2016 Apr - Active surveillance of carbapenem-resistant Enterobacteriaceae in intensive care units: Is it cost-effective in a nonendemic region?

Ho KW, Ng WT, Ip M, You JH.; Am J Infect Control. 2016 Apr 1;44(4):394-9.

OBJECTIVE: Carbapenem-resistant Enterobacteriaceae (CRE) cause significant morbidity and mortality in intensive care unit (ICU) settings. We examined potential cost-effectiveness of active CRE surveillance at ICUs in a nonendemic region from the perspective of a Hong Kong health care provider.

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2016 Apr - Plasma neutrophil gelatinase-associated lipocalin as an early predicting biomarker of acute kidney injury and clinical outcomes after recovery of spontaneous circulation in out-of-hospital cardiac arrest patients

Park SO, Ahn JY, Lee YH, Kim YJ, Min YH, Ahn HC, Sohn YD, Park SM, Oh YT, Shin DH.; Resuscitation. 2016 Apr;101:84-90.

AIMS: To determine whether the level of plasma neutrophil gelatinase-associated lipocalin (NGAL) can predict acute kidney injury (AKI) and clinical outcomes after recovery of spontaneous circulation (ROSC) in patients with out-of-hospital cardiac arrest (OHCA).

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2016 Mar - Corticosteroids as adjunctive therapy in the treatment of influenza

Rodrigo C, Leonardi-Bee J, Nguyen-Van-Tam J, Lim WS.; Cochrane Database Syst Rev. 2016 Mar 7;3:CD010406.

BACKGROUND: Specific treatments for influenza are limited to neuraminidase inhibitors and adamantanes. Corticosteroids show evidence of benefit in sepsis and related conditions, most likely due to their anti-inflammatory and immunomodulatory properties. Although commonly prescribed for severe influenza, there is uncertainty over their potential benefit or harm.

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2016 Feb - The Insertion and Management of External Ventricular Drains: An Evidence-Based Consensus Statement : A Statement for Healthcare Professionals from the Neurocritical Care Society

Fried HI, Nathan BR, Rowe AS, Zabramski JM, Andaluz N, Bhimraj A, Guanci MM, Seder DB, Singh JM.; Neurocrit Care. 2016 Feb;24(1):61-81.

External ventricular drains (EVDs) are commonly placed to monitor intracranial pressure and manage acute hydrocephalus in patients with a variety of intracranial pathologies. The indications for EVD insertion and their efficacy in the management of these various conditions have been previously addressed in guidelines published by the Brain Trauma Foundation, American Heart Association and combined committees of the American Association of Neurological Surgeons and the Congress of Neurological Surgeons..

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2016 Mar - Methylprednisolone for the Treatment of Patients with Acute Spinal Cord Injuries: A Systematic Review and Meta-Analysis

Evaniew N, Belley-Côté EP, Fallah N, Noonan VK, Rivers CS, Dvorak MF.; J Neurotrauma. 2016 Mar 1;33(5):468-81.

Previous meta-analyses of methylprednisolone (MPS) for patients with acute traumatic spinal cord injuries (TSCIs) have not addressed confidence in the quality of evidence used for pooled effect estimates, and new primary studies have been recently published. We aimed to determine whether MPS improves motor recovery and is associated with increased risks for adverse events. We searched MEDLINE, EMBASE, and The Cochrane Library, and two reviewers independently screened articles, extracted data, and evaluated risk of bias...

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2016 Feb - Shock, acute disseminated intravascular coagulation, and microvascular thrombosis: is 'shock liver' the unrecognized provocateur of ischemic limb necrosis?

Warkentin TE, Pai M.; J Thromb Haemost. 2016 Feb;14(2):231-5.

For unknown reasons, a small minority of critically ill patients with septic or cardiogenic shock, multiorgan failure, and disseminated intravascular coagulation develop symmetrical acral (distal extremity) limb loss due to microvascular thrombosis ('limb gangrene with pulses'). Case reports have described preceding 'shock liver' in some critically ill patients who developed such a picture of ischemic limb necrosis. This suggests that profoundly disturbed procoagulant-anticoagulant balance featuring uncontrolled generation of thrombin-resulting from failure of the protein C and antithrombin natural anticoagulant systems due to insufficient hepatic synthesis of these crucial proteins-could explain the microvascular thrombosis and associated limb loss.

