Suchitra Ranjit, Rajeswari Natraj, Niranjan Kissoon, Ravi Thiagarajan, Balasubramaniam Ramakrishnan, M Ignacio Monge Garcia
Objectives: Fluid boluses are commonly administered to improve the cardiac output and tissue oxygen delivery in pediatric septic shock. The objective of this study is to evaluate the effect of an early fluid bolus administered to children with septic shock on the cardiac index and mean arterial pressure, as well as on the hemodynamic response and its relationship with outcome. Design, Setting, Patients, and Interventions: We prospectively collected hemodynamic data from children with septic shock presenting to the emergency department or the PICU who received a fluid bolus (10 mL/kg of Ringers Lactate over 30 min)...
March 15, 2021: Pediatric Critical Care Medicine
Timothy D Henry, Matthew I Tomey, Jacqueline E Tamis-Holland, Holger Thiele, Sunil V Rao, Venu Menon, Deborah G Klein, Yoshifumi Naka, Ileana L Piña, Navin K Kapur, George D Dangas
Cardiogenic shock (CS) remains the most common cause of mortality in patients with acute myocardial infarction. The SHOCK trial (Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock) demonstrated a survival benefit with early revascularization in patients with CS complicating acute myocardial infarction (AMICS) 20 years ago. After an initial improvement in mortality related to revascularization, mortality rates have plateaued. A recent Society of Coronary Angiography and Interventions classification scheme was developed to address the wide range of CS presentations...
March 4, 2021: Circulation
Ishaq Lat, Craig M Coopersmith, Daniel De Backer, Craig M Coopersmith
OBJECTIVE: To expand upon the priorities of fluid resuscitation and vasopressor therapy research priorities identified by a group of experts assigned by the Society of Critical Care Medicine and the European Society of Intensive Care Medicine. DATA SOURCES: Original paper and literature search. STUDY SELECTION: Several members of the original task force with expertise specific to the area of fluid resuscitation and vasopressor therapy. DATA EXTRACTION: None...
March 1, 2021: Intensive Care Medicine Experimental
Charles-Edouard Luyt, Lila Bouadma, Andrew Conway Morris, Jayesh A Dhanani, Marin Kollef, Jeffrey Lipman, Ignacio Martin-Loeches, Saad Nseir, Otavio T Ranzani, Antoine Roquilly, Matthieu Schmidt, Antoni Torres, Jean-François Timsit
Pulmonary infection is one of the main complications occurring in patients suffering from acute respiratory distress syndrome (ARDS). Besides traditional risk factors, dysregulation of lung immune defenses and microbiota may play an important role in ARDS patients. Prone positioning does not seem to be associated with a higher risk of pulmonary infection. Although bacteria associated with ventilator-associated pneumonia (VAP) in ARDS patients are similar to those in patients without ARDS, atypical pathogens (Aspergillus, herpes simplex virus and cytomegalovirus) may also be responsible for infection in ARDS patients...
November 11, 2020: Intensive Care Medicine
Ken Kuljit S Parhar, Danny J Zuege, Karen Shariff, Gwen Knight, Sean M Bagshaw
Many patients with coronavirus disease (COVID-19) will develop acute respiratory distress syndrome (ARDS). Prone positioning is an important non-pharmacologic strategy that should be considered for all invasively ventilated patients with moderate to severe ARDS (including those with COVID-19). Prone positioning offers several physiologic and clinical benefits, including improving hypoxemia, matching ventilation with perfusion, reducing regional hyperinflation, and improving survival. To safely offer prone positioning, appropriate training, simulation, and health system planning should be undertaken...
December 24, 2020: Canadian Journal of Anaesthesia
Elisabeth A J de Vos, Peter H J van der Voort
PURPOSE: ICU acquired hypernatremia (IAH) is associated with increased morbidity and mortality, however treatment remains controversial. This study aims to determine the effect of enteral free water suppletion in patients with IAH. MATERIALS AND METHODS: Retrospective single center study in a tertiary ICU. INCLUSION CRITERIA: patients with IAH and treatment with enteral free water. EXCLUSION CRITERIA: patients with renal replacement therapy, diabetic ketoacidosis or hyperosmolar hyperglycaemic state...
