendations-summary
#15
Jasmeet Soar, Michael W Donnino, Ian Maconochie, Richard Aickin, Dianne L Atkins, Lars W Andersen, Katherine M Berg, Robert Bingham, Bernd W Böttiger, Clifton W Callaway, Keith Couper, Thomaz Bittencourt Couto, Allan R de Caen, Charles D Deakin, Ian R Drennan, Anne-Marie Guerguerian, Eric J Lavonas, Peter A Meaney, Vinay M Nadkarni, Robert W Neumar, Kee-Chong Ng, Tonia C Nicholson, Gabrielle A Nuthall, Shinichiro Ohshimo, Brian J O'Neil, Gene Yong-Kwang Ong, Edison F Paiva, Michael J Parr, Amelia G Reis, Joshua C Reynolds, Giuseppe Ristagno, Claudio Sandroni, Stephen M Schexnayder, Barnaby R Scholefield, Naoki Shimizu, Janice A Tijssen, Patrick Van de Voorde, Tzong-Luen Wang, Michelle Welsford, Mary Fran Hazinski, Jerry P Nolan, Peter T Morley
The International Liaison Committee on Resuscitation has initiated a continuous review of new, peer-reviewed, published cardiopulmonary resuscitation science. This is the second annual summary of International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations that includes the most recent cardiopulmonary resuscitation science reviewed by the International Liaison Committee on Resuscitation. This summary addresses the role of antiarrhythmic drugs in adults and children and includes the Advanced Life Support Task Force and Pediatric Task Force consensus statements, which summarize the most recent published evidence and an assessment of the quality of the evidence based on Grading of Recommendations, Assessment, Development, and Evaluation criteria...
December 2018: Resuscitation
https://read.qxmd.com/read/30374729/hemodynamic-support-in-the-early-phase-of-septic-shock-a-review-of-challenges-and-unanswered-questions
#16
REVIEW
Olivier Lesur, Eugénie Delile, Pierre Asfar, Peter Radermacher
BACKGROUND: Improving sepsis support is one of the three pillars of a 2017 resolution according to the World Health Organization (WHO). Septic shock is indeed a burden issue in the intensive care units. Hemodynamic stabilization is a cornerstone element in the bundle of supportive treatments recommended in the Surviving Sepsis Campaign (SSC) consecutive biannual reports. MAIN BODY: The "Pandera's box" of septic shock hemodynamics is an eternal debate, however, with permanent contentious issues...
October 29, 2018: Annals of Intensive Care
https://read.qxmd.com/read/11155418/anteroapical-stunning-and-left-ventricular-outflow-tract-obstruction
#17
R P Villareal, A Achari, S Wilansky, J M Wilson
Dynamic left ventricular outflow tract (LVOT) obstruction is typically observed in the setting of hypertrophic cardiomyopathy. It has also been reported with concentric LV hypertrophy, excessive sympathetic stimulation, and acute myocardial infarction. We describe 3 patients with chest discomfort after emotional stress, who had pronounced abnormalities on electrocardiograms, insignificant obstructive coronary disease and hemodynamic instability with LVOT obstruction, and regional wall motion abnormalities. Suppression of contractility with beta-blockers resulted in resolution of the gradient and in clinical improvement...
January 2001: Mayo Clinic Proceedings
https://read.qxmd.com/read/27190729/sonography-in-hypotension-and-cardiac-arrest-shoc-rates-of-abnormal-findings-in-undifferentiated-hypotension-and-during-cardiac-arrest-as-a-basis-for-consensus-on-a-hierarchical-point-of-care-ultrasound-protocol
#18
James Milne, Paul Atkinson, David Lewis, Jacqueline Fraser, Laura Diegelmann, Paul Olszynski, Melanie Stander, Hein Lamprecht
INTRODUCTION: Point of care ultrasound (PoCUS) has become an established tool in the initial management of patients with undifferentiated hypotension. Current established protocols (RUSH and ACES) were developed by expert user opinion, rather than objective, prospective data. PoCUS also provides invaluable information during resuscitation efforts in cardiac arrest by determining presence/absence of cardiac activity and identifying reversible causes such as pericardial tamponade. There is no agreed guideline on how to safely and effectively incorporate PoCUS into the advanced cardiac life support (ACLS) algorithm...
April 8, 2016: Curēus
https://read.qxmd.com/read/29866583/does-point-of-care-ultrasonography-improve-clinical-outcomes-in-emergency-department-patients-with-undifferentiated-hypotension-an-international-randomized-controlled-trial-from-the-shoc-ed-investigators
#19
Paul R Atkinson, James Milne, Laura Diegelmann, Hein Lamprecht, Melanie Stander, David Lussier, Chau Pham, Ryan Henneberry, Jacqueline M Fraser, Michael K Howlett, Jayanand Mekwan, Brian Ramrattan, Joanna Middleton, Daniel J van Hoving, Mandy Peach, Luke Taylor, Tara Dahn, Sean Hurley, Kayla MacSween, Luke R Richardson, George Stoica, Samuel Hunter, Paul A Olszynski, David A Lewis
STUDY OBJECTIVE: Point-of-care ultrasonography protocols are commonly used in the initial management of patients with undifferentiated hypotension in the emergency department (ED). There is little published evidence for any mortality benefit. We compare the effect of a point-of-care ultrasonography protocol versus standard care without point-of-care ultrasonography for survival and clinical outcomes. METHODS: This international, multicenter, randomized controlled trial recruited from 6 centers in North America and South Africa and included selected hypotensive patients (systolic blood pressure <100 mm Hg or shock index >1) randomized to early point-of-care ultrasonography plus standard care versus standard care without point-of-care ultrasonography...
October 2018: Annals of Emergency Medicine
https://read.qxmd.com/read/27998322/international-federation-for-emergency-medicine-consensus-statement-sonography-in-hypotension-and-cardiac-arrest-shoc-an-international-consensus-on-the-use-of-point-of-care-ultrasound-for-undifferentiated-hypotension-and-during-cardiac-arrest
#20
REVIEW
Paul Atkinson, Justin Bowra, James Milne, David Lewis, Mike Lambert, Bob Jarman, Vicki E Noble, Hein Lamprecht, Tim Harris, Jim Connolly
Introduction The International Federation for Emergency Medicine (IFEM) Ultrasound Special Interest Group (USIG) was tasked with development of a hierarchical consensus approach to the use of point of care ultrasound (PoCUS) in patients with hypotension and cardiac arrest. METHODS: The IFEM USIG invited 24 recognized international leaders in PoCUS from emergency medicine and critical care to form an expert panel to develop the sonography in hypotension and cardiac arrest (SHoC) protocol...
November 2017: CJEM
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