focused echocardiography in the icu

... prognostic indicator in fulminant hepatitis in patients without encephalopathy upon admission [10,11] In the present study, we examined 11 proinflammatory genes in patients receiving therapy in the ICU ... levels (a) Change in circulating CRP mRNA expression during the clinical course in ICU Upregulation of CRP mRNA was induced at POD by the surgical intervention The longitudinal axis is relative ... GPIb-IX-V Therefore, upregulated VWF may represent unstable hemostasis and reflect damage to endothelial megakaryocytes expressing VWF In the signaling pathway, VWF interacts with integrins in the...

Ngày tải lên: 18/06/2014, 16:20

... [22]; 35.2% at 12 weeks in the PATH study [12]; 37.9% in the ECMM study [8]; and 53.4% in non -ICU vs 85.9% in ICU patients in the Brazilian SCOPE study [11] In the PATH study, the highest mortality ... [57] The index increased significantly by 0.1 during the ICU stay (p = 0.016) and the threshold of 0.5 was reached in 36 (39.1%) of 92 nonsurgical ICU patients staying > days; of them developed invasive ... their value in an ICU population is still insufficiently documented [47,48] The second noncultural approach relies in detecting the presence of Candida DNA in the blood of at-risk patients The major...

Ngày tải lên: 21/06/2014, 00:20

... was no increase in the number of unscheduled CXRs performed in the afternoon or in the night in the on-demand strategy, and therefore no disruption in the organisation of the medical imaging department ... venous catheter insertion The French ICU physicians who participated in the Delphi study agreed on the appropriateness of performing a CXR after central venous catheter (CVC) insertion in the superior ... the design and in the redaction of the first draft of the article, corrected and approved the final version Competing interests The authors declare that they have no competing interests Received:...

Ngày tải lên: 21/06/2014, 05:20

... Common Infections in ICU • • • • • • • Pneumonia Sinusitis Catheter-related sepsis C difficile colitis Abdominal sepsis Complicated wound infection Bacteremia of uncertain source Fever Common Infections ... Meninigitis Empiric Treatment • Neonate – Ampicillin, 3rd cephalosporin • 1-18 years – 3rd cephalosporin, vancomycin Meninigitis Empiric Treatment • 18 - 60 years – 3rd cephalosporin, vancomycin ... Fever Common Infections in ICU • • • • • • • Pneumonia Sinusitis Catheter-related sepsis C difficile colitis Abdominal sepsis Complicated wound infection Bacteremia of uncertain source Antibiotics...

Ngày tải lên: 15/07/2014, 15:22

... hypothalamus to the reticular activating system via the reticular formation, beginning in the medulla and extending to the midbrain This pathway links the brain with perception of external events Pain is ... epinephrine and norepinephrine are released into the blood stream from the adrenal medulla The more intense the stimuli, the more pronounced the response The levels of norepinephrine generally increase ... complexes in the brain, enhancing chloride conduction resulting in the release of GABA This opens a chloride channel leading to inhibition of neuronal excitation in the limbic system, resulting in anxiolysis,...

Ngày tải lên: 12/08/2014, 18:20

... of ICUs with a full-time doctor, while The Netherlands and Finland had the lowest number In 67% of the ICUs surveyed there was an ICU director In a recent survey from the German Interdisciplinary ... defined the requirements for certification of an ICU for training in ICM [9] Under the prerequisites of a training institution providing optimal specialist training in base specialty-related intensive ... dedicated ICU team: Experience in inserting, controlling, and maintaining invasive catheters is built up Insertion techniques (e.g for pulmonary artery catheters) can be standardised Experience is gained...

Ngày tải lên: 12/08/2014, 18:20

... of the drugs used in the ICU and those used in HIV therapy The protease inhibitors and the non-nucleosides can act as cytochrome P450 3A4 inhibitors, and affect the metabolism of many of the ... needed on drug absorption and stopping-and-starting therapy in the ICU, as well as drug interactions The effect of HAART on ICU outcomes, either directly or indirectly through its effect on viral ... with HAART, in its own right and in combination with certain other agents used in ICU, especially in patients with chronic viral hepatitis Resistance, absorption, and interactions The critically...

Ngày tải lên: 12/08/2014, 18:21

... (FFP) is available in limited amounts • If done continuously, after a while one is removing the FFP given • FFP contains many of the proteins we want to remove Intermittent therapy is unlikely ... “toxemia” • “Toxemia” induces widespread injury • The mediators of “toxemia” are ill-defined • Continuous removal beneficial ? • Use Hemofiltration? The Mediators of Sepsis (the Humoral Theory of Sepsis) ... 1998; 13: 1458-64 CPFA in animal models • Test whether biochemical findings translate into clinical effects • • • • Assess magnitude of clinical effects Assess nature of clinical effects Exclude...

Ngày tải lên: 12/08/2014, 20:50

... study include the use of standard definitions for septic shock and infection as well as invasive monitoring with goal directed therapy Patients were excluded if they received steroids in the month ... replacement; on the other hand, steroids can cause important side effects, such as increased risk of infection or impair wound healing Furthermore, there is no evidence of that administering corticosteroid ... especially during the first 24 hours after administration [4], though the duration of adrenal suppression induced by etomidate is controversial [5] Exclusion of these patients may explain the lower...

Ngày tải lên: 13/08/2014, 02:24

... No Gladman and Lapinsky Regardless of the potential risks, wireless technology is becoming increasingly prevalent in the critical care environment Hospitals are routinely using wireless solutions ... medical engineers must determine the impact on existing hospital network infrastructure and medical devices There are those that argue that the intangible benefits of improved communication using wireless ... equipment Competing interests The author(s) declare that they have no competing interests References van Lieshout, JE, van der Veer SN, Hensbroek R, Korevaar JC, Vroom MB, Schultz MJ: Interference...