April 2021: Journal of Critical Care
Ned Hartfiel, Girendra Sadera, Victoria Treadway, Catherine Lawrence, Rhiannon Tudor Edwards
BACKGROUND: Timely information provided by clinical librarians can contribute to outcomes such as improved patient care and time savings for hospital staff. What is unknown is the return on investment (ROI) of a clinical librarian on a critical care unit. OBJECTIVE: The aim of this study was to assess the ROI, from the employer perspective, of placing a clinical librarian in a critical care unit in a large UK acute hospital. METHODS: Using a mixed methods approach, ROI was estimated by comparing the total costs with the total monetised benefits of implementing the clinical librarian intervention...
November 16, 2020: Health Information and Libraries Journal
Ketan K Dhatariya, Nicole S Glaser, Ethel Codner, Guillermo E Umpierrez
Diabetic ketoacidosis (DKA) is the most common acute hyperglycaemic emergency in people with diabetes mellitus. A diagnosis of DKA is confirmed when all of the three criteria are present - 'D', either elevated blood glucose levels or a family history of diabetes mellitus; 'K', the presence of high urinary or blood ketoacids; and 'A', a high anion gap metabolic acidosis. Early diagnosis and management are paramount to improve patient outcomes. The mainstays of treatment include restoration of circulating volume, insulin therapy, electrolyte replacement and treatment of any underlying precipitating event...
May 14, 2020: Nature Reviews. Disease Primers
John A Harvin, Lillian S Kao
PURPOSE OF REVIEW: Acute pain management in the surgical ICU is imperative. Effective acute pain management hastens a patient's return to normal function and avoid the negative sequelae of untreated acute pain. Traditionally, opioids have been the mainstay of acute pain management strategies in the surgical ICU, but alternative medications and management strategies are increasingly being utilized. RECENT FINDINGS: Extrapolating from lessons learned from enhanced recovery after surgery protocols, surgical intensivists are increasingly utilizing multimodal pain regimens (MMPRs) in critically ill surgical patients recovering from major surgical procedures and injuries...
December 2020: Current Opinion in Critical Care
Olivier Hermine, Xavier Mariette, Pierre-Louis Tharaux, Matthieu Resche-Rigon, Raphaël Porcher, Philippe Ravaud
Importance: Severe pneumonia with hyperinflammation and elevated interleukin-6 is a common presentation of coronavirus disease 2019 (COVID-19). Objective: To determine whether tocilizumab (TCZ) improves outcomes of patients hospitalized with moderate-to-severe COVID-19 pneumonia. Design, Setting, and Particpants: This cohort-embedded, investigator-initiated, multicenter, open-label, bayesian randomized clinical trial investigating patients with COVID-19 and moderate or severe pneumonia requiring at least 3 L/min of oxygen but without ventilation or admission to the intensive care unit was conducted between March 31, 2020, to April 18, 2020, with follow-up through 28 days...
January 1, 2021: JAMA Internal Medicine
Klaus Stahl, Rolf Bikker, Benjamin Seeliger, Julius J Schmidt, Heiko Schenk, Bernhard M W Schmidt, Tobias Welte, Hermann Haller, Marius M Hoeper, Korbinian Brand, Sascha David
BACKGROUND: Deficiency of immunoglobulins of the classes IgG, IgG1, IgA and IgM is associated with severity of disease and mortality in sepsis and septic shock. Therapeutic plasma exchange (TPE) with fresh frozen plasma (FFP) has recently gained attention as an adjunctive therapeutic option in early septic shock. We hypothesized that TPE might modulate immunoglobulin deficiencies besides sole elimination of circulating injurious molecules. METHODS: We conducted a prospective single center study with TPE in 33 patients with early septic shock (onset < 12 h) requiring high doses of norepinephrine (NE > 0...
