Collections Outstanding Clinical Review

Outstanding Clinical Review

Topics related to cardiac anesthesia & critical care
Kjetil Andreas Hognestad Karlsen, Sven Erik Gisvold, Trond Nordseth, Sigurd Fasting
Awake fibreoptic intubation has been considered a gold standard in the management of the difficult airway. However, failure may cause critical situations. The aim of this study was to investigate the incidence and causes of failed awake fibreoptic intubation at a tertiary care hospital. The study was conducted at St. Olav University Hospital in Trondheim, Norway. Problems occurring during anaesthesia are routinely recorded in the electronic anaesthesia information system (Picis Clinical Solutions Inc.), including difficult intubations...
November 2023: Acta Anaesthesiologica Scandinavica
Samuel Seitler, Konstantinos Dimopoulos, Sabine Ernst, Laura C Price
The management of acute medical emergencies in patients with pulmonary hypertension (PH) can be challenging. Patients with preexisting PH can rapidly deteriorate due to right ventricular decompensation when faced with acute physiological challenges that would usually be considered low-risk scenarios. This review considers the assessment and management of acute medical emergencies in patients with PH, encompassing both pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH), acknowledging these comprise the more severe groups of PH...
December 2023: Seminars in Respiratory and Critical Care Medicine
Tanveer Mir, Obeid Shafi, Sudarshan Balla, Muhammad Bilal Munir, Waqas T Qurehi, Nikolaos Kakouros, Zeenat Bhat, Parvaiz Koul, Tanveer Rab
OBJECTIVE: Outcomes of cardiac arrest among patients who had cardiopulmonary resuscitation (CPR) in intensive care units (ICU) has limited data on the national level basis in the United States. We aimed to study the outcomes of ICU CPRs. METHODS: Data from the national readmissions database (NRD) sample that constitutes 49.1% of the stratified sample of all hospitals in the United States were analyzed for ICU-related hospitalizations for the years 2016 to 2019. ICU CPR was defined by procedure codes...
February 2024: Journal of Intensive Care Medicine
Hailey Hobbs, Scott Millington, Katie Wiskar
Traditional point-of-care ultrasound (POCUS) training highlights discrete techniques, single-organ assessment, and focused protocols. More recent developments argue for a whole-body approach, where the experienced clinician-ultrasonographer crafts a personalized POCUS protocol depending on specific clinical circumstances. This article describes this problem-based approach, focusing on common acute care scenarios while highlighting practical considerations and performance characteristics.
March 2024: Journal of Intensive Care Medicine
Chris F Duncan, Emma Bowcock, Faraz Pathan, Sam R Orde
Mitral regurgitation (MR) is common in the critically unwell and encompasses a heterogenous group of conditions with diverging therapeutic strategies. MR may present acutely with haemodynamic instability or more insidiously with failure to wean from mechanical ventilation. Critical illness is associated with marked physiological stress and haemodynamic changes that dynamically influence the severity and implication of MR. The expanding role of critical care echocardiography uniquely positions the intensivist to apply advanced bedside valvular assessment to recognise haemodynanically significant MR, manipulate and optimise cardiopulmonary physiology and identify patients requiring urgent cardiology and surgical referral...
August 2, 2023: Annals of Intensive Care
Charlotte J Van Edom, Guido Tavazzi, Christophe Vandenbriele
PURPOSE OF REVIEW: Cardiogenic shock (CS) remains a very challenging condition with high mortality, despite the advances in therapeutic options. Haematological complications, including coagulopathy and haemolysis, frequently arise in these critically ill patients in CS, especially if they need percutaneous mechanical circulatory support (pMCS), and impair the outcome. This stresses the urgent need for further advancement of this field. RECENT FINDINGS: Here, we discuss the different haematological challenges during CS and additional pMCS...
August 1, 2023: Current Opinion in Critical Care
Jacob C Jentzer, Peter A Noseworthy, Anthony H Kashou, Adam M May, Jonathan Chrispin, Rajesh Kabra, Kelly Arps, Vanessa Blumer, James E Tisdale, Michael A Solomon
Electrical storm (ES) reflects life-threatening cardiac electrical instability with 3 or more ventricular arrhythmia episodes within 24 hours. Identification of underlying arrhythmogenic cardiac substrate and reversible triggers is essential, as is interrogation and programming of an implantable cardioverter-defibrillator, if present. Medical management includes antiarrhythmic drugs, beta-adrenergic blockade, sedation, and hemodynamic support. The initial intensity of these interventions should be matched to the severity of ES using a stepped-care algorithm involving escalating treatments for higher-risk presentations or recurrent ventricular arrhythmias...
