2013 Dec - Weaning of extracorporeal membrane oxygenation using continuous hemodynamic transesophageal echocardiography

Cavarocchi NC, Pitcher HT, Yang Q, Karbowski P, Miessau J, Hastings HM, Hirose H.; J Thorac Cardiovasc Surg. 2013 Dec;146(6):1474-9.

BACKGROUND: Venoarterial extracorporeal membrane oxygenation (VA ECMO) has been used for profound cardiogenic shock to bridge to decision, ventricular assist device(s) (VADs), or transplant. To assess ventricular function and volume status along with hemodynamics during ECMO weaning, we developed a standardized weaning protocol, guided by a miniaturized transesophageal echocardiography probe designed for continuous hemodynamic monitoring (hemodynamic transesophageal echocardiography [hTEE]). We reviewed our experience with this weaning protocol with hTEE guidance to assess if we could predict patient outcomes.

Read more ...

2013 Oct - Outcomes among patients discharged from busy intensive care units

Wagner J, Gabler NB, Ratcliffe SJ, Brown SE, Strom BL, Halpern SD.; Ann Intern Med. 2013 Oct 1;159(7):447-55.

BACKGROUND: Strains on the capacities of intensive care units (ICUs) may influence the quality of ICU-to-floor transitions.

OBJECTIVE: To determine how 3 metrics of ICU capacity strain (ICU census, new admissions, and average acuity) measured on days of patient discharges influence ICU length of stay (LOS) and post-ICU discharge outcomes.

Read more ...

2013 Nov - Intra-abdominal Hypertension in Medical Critically Ill Patients. A narrative review

Ortiz-Diaz E, Lan CK.; Shock. 2013 Nov 25. [Epub ahead of print]

Intra-abdominal Hypertension/ Abdominal Compartment Syndrome (IAH/ACS) is a well-recognized entity among surgical sub-specialties. Nevertheless, it has been proven to be present in the medical critically ill population...

Read more ...

2013 Nov - Cytokines and signaling molecules predict clinical outcomes in sepsis

Fjell CD, Thair S, Hsu JL, Walley KR, Russell JA, Boyd J.; PLoS One. 2013 Nov 14;8(11):e79207.

INTRODUCTION: Inflammatory response during sepsis is incompletely understood due to small sample sizes and variable timing of measurements following the onset of symptoms. The vasopressin in septic shock trial (VASST) compared the addition of vasopressin to norepinephrine alone in patients with septic shock. During this study plasma was collected and 39 cytokines measured in a 363 patients at both baseline (before treatment) and 24 hours. Clinical features relating to both underlying health and the acute organ dysfunction induced by the severe infection were collected during the first 28 days of admission.

Read more ...

2013 Sep - Mechanical circulatory support in cardiogenic shock

Werdan K, Gielen S, Ebelt H, Hochman JS.; Eur Heart J. 2013 Sep 7. [Epub ahead of print]

Despite advances in coronary revascularization and widespread use of primary percutaneous interventions, cardiogenic shock complicating an acute ST-elevation myocardial infarction (CSMI) remains a clinical challenge with high mortality rates. Conservative management with catecholamines is associated with serious limitations, including arrhythmias, increased myocardial oxygen consumption, and inadequate circulatory support. Clinicians have therefore turned to mechanical means of circulatory support...

Read more ...

2013 Aug - Do either early warning systems or emergency response teams improve hospital patient survival? A systematic review

McNeill G, Bryden D.; Resuscitation. 2013 Aug 17.[Epub ahead of print]

BACKGROUND:For critical care to be effective it must have a system in place to achieve optimal care for the deteriorating ward patient.

Read more ...

2013 Sep - Incidence of postoperative death and acute kidney injury associated with i.v. 6% hydroxyethyl starch use: systematic review and meta-analysis

Gillies MA, Habicher M, Jhanji S, Sander M, Mythen M, Hamilton M, Pearse RM.; Br J Anaesth. 2013 Sep 17. [Epub ahead of print]

BACKGROUND: Trials suggest that the use of i.v. hydroxyethyl starch (HES) solutions is associ-ated with increased risk of death and acute kidney injury (AKI) in critically ill patients. It is uncertain whether similar adverse effects occur in surgical patients.

Read more ...