October 16, 2020: Journal of Intensive Care Medicine
James E Tisdale, Mina K Chung, Kristen B Campbell, Muhammad Hammadah, Jose A Joglar, Jacinthe Leclerc, Bharath Rajagopalan
Many widely used medications may cause or exacerbate a variety of arrhythmias. Numerous antiarrhythmic agents, antimicrobial drugs, psychotropic medications, and methadone, as well as a growing list of drugs from other therapeutic classes (neurological drugs, anticancer agents, and many others), can prolong the QT interval and provoke torsades de pointes. Perhaps less familiar to clinicians is the fact that drugs can also trigger other arrhythmias, including bradyarrhythmias, atrial fibrillation/atrial flutter, atrial tachycardia, atrioventricular nodal reentrant tachycardia, monomorphic ventricular tachycardia, and Brugada syndrome...
September 15, 2020: Circulation
Xiaoying Gu, Fei Zhou, Yeming Wang, Guohui Fan, Bin Cao
According to the Third International Consensus Definition for Sepsis and Septic Shock, sepsis is a life-threatening organ dysfunction resulting from dysregulated host responses to infection. Epidemiological data about sepsis from the 2017 Global Burden of Diseases, Injuries and Risk Factor Study showed that the global burden of sepsis was greater than previously estimated. Bacteria have been shown to be the predominant pathogen of sepsis among patients with pathogens detected, while sepsis caused by viruses is underdiagnosed worldwide...
September 30, 2020: European Respiratory Review: An Official Journal of the European Respiratory Society
Ryan P Barbaro, Graeme MacLaren, Philip S Boonstra, Theodore J Iwashyna, Arthur S Slutsky, Eddy Fan, Robert H Bartlett, Joseph E Tonna, Robert Hyslop, Jeffrey J Fanning, Peter T Rycus, Steve J Hyer, Marc M Anders, Cara L Agerstrand, Katarzyna Hryniewicz, Rodrigo Diaz, Roberto Lorusso, Alain Combes, Daniel Brodie
BACKGROUND: Multiple major health organisations recommend the use of extracorporeal membrane oxygenation (ECMO) support for COVID-19-related acute hypoxaemic respiratory failure. However, initial reports of ECMO use in patients with COVID-19 described very high mortality and there have been no large, international cohort studies of ECMO for COVID-19 reported to date. METHODS: We used data from the Extracorporeal Life Support Organization (ELSO) Registry to characterise the epidemiology, hospital course, and outcomes of patients aged 16 years or older with confirmed COVID-19 who had ECMO support initiated between Jan 16 and May 1, 2020, at 213 hospitals in 36 countries...
September 25, 2020: Lancet
Shrinjaya B Thapa, Tanya S Kakar, Corey Mayer, Dilip Khanal
No abstract text is available yet for this article.
September 28, 2020: JAMA Internal Medicine
Sheldon Magder, Douglas Slobod, Nawaporn Assanangkornchai
No abstract text is available yet for this article.
September 30, 2020: American Journal of Respiratory and Critical Care Medicine
Pretty Sara Idiculla, Dhineshreddy Gurala, Manikandan Palanisamy, Rajendran Vijayakumar, Sindhu Dhandapani, Elanagan Nagarajan
BACKGROUND: Cerebral sinus venous thrombosis (CSVT) is a relatively rare, potentially fatal neurological condition that can be frequently overlooked due to the vague nature of its clinical and radiological presentation. A literature search on PubMed using the keyword "Cerebral sinus venous thrombosis" was performed. We searched for the epidemiology, risk factors, pathophysiology, clinical features, diagnosis, and treatment of CSVT. All full-text articles in the last 10 years, in adults (>18 years), and the English language were included...
