Critical care

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By Varun Shetty Critical Care fellow with background training in Internal Medicine-Pediatrics
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
Jeremy R Beitler
PURPOSE OF REVIEW: Most clinical trials of lung-protective ventilation have tested one-size-fits-all strategies with mixed results. Data are lacking on how best to tailor mechanical ventilation to patient-specific risk of lung injury. RECENT FINDINGS: Risk of ventilation-induced lung injury is determined by biological predisposition to biophysical lung injury and physical mechanical perturbations that concentrate stress and strain regionally within the lung. Recent investigations have identified molecular subphenotypes classified as hyperinflammatory and hypoinflammatory acute respiratory distress syndrome (ARDS), which may have dissimilar risk for ventilation-induced lung injury...
December 6, 2019: Current Opinion in Critical Care
Gerald S Supinski, Elizabeth A Schroder, Leigh Ann Callahan
Classically, mitochondria have largely been thought to influence the development of illness by modulating cell metabolism and determining the rate of production of high energy phosphate compounds (e.g. ATP). It is now recognized that this is a simplistic view and that mitochondria play key roles in many other processes, including cell signaling, regulating gene expression, modulating cellular calcium levels and influencing the activation of cell death pathways (e.g. caspase activation). Moreover, these multiple mitochondrial functional characteristics are now known to influence the evolution of cellular and organ function in many disease states, including sepsis, ICU acquired skeletal muscle dysfunction, acute lung injury, acute renal failure, and critical illness related immune function dysregulation...
September 5, 2019: Chest
Adeel Rafi Ahmed, Ayanfeoluwa Obilana, David Lappin
Renal replacement therapy (RRT) is frequently required to manage critically ill patients with acute kidney injury (AKI). There is limited evidence to support the current practice of RRT in intensive care units (ICUs). Recently published randomized control trials (RCTs) have further questioned our understanding of RRT in critical care. The optimal timing and dosing continues to be debatable; however, current evidence suggests delayed strategy with less intensive dosing when utilising RRT. Various modes of RRT are complementary to each other with no definite benefits to mortality or renal function preservation...
2019: Critical Care Research and Practice
Mathieu Echivard, Daniel A Lichtenstein, Adrian Lala, Anais Perez Sanchez, Nicolas Girerd
OBJECTIVES: Lung ultrasound has shown increasing diagnostic value in many lung diseases and has become an efficient tool in the management of dyspnea. In the present case report, we describe a new ultrasound feature of potential interest. DATA SOURCES: Clinical observation of a patient. STUDY SELECTION: Case report. DATA EXTRACTION: Data were extracted from medical records, after obtaining consent from the patient's family...
October 2019: Critical Care Medicine
Cristina Sarda, Pedro Palma, Jordi Rello
PURPOSE OF REVIEW: Overview of influenza infection, focusing on outcome and complications in critically ill patients. We also discuss relevant elements in immunopathogenesis and their role as predictors of severity. RECENT FINDINGS: Pandemic influenza A (H1N1) virus circulates seasonally and remains the predominant subtype among intensive care patients. Mortality in acute respiratory failure (ARF) is around 20%, independent of influenza subtypes. During severe infection, the imbalance between pro-inflammatory and anti-inflammatory molecules, such as Th1 and Th17 cytokines, is associated with complicated infections and mortality...
October 2019: Current Opinion in Critical Care
Raj Dalsania, Field F Willingham
PURPOSE OF REVIEW: To review the current management of walled-off pancreatic necrosis (WOPN). RECENT FINDINGS: The management of WOPN has evolved. Many collections do not require intervention and may resolve over time. Nutritional support and treatment of infection are two critical components of medical management. For collections requiring drainage, minimally invasive endoscopic therapies now play a primary role. Endoscopic transmural puncture with stent placement may provide access for drainage and decompression...
September 2019: Current Opinion in Gastroenterology
Cyrus Vahdatpour, David Collins, Sheldon Goldberg
No abstract text is available yet for this article.
April 16, 2019: Journal of the American Heart Association
Marie Warrer Petersen, Anders Perner, Fredrik Sjövall, Andreas Bender Jonsson, Morten Steensen, Jakob Steen Andersen, Michael Patrick Achiam, Niels Frimodt-Møller, Morten Hylander Møller
INTRODUCTION: Early empirical broad-spectrum antimicrobial therapy is recommended for patients with severe infections, including sepsis. β-lactam/β-lactamase inhibitor combinations or carbapenems are often used to ensure coverage of likely pathogens. Piperacillin/tazobactam is proposed as a carbapenem-sparing agent to reduce the incidence of multidrug-resistant bacteria and superinfections. In the recently published MERINO trial, increased mortality from piperacillin/tazobactam was suggested in patients with bacteraemia with resistant Escherichia coli or Klebsiella species...
August 2019: Acta Anaesthesiologica Scandinavica
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...
August 2019: Journal of Critical Care
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 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 outcome 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 day" composites, and we provide a framework for when and how to use these outcome measures...
October 1, 2019: American Journal of Respiratory and Critical Care Medicine
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
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
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...
July 2019: Journal of Nursing Scholarship
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
Stéphane Gaudry, Jean-Pierre Quenot, Alexandre Hertig, Saber Davide Barbar, David Hajage, Jean-Damien Ricard, Didier Dreyfuss
Acute kidney injury (AKI) affects many ICU patients and is responsible for increased morbidity and mortality. Although lifesaving 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...
May 1, 2019: American Journal of Respiratory and Critical Care Medicine
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
Andrea Bruni, Eugenio Garofalo, Corrado Pelaia, Antonio Messina, Gianmaria Cammarota, Paolo Murabito, Silvia Corrado, Luigi Vetrugno, Federico Longhini, Paolo Navalesi
INTRODUCTION: Patient-ventilator asynchrony is considered 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. EVIDENCE ACQUISITION: We selected 62 studies. The different forms of asynchrony are first defined and classified...
June 2019: Minerva Anestesiologica
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...
March 1, 2019: Journal of Antimicrobial Chemotherapy
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 observed 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 patient with sepsis and cirrhosis has not been well established and is generally extrapolated from consensus guidelines and expert recommendations made for management of patients without cirrhosis with sepsis...
July 2019: Hepatology: Official Journal of the American Association for the Study of Liver Diseases
2019-01-20 20:28:33
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