Ngày tải lên: 13/08/2014, 08:20

... retain their clinical and even prognostic value and therefore should not be forgotten whenever performing an echocardiographic investigation Competing interests The authors have no competing interests ... Roosens Finally, there is the discussion on load dependency of E’ This issue remains controversial and not at all completely clarified, as outlined in a recent commentary [12] In particular, the disparity ... helpful in predicting fluid responsiveness in ventilated septic patients Intensive Care Med 2004, 30:1740-1746 Feissel M, Michard F, Faller JP, Teboul JL: The respiratory variation in inferior...

Ngày tải lên: 13/08/2014, 08:20

... 45% and ICU mortality from 6.3% to 37% Studies were heterogeneous in the way they used SOFA The major themes identified in the evaluation studies were investigating the performance of: single SOFA ... regression); and whether the model was validated on the developmental or independent validation set Emailing the authors confirmed the type of ICU outcome (hospital or ICU mortality) used in one study ... prespecified time interval, and mean SOFA was always calculated by taking the average of all total SOFA scores in the prespecified time interval These intervals varied in length, but generally they were...

Ngày tải lên: 13/08/2014, 11:23

... and the baseline infection rates were low BSI at baseline, costs of treating the infection, the proportion of patients requiring central venous catheters, the duration of catheterization and the ... dressings [16] Competing interests The author declares that they have no competing interests References 10 11 12 The findings of Halton and colleagues’ study should be interpreted in the context of ... authors found that the minocycline– rifampin-coated catheters dominated the other types of catheters Fifteen infections could be avoided compared with the uncoated catheters, and 1.6 quality-adjusted...

Ngày tải lên: 13/08/2014, 16:20

... area under the curve; CABG, coronary artery bypass grafting; GLP-1, glucagon-like peptide-1; ICU, intensive care unit insulin secretion in euglycemic ranges, thus potentially eliminating the risk ... feeding No parenteral feeding Allowed to eat Fasting Intervention GLP-1 at 1.2 pmol/kg/minute GLP-1 at 3.6 pmol/kg/minute GLP-1 at 1.5 pmol/kg/minute GLP-1 at 1.2 pmol/kg/minute Duration of intervention ... nondiabetic patients may be alleviated with use of GLP-1 infusion, resulting in either no or reduced insulin requirements, which in turn should reduce the incidence of hypoglycemia and avoid adverse outcomes...

Ngày tải lên: 13/08/2014, 16:21

... of the general population [12,13] These overestimations exaggerate the affordability of empiric micafungin Nevertheless, the main finding of this study by Zilberberg and colleagues is encouraging ... revisited Clin Infect Dis 2003, 37: 1172-1177 Kumar A; CATSS Study Group: The high mortality of Candida septic shock is explained by excessive delays in initiation of antifungal therapy In Proceedings ... by Zilberberg and colleagues is encouraging The reduction in the acquisition cost of micafungin, as well as that of other echinocandins, has made these effective anti-Candida agents more affordable...

Ngày tải lên: 13/08/2014, 18:22

... disturbances and the fluctuating nature of consciousness were the most difficult points for the ICU nurses Individual problems with the assessment were addressed by focusing the training on the difficulties ... All ICU nurses were trained in the use of the CAM -ICU and performed a knowledge test prior to the training The education consisted of a one-hour group training prior to the implementation of the ... screening instrument on the use of haloperidol The first aim of our study was to evaluate our strategy for the implementation of the CAM -ICU Therefore, the compliance with scoring of the CAM -ICU, the...

Ngày tải lên: 13/08/2014, 18:22

... complement to current strategies for early physical therapy and mobilization in the ICU Competing interests The authors declare that they have no competing interests Page of (page number not for citation ... results are sufficiently interesting to warrant more clinical trials evaluating the effects of EMS in ICU patients, particularly in those who are unable to participate in early mobilization because ... sedation, or musculoskeletal injury These studies will need to assess a range of questions, including: what is the clinical effect of EMS - namely, is the preservation in muscle mass corroborated...

Ngày tải lên: 13/08/2014, 19:20

... categories The majority of studies (20) were published after 2002, indicating the increasing interest in the practice of sedation quality in recent years, in particular following the publication ... further study [2] that looked at the introduction of a sedation guideline did not record the incidence of sub-optimal sedation but recorded the median Ramsay scale values These were during the ... high incidence of deep sedation This finding illustrates the importance of the perception of the health care worker or assessor or both in describing the prevalence of sub-optimal sedation The...

Ngày tải lên: 13/08/2014, 20:21

... to 32% in the 1980s, and an increase in undiagnosed infections of 30% Gerain and colleagues [36] studied the causes of death in oncology patients who died in an ICU In 23.5% of all deaths the primary ... means a joint effort of both intensivists and pathologists The clinicians need to inform the pathologist about the patient’s pre-mortem status, the expected findings and the unsolved questions The pathologist ... autopsy The lack of a decrease in the proportion of missed diagnoses during the past decades does not indicate a lack of progress in medical science since the types of missed diagnoses varied in the...

Ngày tải lên: 13/08/2014, 20:21

... on incidence of delirium In the RCT comparing SBTs alone with SBTs plus daily sedation hold there was no difference in the incidence of delirium [6] An RCT comparing sedation with dexmedetomidine ... sedation break, the rapid shallow breathing index was significantly higher in patients randomised to lorazepam, suggesting that sedative drug may influence performance during SBTs [8] In the RCT by ... sedated in 10, 11 studies were not set in the ICU, patients were not mechanically ventilated in 21 and 28 studies did not report outcomes of interest Summary of included studies Nineteen studies investigated...

Ngày tải lên: 13/08/2014, 20:21