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2016 Jan - Monophasic and biphasic shock for transthoracic conversion of atrial fibrillation: Systematic review and network meta-analysis

Inácio JF, Rosa MD, Shah J, Rosário J, Vissoci JR, Manica AL, Rodrigues CG.; Resuscitation. 2016 Jan 8;100:66-75.

OBJECTIVES: Conduct a systematic review of the literature to compare the efficacy of different biphasic and monophasic shock waveforms technologies for transthoracic cardioversion of Atrial Fibrillation (AF).

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2016 Feb - Vasopressors for hypotensive shock

Gamper G, Havel C, Arrich J, Losert H, Pace NL, Müllner M, Herkner H.; Cochrane Database Syst Rev. 2016 Feb 15;2:CD003709. [Epub ahead of print]

BACKGROUND: Initial goal-directed resuscitation for hypotensive shock usually includes administration of intravenous fluids, followed by initiation of vasopressors. Despite obvious immediate effects of vasopressors on haemodynamics, their effect on patient-relevant outcomes remains controversial. This review was published originally in 2004 and was updated in 2011 and again in 2016.

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2016 Feb - Multi-Center Study of Diffusion-Weighted Imaging in Coma After Cardiac Arrest

Hirsch KG, Mlynash M, Eyngorn I, Pirsaheli R, Okada A, Komshian S, Chen C, Mayer SA, Meschia JF, Bernstein RA, Wu O, Greer DM, Wijman CA, Albers GW.; Neurocrit Care. 2016 Feb;24(1):82-9.

Background: The ability to predict outcomes in acutely comatose cardiac arrest survivors is limited. Brain diffusion-weighted magnetic resonance imaging (DWI MRI) has been shown in initial studies to be a simple and effective prognostic tool. This study aimed to determine the predictive value of previously defined DWI MRI thresholds in a multi-center cohort.

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2016 Feb - Neuroleptic Malignant Syndrome: Complications, Outcomes, and Mortality

Modi S, Dharaiya D, Schultz L, Varelas P.; Neurocrit Care. 2016 Feb;24(1):97-103.

Objective: Our study objective was to identify real-world rates of complications, mortality, and outcomes in patients with neuroleptic malignant syndrome (NMS) over the last decade in the United States.

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2016 Feb - Guideline for Reversal of Antithrombotics in Intracranial Hemorrhage : A Statement for Healthcare Professionals from the Neurocritical Care Society and Society of Critical Care Medicine

Frontera JA, Lewin Iii JJ, Rabinstein AA, Aisiku IP, Alexandrov AW, Cook AM, Del Zoppo GJ, Kumar MA, Peerschke EI, Stiefel MF, Teitelbaum JS, Wartenberg KE, Zerfoss CL.: Neurocrit Care. 2016 Feb;24(1):6-46.

Background: The use of antithrombotic agents, including anticoagulants, antiplatelet agents, and thrombolytics has increased over the last decade and is expected to continue to rise. Although antithrombotic-associated intracranial hemorrhage can be devastating, rapid reversal of coagulopathy may help limit hematoma expansion and improve outcomes.

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2016 Feb - Prophylaxis of Venous Thrombosis in Neurocritical Care Patients: An Evidence-Based Guideline: A Statement for Healthcare Professionals from the Neurocritical Care Society

Nyquist P, Bautista C, Jichici D, Burns J, Chhangani S, DeFilippis M, Goldenberg FD, Kim K, Liu-DeRyke X, Mack W, Meyer K.; Neurocrit Care. 2016 Feb;24(1):47-60.

The risk of death from venous thromboembolism (VTE) is high in intensive care unit patients with neurological diagnoses. This is due to an increased risk of venous stasis secondary to paralysis as well as an increased prevalence of underlying pathologies that cause endothelial activation and create an increased risk of embolus formation.

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2016 Feb - Spinal injury: assessment and initial management

National Institute for Health and Care Excellence; 2016 Feb. (NICE guideline; NG41)

This guideline covers the assessment and early management of spinal column and spinal cord injury in pre-hospital settings (including ambulance services), emergency departments and major trauma centres. It covers traumatic injuries to the spine but does not cover spinal injury caused by a disease.It aims to reduce death and disability by improving the quality of emergency and urgent care.

