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...
June 24, 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...
June 10, 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...
May 26, 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...
May 14, 2021: 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...
May 21, 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...
April 26, 2021: 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...
April 15, 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
Senta Jorinde Raasveld, Thijs S R Delnoij, Lars M Broman, Annemieke Oude Lansink-Hartgring, Greet Hermans, Erwin De Troy, Fabio S Taccone, Manuel Quintana Diaz, Franciska van der Velde, Dinis Dos Reis Miranda, Erik Scholten, Alexander P J Vlaar
BACKGROUND: To report and compare the characteristics and outcomes of COVID-19 patients on extracorporeal membrane oxygenation (ECMO) to non-COVID-19 acute respiratory distress syndrome (ARDS) patients on ECMO. METHODS: We performed an international retrospective study of COVID-19 patients on ECMO from 13 intensive care units from March 1 to April 30, 2020. Demographic data, ECMO characteristics and clinical outcomes were collected. The primary outcome was to assess the complication rate and 28-day mortality; the secondary outcome was to compare patient and ECMO characteristics between COVID-19 patients on ECMO and non-COVID-19 related ARDS patients on ECMO (non-COVID-19; January 1, 2018 until July 31, 2019)...
April 7, 2021: Journal of Intensive Care Medicine
Saro Khemichian, Claire Francoz, Francois Durand, Constantine J Karvellas, Mitra K Nadim
Development of acute kidney injury in patients with chronic liver disease is common and portends a poor prognosis. Diagnosis remains challenging, as traditional markers, such as serum creatinine, are not reliable. Recent development of novel biomarkers may assist with this. Pathophysiology of this condition is multifactorial, relating to physiologic changes associated with portal hypertension, kidney factors, and systemic inflammatory response. Mainstay of treatment remains use of vasoconstrictors along with albumin...
April 2021: Critical Care Clinics
Zaccaria Ricci, Stefano Romagnoli, Claudio Ronco
Cardiorenal syndrome (CRS) describes a specific acute and chronic clinical picture in which the heart or the kidney are primarily dysfunctioning and secondarily affect each other. CRS is divided into five classes: acute and chronic CRS, acute and chronic renocardiac syndromes, and secondary dysfunction of heart and kidneys. This article specifically details the classification and the epidemiology, some risk factors, and the pathophysiology of CRS. Some emerging aspects of CRS are also discussed, such as CRS in patients with end-stage heart failure, with mechanical ventricular assistance, and after heart transplantation...
April 2021: Critical Care Clinics
Sean M Bagshaw, Ron Wald
Kidney replacement therapy (KRT) is a core organ support in critical care settings. In patients suitable for escalation in support, who develop acute kidney injury (AKI) complications and urgent indications, there is consensus that KRT should be promptly initiated. In the absence of such urgent indications, the optimal timing has been less certain. Current clinical practice guidelines do not present strong recommendations for when to start KRT for patients with AKI in the absence of life-threatening and urgent indications...
April 2021: Critical Care Clinics
Tim Balthazar, Christophe Vandenbriele, Frederik H Verbrugge, Corstiaan Den Uil, Annemarie Engström, Stefan Janssens, Steffen Rex, Bart Meyns, Nicolas Van Mieghem, Susanna Price, Tom Adriaenssens
The use of mechanical circulatory support for patients presenting with cardiogenic shock is rapidly increasing. Currently, there is only limited and conflicting evidence available regarding the role of the Impella (a microaxial, continuous-flow, short-term, left or right ventricular assist device) in cardiogenic shock; further randomized trials are needed. Patient selection, timing of implantation, and post-implantation management in the cardiac intensive care unit are crucial elements for success. Particular challenges at the bedside include the practical management of anticoagulation, evaluation of correct device position, and the approach to use in a patient with signs of insufficient hemodynamic support...
March 9, 2021: Journal of the American College of Cardiology
James F Crismale, Tsipora Huisman, Richa Deshpande, Cindy Law, Gene Y Im, David Bronster, Samuel DeMaria, Sander Florman, Thomas D Schiano
Rapid changes in serum sodium (ΔSNa) peri-liver transplant (LT) predispose to post-LT neurological complications (NC). We aimed to assess whether implementation of a protocol directed at limiting peri-LT ΔSNa reduced post-LT NC. A retrospective single-center review of adult LT recipients from 1/2016 to 10/2017 was performed. Patients with hyponatremia (SNa < 135 mEq/L) within 7 days of LT were analyzed in two eras: pre-protocol (1/2016-9/2016) and post-protocol (10/2016-10/2017). The primary outcome was the development of NC within 1 month of LT...
May 2021: Clinical Transplantation
Marcus Robertson, William Chung, Dorothy Liu, Rosemary Seagar, Tess O'Halloran, Anoop N Koshy, Mark Horrigan, Omar Farouque, Paul Gow, Peter Angus
BACKGROUND AND AIMS: Coronary artery disease (CAD) confers increased peri-operative risk in patients undergoing liver transplantation (LT). Although routine screening for CAD is recommended, there is limited data on the effectiveness of screening strategies. We evaluated the safety and efficacy of a 3-tiered cardiac risk-assessment protocol that stratifies patients based on age and traditional cardiac risk factors. METHODS: A single-centre, prospective, observational study of consecutive adult patients undergoing LT assessment (2010 - 2017)...
February 19, 2021: Liver Transplantation
Laura C Price, Guillermo Martinez, Aimee Brame, Thomas Pickworth, Chinthaka Samaranayake, David Alexander, Benjamin Garfield, Tuan-Chen Aw, Colm McCabe, Bhashkar Mukherjee, Carl Harries, Aleksander Kempny, Michael Gatzoulis, Philip Marino, David G Kiely, Robin Condliffe, Luke Howard, Rachel Davies, Gerry Coghlan, Benjamin E Schreiber, James Lordan, Dolores Taboada, Sean Gaine, Martin Johnson, Colin Church, Samuel V Kemp, Davina Wong, Andrew Curry, Denny Levett, Susanna Price, Stephane Ledot, Anna Reed, Konstantinos Dimopoulos, Stephen John Wort
BACKGROUND: The risk of complications, including death, is substantially increased in patients with pulmonary hypertension (PH) undergoing anaesthesia for surgical procedures, especially in those with pulmonary arterial hypertension (PAH) and chronic thromboembolic PH (CTEPH). Sedation also poses a risk to patients with PH. Physiological changes including tachycardia, hypotension, fluid shifts, and an increase in pulmonary vascular resistance (PH crisis) can precipitate acute right ventricular decompensation and death...
April 2021: British Journal of Anaesthesia
William L Gross, Raphael H Sacho
Anesthesia for intracranial vascular procedures is complex because it requires a balance of several competing interests and potentially can result in significant morbidity and mortality. Frequently, periods of ischemia, where perfusion must be maintained, are combined with situations that are high risk for hemorrhage. This review discusses the basic surgical approach to several common pathologies (intracranial aneurysms, arteriovenous malformations, and moyamoya disease) along with the goals for anesthetic management and specific high-yield recommendations...
March 2021: Anesthesiology Clinics
Kate Petty, Brian P Lemkuil, Brian Gierl
Anesthesiologists provide care to acute and subacute ischemic stroke (IS) patients and stroke survivors in interventional radiology, intensive care, and operating rooms. These encounters will become more frequent following studies that have extended the treatment window from last known well time for fibrinolytic and endovascular thrombectomy (EVT). The number of stroke centers certified to quickly and effectively initiate treatment of IS patients and the number of patients connected to them by telehealth continue to grow...
March 2021: Anesthesiology Clinics
2021-02-12 10:46:54
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