Yiqi Fu, Qing Yang, Min Xu, Haishen Kong, Hongchao Chen, Yajie Fu, Yake Yao, Hua Zhou, Jianying Zhou
Secondary bacterial infections occurred in 13.9% (5 of 36) of critical ill patients with coronavirus disease 2019. All 5 patients had been admitted to intensive care unit and received mechanical ventilation before developing bacterial infection. Active surveillance of culture should be performed for critically ill patients. Prevention of nosocomial infection should to be taken seriously.
June 2020: Open Forum Infectious Diseases
Tarun D Singh, John C O'Horo, Courtney N Day, Jay Mandrekar, Alejandro A Rabinstein
BACKGROUND: Acute encephalopathy (AE) is a common complication of critical illness and is associated with increased short and long-term mortality. In this study, we evaluated the role of cefepime in causing AE. METHODS: Retrospective case-control study involving consecutive patients enrolled in the intensive care units (ICUs) of Mayo Clinic Rochester, MN between July 1, 2004 and December 31, 2015. AE was defined by the presence of delirium or depressed level of consciousness in the absence of deep sedation...
July 1, 2020: Neurocritical Care
Paul J Secombe, Alex Brown, Michael J Bailey, David Pilcher
No abstract text is available yet for this article.
June 13, 2020: Medical Journal of Australia
Prashant Rao, Daniel Katz, Michinari Hieda, Marwa Sabe
The incidence of cardiogenic shock and the utilization of mechanical circulatory support devices are increasing in the US. In this review we discuss the pathophysiology of cardiogenic shock through basic hemodynamic and myocardial energetic principles. We also explore the commonly used platforms for temporary mechanical circulatory support, their advantages, disadvantages and practical considerations relating to implementation and management. It is through the translation of underlying physiological principles that we can attempt to maximize the clinical utility of circulatory support devices and improve outcomes in cardiogenic shock...
July 2020: Heart Failure Clinics
Christian Sebat, Mary Anne Vandegrift, Sean Oldroyd, Andrew Kramer, Frank Sebat
BACKGROUND: Capillary refill time (CRT) is easy, quick to perform and when prolonged in critical illness, correlates with progression of organ failure and mortality. It is utilized in our hospital's early warning score (EWS) as one of 11 parameters. We sought to define CRT's value in predicting patient outcomes, compared to the remaining EWS elements. METHODS: Five-year prospective observational study of 6480 consecutive Rapid Response Team (RRT) patients. CRT measured at the index finger was considered prolonged if time to previous-color return was>3seconds...
June 3, 2020: Resuscitation
Francesco Licciardi, Giulia Pruccoli, Marco Denina, Emilia Parodi, Manuela Taglietto, Sergio Rosati, Davide Montin
No abstract text is available yet for this article.
May 21, 2020: Pediatrics
Mandeep R Mehra, Sapan S Desai, Frank Ruschitzka, Amit N Patel
BACKGROUND: Hydroxychloroquine or chloroquine, often in combination with a second-generation macrolide, are being widely used for treatment of COVID-19, despite no conclusive evidence of their benefit. Although generally safe when used for approved indications such as autoimmune disease or malaria, the safety and benefit of these treatment regimens are poorly evaluated in COVID-19. METHODS: We did a multinational registry analysis of the use of hydroxychloroquine or chloroquine with or without a macrolide for treatment of COVID-19...
May 22, 2020: Lancet
Yeming Wang, Dingyu Zhang, Guanhua Du, Ronghui Du, Jianping Zhao, Yang Jin, Shouzhi Fu, Ling Gao, Zhenshun Cheng, Qiaofa Lu, Yi Hu, Guangwei Luo, Ke Wang, Yang Lu, Huadong Li, Shuzhen Wang, Shunan Ruan, Chengqing Yang, Chunlin Mei, Yi Wang, Dan Ding, Feng Wu, Xin Tang, Xianzhi Ye, Yingchun Ye, Bing Liu, Jie Yang, Wen Yin, Aili Wang, Guohui Fan, Fei Zhou, Zhibo Liu, Xiaoying Gu, Jiuyang Xu, Lianhan Shang, Yi Zhang, Lianjun Cao, Tingting Guo, Yan Wan, Hong Qin, Yushen Jiang, Thomas Jaki, Frederick G Hayden, Peter W Horby, Bin Cao, Chen Wang
BACKGROUND: No specific antiviral drug has been proven effective for treatment of patients with severe coronavirus disease 2019 (COVID-19). Remdesivir (GS-5734), a nucleoside analogue prodrug, has inhibitory effects on pathogenic animal and human coronaviruses, including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in vitro, and inhibits Middle East respiratory syndrome coronavirus, SARS-CoV-1, and SARS-CoV-2 replication in animal models. METHODS: We did a randomised, double-blind, placebo-controlled, multicentre trial at ten hospitals in Hubei, China...