2013 Aug - Use of myoglobin as a marker and predictor in myoglobinuric acute kidney injury

Premru V, Kova─Ź J, Ponikvar R.; Ther Apher Dial. 2013 Aug;17(4):391-5.

Serum creatine kinase (CK) is routinely used as a marker in the assessment of rhabdomyolysis and acute myoglobinuric kidney injury (Mb-AKI), while the use of myoglobin is much less explored in this respect. We retrospectively analyzed the incidence of Mb-AKI (creatinine [Cr] > 200 μmol/L) and the need for hemodialysis (HD) in 484 patients (70.5% males) with suspected rhabdomyolysis, grouped according to peak serum myoglobin (A: 1-5 mg/L, B: 5-15 mg/L, C: >15 mg/L)...

Read more ...

2013 Jul - Outcomes of urgent warfarin reversal with frozen plasma versus prothrombin complex concentrate in the emergency department

Hickey M, Gatien M, Taljaard M, Aujnarain A, Giulivi A, Perry JJ.; Circulation. 2013 Jul 23;128(4):360-4.

BACKROUND: Physicians reverse patients' warfarin anticoagulation with frozen plasma or prothrombin complex concentrate. Our objective was to determine adverse event frequency after urgent reversal with frozen plasma versus the prothrombin complex concentrate Octaplex.

Read more ...

2013 Sep - Nursing challenges with a severely injured patient in critical care

Crossan L, Cole E.; Nurs Crit Care. 2013 Sep;18(5):236-44.

BACKGROUND: Patients with severe, multiple, traumatic injuries are challenging to manage in critical care. Early identification of injuries and optimal resuscitation is essential for favourable outcomes. Trauma-related haemorrhage can lead to the lethal triad of hypothermia, coagulopathy and acidosis. Many trauma patients require urgent haemorrhage control and structural fixation through operative intervention. However, metabolic derangement and cardiovascular instability may delay surgery, resulting in an ongoing cycle of deterioration. Damage control surgery (DCS) may be used as a temporizing measure until the patient is stabilized in critical care. The aim of this case study is to discuss the complex issues faced in the critical care management of a severely injured patient.

Read more ...

2013 Aug - Intracranial pressure monitoring in severe head injury: compliance with Brain Trauma Foundation guidelines and effect on outcomes: a prospective study

Talving P, Karamanos E, Teixeira PG, Skiada D, Lam L, Belzberg H, Inaba K, Demetriades D.; J Neurosurg. 2013 Aug 23. [Epub ahead of print]

Object The Brain Trauma Foundation (BTF) has established guidelines for intracranial pressure (ICP) monitoring in severe traumatic brain injury (TBI). This study assessed compliance with these guidelines and the effect on outcomes.

Read more ...

2013 Aug - Novel modes of mechanical ventilation

Al-Hegelan M, Macintyre NR.; Semin Respir Crit Care Med. 2013 Aug;34(4):499-507.

The overarching goal of positive pressure mechanical ventilation is to provide adequate gas exchange support while not causing harm. Indeed, positive pressure mechanical ventilators are only support technologies, not therapeutic technologies. As such they cannot be expected to "cure" disease; they can only "buy time" for other therapies (including the patient's own defenses) to work...

Read more ...

2013 Aug - Prehospital therapeutic hypothermia after cardiac arrest: A systematic review and meta-analysis of randomized controlled trials

Diao M, Huang F, Guan J, Zhang Z, Xiao Y, Shan Y, Lin Z, Ding L.; Resuscitation. 1021-1028, Aug 2013

BACKGROUND: Therapeutic hypothermia has been recommended for the treatment of cardiac arrest patients who remain comatose after the return of spontaneous circulation. However, the optimal time to initiate therapeutic hypothermia remains unclear. The objective of the present study is to assess the effectiveness and safety of prehospital therapeutic hypothermia after cardiac arrest.

Read more ...

2013 Jun - "Less Is More" in Critically Ill Patients: Not Too Intensive

Kox M, Pickkers P.; JAMA Intern Med. 2013 Jun 10:1-4. [Epub ahead of print]

The current view in intensive care medicine is that very sick patients need very intensive treatment. However, in this group of highly vulnerable patients, more intensive treatment may promote the chances of unwanted adverse effects and hence, iatrogenic damage. Therefore, we state that critically ill patients probably benefit from a more cautious approach..

Read more ...