September 2, 2020: European Neurology
Brian T Garibaldi, Jacob Fiksel, John Muschelli, Matthew L Robinson, Masoud Rouhizadeh, Jamie Perin, Grant Schumock, Paul Nagy, Josh H Gray, Harsha Malapati, Mariam Ghobadi-Krueger, Timothy M Niessen, Bo Soo Kim, Peter M Hill, M Shafeeq Ahmed, Eric D Dobkin, Renee Blanding, Jennifer Abele, Bonnie Woods, Kenneth Harkness, David R Thiemann, Mary G Bowring, Aalok B Shah, Mei-Cheng Wang, Karen Bandeen-Roche, Antony Rosen, Scott L Zeger, Amita Gupta
BACKGROUND: Risk factors for progression of coronavirus disease 2019 (COVID-19) to severe disease or death are underexplored in U.S. cohorts. OBJECTIVE: To determine the factors on hospital admission that are predictive of severe disease or death from COVID-19. DESIGN: Retrospective cohort analysis. SETTING: Five hospitals in the Maryland and Washington, DC, area. PATIENTS: 832 consecutive COVID-19 admissions from 4 March to 24 April 2020, with follow-up through 27 June 2020...
January 2021: Annals of Internal Medicine
Christiane Maria Prado Jeronimo, Maria Eduarda Leão Farias, Fernando Fonseca Almeida Val, Vanderson Souza Sampaio, Marcia Almeida Araújo Alexandre, Gisely Cardoso Melo, Izabella Picinin Safe, Mayla Gabriela Silva Borba, Rebeca Linhares Abreu-Netto, Alex Bezerra Silva Maciel, João Ricardo Silva Neto, Lucas Barbosa Oliveira, Erick Frota Gomes Figueiredo, Kelry Mazurega Oliveira Dinelly, Maria Gabriela de Almeida Rodrigues, Marcelo Brito, Maria Paula Gomes Mourão, Guilherme Augusto Pivoto João, Ludhmila Abrahão Hajjar, Quique Bassat, Gustavo Adolfo Sierra Romero, Felipe Gomes Naveca, Heline Lira Vasconcelos, Michel de Araújo Tavares, José Diego Brito-Sousa, Fabio Trindade Maranhão Costa, Maurício Lacerda Nogueira, Djane Baía-da-Silva, Mariana Simão Xavier, Wuelton Marcelo Monteiro, Marcus Vinícius Guimarães Lacerda
BACKGROUND: Steroid use for COVID-19 is based on the possible role of these drugs in mitigating the inflammatory response, mainly in the lungs, triggered by SARS-CoV-2. This study aimed at evaluating at evaluating the efficacy of methylprednisolone (MP) among hospitalized patients with suspected COVID-19. METHODS: Parallel, double-blind, placebo-controlled, randomized, phase IIb clinical trial was performed with hospitalized patients aged ≥ 18 years with clinical, epidemiological and/or radiological suspected COVID-19, at a tertiary care facility in Manaus, Brazil...
August 12, 2020: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
Fabio Silvio Taccone, Pierre Alain Gevenois, Lorenzo Peluso, Zoe Pletchette, Olivier Lheureux, Alexandre Brasseur, Alessandra Garufi, Marta Talamonti, Serge Motte, Leda Nobile, David Grimaldi, Jacques Creteur, Jean-Louis Vincent
OBJECTIVES: To assess the role of thromboprophylaxis regimens on the occurrence of pulmonary embolism in coronavirus disease 2019 patients. DESIGN: Retrospective analysis of prospectively collected data on coronavirus disease 2019 patients, included between March 10, and April 30, 2020. SETTING: ICU of an University Hospital in Belgium. PATIENTS AND INTERVENTIONS: Critically ill adult mechanically ventilated coronavirus disease 2019 patients were eligible if they underwent a CT pulmonary angiography, as part of the routine management in case of persistent hypoxemia or respiratory deterioration...
November 2020: Critical Care Medicine
2020-08-21 20:25:59
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