May 16, 2020: Lancet
Ana Paula de Carvalho Panzeri Carlotti, Werther Brunow de Carvalho, Cíntia Johnston, Isadora Souza Rodriguez, Artur Figueiredo Delgado
This review aims to verify the main epidemiologic, clinical, laboratory-related, and therapeutic aspects of coronavirus disease 2019 (COVID-19) in critically ill pediatric patients. An extensive review of the medical literature on COVID-19 was performed, mainly focusing on the critical care of pediatric patients, considering expert opinions and recent reports related to this new disease. Experts from a large Brazilian public university analyzed all recently published material to produce a report aiming to standardize the care of critically ill children and adolescents...
2020: Clinics
Ivor S Douglas, Philip M Alapat, Keith A Corl, Matthew C Exline, Lui G Forni, Andre L Holder, David A Kaufman, Akram Khan, Mitchell M Levy, Gregory S Martin, Jennifer A Sahatjian, Eric Seeley, Wesley H Self, Jeremy A Weingarten, Mark Williams, Douglas M Hansell
BACKGROUND: Fluid and vasopressor management in septic shock remains controversial. In this randomized controlled trial, we evaluated the efficacy of dynamic measures (stroke volume change during passive leg raise) to guide resuscitation and improve patient outcome. RESEARCH QUESTION: Will resuscitation guided by dynamic assessments of fluid responsiveness in patients with septic shock improve patient outcomes? STUDY DESIGN: and Methods: Prospective, multicenter, randomized clinical trial at 13 hospitals in the United States and United Kingdom...
April 27, 2020: Chest
Ning Tang, Huan Bai, Xing Chen, Jiale Gong, Dengju Li, Ziyong Sun
BACKGROUND: A relatively high mortality of severe coronavirus disease 2019 (COVID-19) is worrying, the application of heparin in COVID-19 has been recommended by some expert consensus due to the risk of disseminated intravascular coagulation and venous thromboembolism. However, its efficacy remains to be validated. METHODS: Coagulation results, medications and outcomes of consecutive patients being classified as severe COVID-19 in Tongji hospital were retrospectively analysed...
March 27, 2020: Journal of Thrombosis and Haemostasis: JTH
Jason Phua, Li Weng, Lowell Ling, Moritoki Egi, Chae-Man Lim, Jigeeshu Vasishtha Divatia, Babu Raja Shrestha, Yaseen M Arabi, Jensen Ng, Charles D Gomersall, Masaji Nishimura, Younsuck Koh, Bin Du
As coronavirus disease 2019 (COVID-19) spreads across the world, the intensive care unit (ICU) community must prepare for the challenges associated with this pandemic. Streamlining of workflows for rapid diagnosis and isolation, clinical management, and infection prevention will matter not only to patients with COVID-19, but also to health-care workers and other patients who are at risk from nosocomial transmission. Management of acute respiratory failure and haemodynamics is key. ICU practitioners, hospital administrators, governments, and policy makers must prepare for a substantial increase in critical care bed capacity, with a focus not just on infrastructure and supplies, but also on staff management...
April 6, 2020: Lancet Respiratory Medicine
Chenguang Shen, Zhaoqin Wang, Fang Zhao, Yang Yang, Jinxiu Li, Jing Yuan, Fuxiang Wang, Delin Li, Minghui Yang, Li Xing, Jinli Wei, Haixia Xiao, Yan Yang, Jiuxin Qu, Ling Qing, Li Chen, Zhixiang Xu, Ling Peng, Yanjie Li, Haixia Zheng, Feng Chen, Kun Huang, Yujing Jiang, Dongjing Liu, Zheng Zhang, Yingxia Liu, Lei Liu
Importance: Coronavirus disease 2019 (COVID-19) is a pandemic with no specific therapeutic agents and substantial mortality. It is critical to find new treatments. Objective: To determine whether convalescent plasma transfusion may be beneficial in the treatment of critically ill patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Design, Setting, and Participants: Case series of 5 critically ill patients with laboratory-confirmed COVID-19 and acute respiratory distress syndrome (ARDS) who met the following criteria: severe pneumonia with rapid progression and continuously high viral load despite antiviral treatment; Pao2/Fio2 <300; and mechanical ventilation...