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2015 Nov - Effectiveness and risks of cricoid pressure during rapid sequence induction for endotracheal intubation

Algie CM, Mahar RK, Tan HB, Wilson G, Mahar PD, Wasiak J.; Cochrane Database Syst Rev. 2015 Nov 18;11:CD011656.

BACKGROUND: Rapid sequence induction (RSI) for endotracheal intubation is a technique widely used in anaesthesia, emergency and intensive care medicine to secure an airway in patients deemed at risk of pulmonary aspiration. Cricoid pressure is conceptually used to reduce the risk of aspiration by compressing the oesophagus.

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2016 Mar - Terlipressin versus noradrenaline in the treatment of hepatorenal syndrome: systematic review with meta-analysis and full economic evaluation

de Mattos ÂZ, de Mattos AA, Ribeiro RA.; Eur J Gastroenterol Hepatol. 2016 Mar;28(3):345-51.

Objective: The aim of this study was to compare the efficacy and costs of terlipressin and noradrenaline for the treatment of hepatorenal syndrome from the perspective of the Brazilian public health system and that of a major private health insurance.

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2015 Dec - Terlipressin given by continuous i.v. infusion versus i.v. boluses in the treatment of hepatorenal syndrome: A randomized controlled study


Cavallin M, Piano S, Romano A, Fasolato S, Chiara Frigo A, Benetti G, Gola E, Morando F, Stanco M, Rosi S, Sticca A, Cillo U, Angeli P.; Hepatology. 2015 Dec 13.

BACKGROUND: In patients with cirrhosis and hepatorenal syndrome (HRS), terlipressin has been used either as continuous i.v. infusion or as i.v. boluses. Up to now these two schedules have never been compared.

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2016 Feb - Pharmacist involvement in a multidisciplinary initiative to reduce sepsis-related mortality

Beardsley JR, Jones CM, Williamson J, Chou J, Currie-Coyoy M, Jackson T.; Am J Health Syst Pharm. 2016 Feb 1;73(3):143-9

PURPOSE: Pharmacy department contributions to a medical center's broad initiative to improve sepsis care outcomes are described.

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2015 Nov - Albumin treatment regimen for type 1 hepatorenal syndrome: a dose-response meta-analysis

Salerno F, Navickis RJ, Wilkes MM.; BMC Gastroenterol. 2015 Nov 25;15(1):167.

BACKGROUND: Recommended treatment for type 1 hepatorenal syndrome consists of albumin and vasoconstrictor. The optimal albumin dose remains poorly characterized. This meta-analysis aimed to determine the impact of albumin dose on treatment outcomes.

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2015 Oct - To increase or decrease dosage of antimicrobials in septic patients during continuous renal replacement therapy: the eternal doubt

Wong WT, Choi G, Gomersall CD, Lipman J.; Curr Opin Pharmacol. 2015 Oct;24:68-78.

Critical illness, acute renal failure and continuous renal replacement therapy (CRRT) are associated with changes in pharmacokinetics. Initial antibiotic dose should be based on published volume of distribution and generally be at least the standard dose, as volume of distribution is usually unchanged or increased. Subsequent doses should be based on total clearance. Total clearance varies with the CRRT clearance which mainly depends on effluent flow rate, sieving coefficient/saturation coefficient. As antibiotic clearance by healthy kidneys is usually higher than clearance by CRRT, except for colistin, subsequent doses should generally be lower than given to patients without renal dysfunction. In the future therapeutic drug monitoring, together with sophisticated pharmacokinetic models taking into account the pharmacokinetic variability, may enable more appropriate individualized dosing.

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2016 Jan - Comprehensive Interpretation of Central Venous Oxygen Saturation and Blood Lactate Levels During Resuscitation of Patients With Severe Sepsis and Septic Shock in the Emergency Department

Shin TG, Jo IJ, Hwang SY, Jeon K, Suh GY, Choe E, Lee YK, Lee TR, Cha WC, Sim MS. Shock. 2016 Jan;45(1):4-9. doi: 10.1097/SHK.0000000000000466.

OBJECTIVES: We evaluated central venous oxygen saturation (Scvo2) and lactate levels as a combination measure to predict mortality in patients with severe sepsis or septic shock.

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