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...
March 16, 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...
January 5, 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
Elizabeth B Malinzak
Because of enhanced life expectancy due to medical and surgical therapeutic advances, it is estimated that there are more adults than children living with Down syndrome (DS), or trisomy 21, in the United States. Therefore, DS can no longer be considered a syndrome limited to the pediatric population. These patients are presenting for surgery and anesthesia in adult care settings, where anesthesiologists will encounter these patients more frequently. As these patients age, their commonly associated co-morbidities not only progress, but they also develop other cardiac, respiratory, gastrointestinal, and neurologic conditions...
October 2021: Canadian Journal of Anaesthesia
Kamel S Kamel, Mitchell L Halperin
We discuss the use of urine electrolytes and urine osmolality in the clinical diagnosis of patients with fluid, electrolytes, and acid-base disorders, emphasizing their physiological basis, their utility, and the caveats and limitations in their use. While our focus is on information obtained from measurements in the urine, clinical diagnosis in these patients must integrate information obtained from the history, the physical examination, and other laboratory data.
May 2021: KI Reports
Itay Ayalon, Lauren Bodilly, Jennifer Kaplan
In the last few decades, obesity became one of the world's greatest health challenges reaching a size of global epidemic in virtually all socioeconomic statuses and all age groups. Obesity is a risk factor for many health problems and as its prevalence gradually increases is becoming a significant economic and health burden. In this manuscript we describe how normal respiratory and cardiovascular physiology is altered by obesity. We review past and current literature to describe how obesity affects outcomes of patients facing critical illnesses and discuss some controversies related to this topic...
November 1, 2021: Shock
Julian Naranjo, Erica R Portner, James W Jakub, Andrea L Cheville, Gregory A Nuttall
BACKGROUND: There is a continued perception that intravenous line (IV) placement is contraindicated in the arm ipsilateral to prior breast cancer surgery to avoid breast cancer-related lymphedema (BCRL). The aim of this retrospective study was to determine the risk for development of BCRL in ipsilateral arm IV placement compared to contralateral arm IV placement to prior breast cancer surgery. METHODS: We performed a retrospective review, via our Integrated Clinical Systems and Epic Electronic Heath Record of IV placement for anesthesia and surgery in patients with a prior history of breast cancer surgery with or without axillary lymph node dissection...
September 1, 2021: Anesthesia and Analgesia
Laurens P Bosman, Anneline S J M Te Riele
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is an inherited cardiomyopathy characterised by fibrofatty replacement of predominantly the right ventricle and high risk of ventricular arrhythmias and sudden cardiac death (SCD). Early diagnosis and accurate risk assessment are challenging yet essential for SCD prevention. This manuscript summarises the current state of the art on ARVC diagnosis and risk stratification. Improving the 2010 diagnostic criteria is an ongoing discussion. Several studies suggest that early diagnosis may be facilitated by including deformation imaging ('strain') for objective assessment of wall motion abnormalities, which was shown to have high sensitivity for preclinical disease...
January 2022: Heart
Mark A Warner, Karen L Meyerhoff, Mary E Warner, Karen L Posner, Linda Stephens, Karen B Domino
BACKGROUND: Perioperative pulmonary aspiration of gastric contents has been associated with severe morbidity and death. The primary aim of this study was to identify outcomes and patient and process of care risk factors associated with gastric aspiration claims in the Anesthesia Closed Claims Project. The secondary aim was to assess these claims for appropriateness of care. The hypothesis was that these data could suggest opportunities to reduce either the risk or severity of perioperative pulmonary aspiration...
August 1, 2021: Anesthesiology
Ernest E Moore, Hunter B Moore, Lucy Z Kornblith, Matthew D Neal, Maureane Hoffman, Nicola J Mutch, Herbert Schöchl, Beverley J Hunt, Angela Sauaia
Uncontrolled haemorrhage is a major preventable cause of death in patients with traumatic injury. Trauma-induced coagulopathy (TIC) describes abnormal coagulation processes that are attributable to trauma. In the early hours of TIC development, hypocoagulability is typically present, resulting in bleeding, whereas later TIC is characterized by a hypercoagulable state associated with venous thromboembolism and multiple organ failure. Several pathophysiological mechanisms underlie TIC; tissue injury and shock synergistically provoke endothelial, immune system, platelet and clotting activation, which are accentuated by the 'lethal triad' (coagulopathy, hypothermia and acidosis)...
April 29, 2021: Nature Reviews. Disease Primers
Alexandru Ogica, Christoph Burdelski, Holger Rohde, Stefan Kluge, Geraldine de Heer
BACKGROUND: Necrotizing soft tissue infections (NSTIs) are typically characterized by extensive soft tissue destruction with systemic signs of toxicity, ranging from sepsis to septic shock. Our aim was to analyze the clinical characteristics, microbiological results, laboratory data, therapies, and outcome of patients with NSTIs admitted to an intensive care unit (ICU). METHODS: A monocentric observational study of patients admitted to the ICU of a university hospital between January 2009 and December 2017...
March 2022: Journal of Intensive Care Medicine
Maxwell A Hockstein, Korbin Haycock, Matthew Wiepking, Skyler Lentz, Siddharth Dugar, Matthew Siuba
BACKGROUND: The impact of critical illness on the right ventricle (RV) can be profound and RV dysfunction is associated with mortality. Intensivists are becoming more facile with bedside echocardiography, however, pedagogy has largely focused on left ventricular function. Here we review measurements of right heart function by way of echocardiographic modalities and list clinical scenarios where the RV dysfunction is a salient feature. MAIN: RV dysfunction is heterogeneously defined across many domains and its diagnosis is not always clinically apparent...
September 2021: Journal of Intensive Care Medicine
Brian L Erstad, Jeffrey F Barletta
Medications used for supportive care or prophylaxis constitute a significant portion of drug utilization in the intensive care unit. Evidence-based guidelines are available for many aspects of supportive care but drug doses listed are typically for patients with normal body habitus and not morbid obesity. Failure to account for the pharmacokinetic changes that occur with obesity can lead to an incorrect dose and treatment failure or toxicity. This paper is intended to help clinicians design initial dosing regimens in critically ill obese patients for medications commonly used for hemodynamic support or prophylaxis...
February 23, 2021: Critical Care: the Official Journal of the Critical Care Forum
2021-04-16 17:11:48
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