June 6, 2023: Journal of the American College of Cardiology
Rebecca T Hahn
New England Journal of Medicine, Volume 388, Issue 20, Page 1876-1891, May 2023.
May 18, 2023: New England Journal of Medicine
Ioannis Gallos, Adam Devall, James Martin, Lee Middleton, Leanne Beeson, Hadiza Galadanci, Fadhlun Alwy Al-Beity, Zahida Qureshi, G Justus Hofmeyr, Neil Moran, Sue Fawcus, Lumaan Sheikh, George Gwako, Alfred Osoti, Ashraf Aswat, Kristie-Marie Mammoliti, Kulandaipalayam N Sindhu, Marcelina Podesek, Isobelle Horne, Rebecca Timms, Idnan Yunas, Jenipher Okore, Mandisa Singata-Madliki, Edna Arends, Aminu A Wakili, Ard Mwampashi, Sidrah Nausheen, Shah Muhammad, Pallavi Latthe, Cherrie Evans, Shahinoor Akter, Gillian Forbes, David Lissauer, Shireen Meher, Andrew Weeks, Andrew Shennan, Anne Ammerdorffer, Eleanor Williams, Tracy Roberts, Mariana Widmer, Olufemi T Oladapo, Fabiana Lorencatto, Meghan A Bohren, Suellen Miller, Fernando Althabe, Metin Gülmezoglu, Jeffrey M Smith, Karla Hemming, Arri Coomarasamy
BACKGROUND: Delays in the detection or treatment of postpartum hemorrhage can result in complications or death. A blood-collection drape can help provide objective, accurate, and early diagnosis of postpartum hemorrhage, and delayed or inconsistent use of effective interventions may be able to be addressed by a treatment bundle. METHODS: We conducted an international, cluster-randomized trial to assess a multicomponent clinical intervention for postpartum hemorrhage in patients having vaginal delivery...
July 6, 2023: New England Journal of Medicine
Abby Tarpey, Shraddha Narechania, Mark Malesker
No abstract text is available yet for this article.
May 1, 2023: Cleveland Clinic Journal of Medicine
Sudarshan Rajagopal, Kurt Ruetzler, Kamrouz Ghadimi, Evelyn M Horn, Marta Kelava, Kristina T Kudelko, Ingrid Moreno-Duarte, Ioana Preston, Leonie L Rose Bovino, Nathaniel R Smilowitz, Anjali Vaidya
Pulmonary hypertension, defined as an elevation in blood pressure in the pulmonary arteries, is associated with an increased risk of death. The prevalence of pulmonary hypertension is increasing, with an aging population, a rising prevalence of heart and lung disease, and improved pulmonary hypertension survival with targeted therapies. Patients with pulmonary hypertension frequently require noncardiac surgery, although pulmonary hypertension is associated with excess perioperative morbidity and death. This scientific statement provides guidance on the evaluation and management of pulmonary hypertension in patients undergoing noncardiac surgery...
April 25, 2023: Circulation
Warren B Gefter, Benjamin A Post, Hiroto Hatabu
Chest radiography (CXR) continues to be the most frequently performed imaging examination worldwide, yet it remains prone to frequent errors in interpretation. These pose potential adverse consequences to patients and are a leading motivation for medical malpractice lawsuits. Commonly missed CXR findings and the principal causes of these errors are reviewed and illustrated. Perceptual errors are the predominant source of these missed findings. The medicolegal implications of such errors are explained. Awareness of commonly missed CXR findings, their causes, and their consequences are important in developing approaches to reduce and mitigate these errors...
March 2023: Chest
Pasquale Paolisso, Alberto Foà, Luca Bergamaschi, Maddalena Graziosi, Andrea Rinaldi, Ilenia Magnani, Francesco Angeli, Andrea Stefanizzi, Matteo Armillotta, Angelo Sansonetti, Michele Fabrizio, Sara Amicone, Andrea Impellizzeri, Francesco Pio Tattilo, Nicole Suma, Francesca Bodega, Lisa Canton, Elisa Gherbesi, Domenico Tuttolomondo, Ilaria Caldarera, Elisa Maietti, Stefano Carugo, Nicola Gaibazzi, Paola Rucci, Elena Biagini, Nazzareno Galiè, Carmine Pizzi
BACKGROUND: The echocardiographic parameters required for a comprehensive assessment of cardiac masses (CMs) are still largely unknown. The aim of this study was to identify and integrate the echocardiographic features of CMs that can accurately predict malignancy. METHODS: An observational cohort study was conducted among 286 consecutive patients who underwent standard echocardiographic assessment for suspected CM at Bologna University Hospital between 2004 and 2022...
May 2023: Journal of the American Society of Echocardiography
Michael Joannidis, Christian J Wiedermann, Marlies Ostermann
No abstract text is available yet for this article.