March 27, 2020: JAMA: the Journal of the American Medical Association
Jinoos Yazdany, Alfred H J Kim
No abstract text is available yet for this article.
June 2, 2020: Annals of Internal Medicine
Stephan V Hendriks, Frederikus A Klok, Paul L den Exter, Michiel Eijsvogel, Laura M Faber, Herman M A Hofstee, Antonio Iglesias Del Sol, Lucia J M Kroft, Albert T A Mairuhu, Menno V Huisman
No abstract text is available yet for this article.
March 23, 2020: American Journal of Respiratory and Critical Care Medicine
David C Miller, Christian Bime, Sairam Partharsarathy, Jarrod M Mosier
High-flow nasal oxygen systems are rapidly being adopted as an initial noninvasive treatment for acute respiratory failure. However, the term "high-flow nasal cannula" is nonspecific and leads to imprecise communication between physicians, respiratory therapists, and nurses with the potential for patient harm. In this viewpoint and a brief review of the technology, we argue for a change in nomenclature in order to reduce the chance for future clinical, administrative, and research misunderstanding surrounding high-flow nasal oxygen systems...
May 2020: Journal of Intensive Care Medicine
Andrés Fabricio Caballero-Lozada, Kapil Laxman Nanwani, Favio Pavón, Andrés Zorrilla-Vaca, Carolina Zorrilla-Vaca
Ultrasonography is part of the multimodal monitoring of the neurocritical patient. Through transcranial color Doppler ultrasound, carotid-color Doppler ultrasound, and ocular ultrasound it is possible to diagnose and monitor a multitude of pathological conditions, such as cerebrovascular events, vasospasm, Terson syndrome, carotid atheromatosis, and brain death. Furthermore, these techniques enable the monitoring of the intracranial pressure, the cerebral perfusion pressure, and the midline deviation, which allows us to understand the patient's neurocritical pathology at their bedside, in a noninvasive way...
March 10, 2020: Journal of Intensive Care Medicine
Tomoko Fujii, Nora Luethi, Paul J Young, Daniel R Frei, Glenn M Eastwood, Craig J French, Adam M Deane, Yahya Shehabi, Ludhmila A Hajjar, Gisele Oliveira, Andrew A Udy, Neil Orford, Samantha J Edney, Anna L Hunt, Harriet L Judd, Laurent Bitker, Luca Cioccari, Thummaporn Naorungroj, Fumitaka Yanase, Samantha Bates, Forbes McGain, Elizabeth P Hudson, Wisam Al-Bassam, Dhiraj Bhatia Dwivedi, Chloe Peppin, Phoebe McCracken, Judit Orosz, Michael Bailey, Rinaldo Bellomo
Importance: It is unclear whether vitamin C, hydrocortisone, and thiamine are more effective than hydrocortisone alone in expediting resolution of septic shock. Objective: To determine whether the combination of vitamin C, hydrocortisone, and thiamine, compared with hydrocortisone alone, improves the duration of time alive and free of vasopressor administration in patients with septic shock. Design, Setting, and Participants: Multicenter, open-label, randomized clinical trial conducted in 10 intensive care units in Australia, New Zealand, and Brazil that recruited 216 patients fulfilling the Sepsis-3 definition of septic shock...
January 17, 2020: JAMA: the Journal of the American Medical Association
Marlena A Fox, Melanie C Perry, Xi Liu-DeRyke
OBJECTIVE: Twice/day dosing of insulin glargine has been used to treat hyperglycemia in clinical practice; however, data supporting its use in the critically ill population are lacking. This study was designed to evaluate the safety and efficacy of twice/day insulin glargine in critically ill patients. METHODS: A retrospective study was conducted in adult patients admitted to the intensive care units between February 2013 and June 2017 who received insulin glargine twice/day or 40 units or more once/day for 48 hours or longer...
March 2020: Pharmacotherapy
O Joe Hines, Stephen J Pandol
The risks, measurements of severity, and management of severe acute pancreatitis and its complications have evolved rapidly over the past decade. Evidence suggests that initial goal directed therapy, nutritional support, and vigilance for pancreatic complications are best practice. Patients can develop pancreatic fluid collections including acute pancreatic fluid collections, pancreatic pseudocysts, acute necrotic collections, and walled-off necrosis. Several randomized controlled trials and cohort studies have recently highlighted the advantage of managing these conditions with a progressive approach, with initial draining for infection followed by less invasive techniques...
December 2, 2019: BMJ: British Medical Journal
2020-01-04 22:21:30
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