2013 May - New Oral Anticoagulants Increase Risk for Gastrointestinal Bleeding: A Systematic Review and Meta-analysis

Holster IL, Valkhoff VE, Kuipers EJ, Tjwa ET.; Gastroenterology. 2013 Mar 5. [Epub ahead of print]

BACKGROUND & AIMS: A new generation of oral anticoagulants (nOAC), which includes thrombin and factor Xa inhibitors, has been shown to be effective, but little is known about whether these drugs increase patients' risk for gastrointestinal bleeding (GIB). Patients who require OAC therapy frequently have significant comorbidities and may also take aspirin and/or thienopyridines. We performed a systematic review and meta-analysis of the risk of GIB and clinically relevant bleeding in patients taking nOAC.

Read more ...

2013 Jul - Using extracorporeal membrane oxygenation to rescue acute myocardial infarction with cardiopulmonary collapse: The impact of early coronary revascularization

Wu MY, Tseng YH, Chang YS, Tsai FC, Lin PJ.; Resuscitation. 2013 Jul;84(7):940-5.

OBJECTIVES: To investigate the therapeutic impact of combining extracorporeal membrane oxygenation (ECMO) and early coronary revascularization on acute myocardial infarction (AMI)-induced cardiopulmonary collapse.

Read more ...

2013 Jul - Neurological prognostication after cardiac arrest-Recommendations from the Swedish Resuscitation Council

Cronberg T, Brizzi M, Liedholm LJ, Rosén I, Rubertsson S, Rylander C, Friberg H.; Resuscitation. 2013 Jul;84(7):867-72.

Cardiopulmonary resuscitation is started in 5000 victims of out-of-hospital cardiac arrest in Sweden each year and the survival rate is approximately 10%. The subsequent development of a global ischaemic brain injury is the major determinant of the neurological prognosis for those patients who reach the hospital alive. Induced hypothermia is a recommended treatment after cardiac arrest and has been implemented in most Swedish hospitals...

Read more ...

2013 Jun - Development of a simple algorithm to guide the effective management of traumatic cardiac arrest

Lockey DJ, Lyon RM, Davies GE.; Resuscitation. 2013 Jun;84(6):738-42.

BACKGROUND: Major trauma is the leading worldwide cause of death in young adults. The mortality from traumatic cardiac arrest remains high but survival with good neurological outcome from cardiopulmonary arrest following major trauma has been regularly reported. Rapid, effective intervention is required to address potential reversible causes of traumatic cardiac arrest if the victim is to survive. Current ILCOR guidelines do not contain a standard algorithm for management of traumatic cardiac arrest. We present a simple algorithm to manage the major trauma patient in actual or imminent cardiac arrest.

Read more ...

2013 May - Treatment of non-traumatic out-of-hospital cardiac arrest with active compression decompression cardiopulmonary resuscitation plus an impedance threshold device

Frascone RJ, Wayne MA, Swor RA, Mahoney BD, Domeier RM, Olinger ML, Tupper DE, Setum CM, Burkhart N, Klann L, Salzman JG, Wewerka SS, Yannopoulos D, Lurie KG, O'Neil BJ, Holcomb RG, Aufderheide TP.; Resuscitation. 2013 May 10. [Epub ahead of print]

BACKGROUND: A recent out-of-hospital cardiac arrest (OHCA) clinical trial showed improved survival to hospital discharge (HD) with favorable neurologic function for patients with cardiac arrest of cardiac origin treated with active compression decompression cardiopulmonary resuscitation (CPR) plus an impedance threshold device (ACD+ICD) versus standard (S) CPR. The current analysis examined whether treatment with ACD+ITD is more effective than standard (S-CPR) for all cardiac arrests of non-traumatic origin, regardless of the etiology.

Read more ...

2013 May - Invasive versus non-invasive cooling after in- and out-of-hospital cardiac arrest: a randomized trial

Pittl U, Schratter A, Desch S, Diosteanu R, Lehmann D, Demmin K, Hörig J, Schuler G, Klemm T, Mende M, Thiele H.; Clin Res Cardiol. 2013 May 5. [Epub ahead of print]

INTRODUCTION: Mild induced hypothermia (MIH) is indicated for comatose survivors of sudden cardiac arrest (SCA) to improve clinical outcome. In this study, we compared the efficacy of two different cooling devices for temperature management in SCA survivors.

Read more ...