March 5, 2022: Intensive Care Medicine
Samuel Heuts, Simon Schalla, Mitch J F G Ramaekers, Elham Bidar, Casper Mihl, Joachim E Wildberger, Bouke P Adriaans
Acute type A aortic dissection (ATAAD) is a life-threatening condition that requires emergency surgery to avert fatal outcome. Conventional surgical procedures comprise excision of the entry tear and replacement of the proximal aorta with a synthetic vascular graft. In patients with DeBakey type I dissection, this approach leaves a chronically dissected distal aorta, putting them at risk for progressive dilatation, dissection propagation and aortic rupture. Therefore, ATAAD survivors should undergo serial imaging for evaluation of the aortic valve, proximal and distal anastomoses, and the aortic segments beyond the distal anastomosis...
December 22, 2022: Heart
Ali B V McMichael, Lindsay M Ryerson, Damian Ratano, Eddy Fan, David Faraoni, Gail M Annich
These guidelines for adult and pediatric anticoagulation for extracorporeal membrane oxygenation are intended for educational use to build the knowledge of physicians and other health professionals in assessing the conditions and managing the treatment of patients undergoing ECLS / ECMO and describe what are believed to be useful and safe practice for extracorporeal life support (ECLS, ECMO) but these are not necessarily consensus recommendations. The aim of clinical guidelines are to help clinicians to make informed decisions about their patients...
March 1, 2022: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
Evan F Gajkowski, Guillermo Herrera, Laura Hatton, Marta Velia Antonini, Leen Vercaemst, Elaine Cooley
This guideline describes the ECMO circuit for all patient populations. These guidelines describe safe practice based on extensive experience and are considered consensus guidelines. These guidelines are not intended to define standard of care and are revised at regular intervals as new information, devices, medications, and techniques become available.
February 1, 2022: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
Auriane Bidaut, Erwan Flécher, Nicolas Nesseler, Karl Bounader, André Vincentelli, Mouhammed Moussa, Clément Delmas, Jean Porterie, Karine Nubret, Mathieu Pernot, Michel Kindo, Clément Schneider, Philippe Gaudard, Philippe Rouvière, Magali Michel, Thomas Sénage, Aude Boignard, Olivier Chavanon, Constance Verdonk, Marylou Para, Baptiste Maille, Vlad Gariboldi, Matteo Pozzi, Elisabeth Hugon-Vallet, Pierre-Yves Litzler, Frédéric Anselme, Katrien Blanchart, Gerard Babatasi, Marie Bielefeld, Sandrine Grosjean, Costin Radu, David Hamon, Thierry Bourguignon, Thibaud Genet, Romain Eschalier, Nicolas D'Ostrevy, Hélène Nougue, Anne Cécile Martin, Fabrice Vanhuyse, Hugues Blangy, Christophe Leclercq, Raphael P Martins, Vincent Galand
OBJECTIVES: Temporary circulatory support (TCS) as a bridge-to-left ventricular assist device (BTL) in cardiogenic shock patients has been increasing, but limited data exists on this BTL strategy. We aimed at analyzing the outcome of BTL patients in a population of cardiogenic shock patients compared with those without TCS at the time of the left ventricular assist device (LVAD) surgery and identify predictors of postoperative mortality in this specific population. DESIGN: A multicenter retrospective observational study conducted in 19 centers from 2006 to 2016...
May 1, 2022: Critical Care Medicine
Catia Cillóniz, Antoni Torres, Michael S Niederman
Severe pneumonia is associated with high mortality (short and long term), as well as pulmonary and extrapulmonary complications. Appropriate diagnosis and early initiation of adequate antimicrobial treatment for severe pneumonia are crucial in improving survival among critically ill patients. Identifying the underlying causative pathogen is also critical for antimicrobial stewardship. However, establishing an etiological diagnosis is challenging in most patients, especially in those with chronic underlying disease; those who received previous antibiotic treatment; and those treated with mechanical ventilation...
December 6, 2021: BMJ: British Medical Journal
Jane G Boggs
PURPOSE OF THIS REVIEW: This review presents current therapy for seizures in the intensive care unit. The reader is provided with recent evidence regarding the use of EEG in determining treatment for acute seizures. Proposed treatment approaches for seizures and status epilepticus are provided. Controversies and complexity of selecting treatments are discussed. RECENT FINDINGS: Critical Care EEG Monitoring Research Consortium analyzed the association of periodic and rhythmic electroencephalographic patterns with seizures and found that lateralized and generalized periodic discharges and lateralized rhythmic delta were associated with increased seizure risk...
2021: Current Treatment Options in Neurology
2021-11-16 00:22:10
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