Tag: hemodynamics

Upvote Story 5
This case report shows that junctional rhythm can cause deterioration of SAM, LVOTO, and MR, and can lead to unstable hemodynamics in a patient with right ventricular failure after MVR. Atrial pacing can resolve SAM, LVOTO, and MR and can improve hemodynamics in a patient with unstable normal sinus rhythm. TEE in the ICU can play a pivotal role in clinical decision-making. Given that there... Read More | Comment
Upvote Story 4
In this article, we review physiologic principles of global oxygen delivery, and discuss the bedside approach to assessing the adequacy of oxygen delivery in critically ill patients. Although there have been technological advances in the assessment of oxygen delivery, we revisit and emphasize the importance of a ‘tried and true’ method – the physical examination. Also potentially important in the evaluation of oxygen delivery is... Read More | Comment
Upvote Story 5
Multi-system organ failure is ubiquitous but treatable with adequate hemodynamic support. Neurologic recovery was prolonged requiring delayed prognostication. Immediate 24/7 availability of surgical and medical specialty expertise was required to achieve 48% functionally intact survival. Of 100 appropriately transported patients, 83 achieved CICU admission. 40/83 (48%) discharged functionally intact. Multi-system organ failure occurred in all patients. Cardiac, pulmonary, renal, and liver injury improved within 3-4... Read More | Comment
Upvote Story 13
Recently released, Abdominal Sepsis examines in detail the topic of sepsis, with a focus on intra-abdominal sepsis. Particular attention is devoted to source control in the management of the infection, antimicrobial therapy and sepsis support, which represent the cornerstones of treating patients with this problem. The importance of a multidisciplinary approach is highlighted not only by the instructive and informative sections on the acute manifestations... Read More | Comment
Upvote Story 6
Sepsis resuscitation generally focuses on hemodynamics. Rivers of ink have been spilled writing about oxygen delivery and fluid responsiveness. This is clearly important, but it's possible that our focus on easily observable phenomena has led us to ignore something of equal importance: metabolic resuscitation. We can deliver all the oxygen we want to the tissues, but if the mitochondria are failing it won't work. Clinical... Read More | Comment
Upvote Story 8
Less than 7 cm H2O positive end-expiratory pressure reduced atelectrauma encountered at zero end-expiratory pressure. Above a defined power threshold, sustained positive end-expiratory pressure contributed to potentially lethal lung damage and hemodynamic impairment. Lung mechanical power was similar at 0 (8.8 ± 3.8 J/min), 4 (8.9 ± 4.4 J/min), and 7 (9.6 ± 4.3 J/min) cm H2O positive end-expiratory pressure, and it linearly increased thereafter... Read More | Comment
Upvote Story 7
Despite timely intervention, there exists a small subgroup of patients with septic shock who develop progressive multi-organ failure. Seemingly refractory to conventional therapy, they exhibit a very high mortality. Such patients are often poorly represented in large clinical trials. The management of refractory septic shock remains extremely challenging. We believe that where established conventional interventions fail to deliver improvements, a different approach using pragmatic strategies... Read More | Comment
Upvote Story 7
Pericardial tamponade occurs when fluid within the pericardial sac impairs filling of the right-sided chambers, leading to a decrease in cardiac output and hemodynamic compromise. It is neither a clinical nor an echocardiographic diagnosis alone. Bedside echocardiography can help diagnose pericardial tamponade when there is already a degree of clinical suspicion. The core findings include: a pericardial effusion, diastolic RV collapse (high specificity), systolic RA... Read More | Comment
Upvote Story 10
This book provides a comprehensive, state-of-the art review of the interventional procedures that can be performed in intensive care settings. The book addresses fundamentals of the indications and technical aspects of procedures, and identifies pitfalls and resource needs. In addition, a section is dedicated to a discussion of the staff-preparation, hemodynamic, and anesthetic concerns necessary for all procedures. Chapters focus on the following specific concerns:... Read More | Comment
Upvote Story 8
Deleterious hemodynamic effects of severe lactic acidosis are largely suggested by experimental data, although not fully confirmed by human studies. Pending the effectiveness of an etiological treatment, there is no efficient and validated symptomatic therapy at hand to correct a life-threatening metabolic acidosis. Upcoming research in this field should be focused on the optimal strategy to treat severe metabolic acidosis, including symptomatic therapy. Alkalinization with... Read More | Comment
Upvote Story 14
Acute kidney injury (AKI) is a common complication of critical illness and is associated with significant morbidity, mortality, and financial cost. Sepsis is the leading association of acute kidney injury in the intensive care unit and is implicated in more than half the cases. Our understanding of the pathogenesis of sepsis-associated acute kidney injury continues to evolve. Current evidence suggests that pathways involving inflammatory injury... Read More | Comment
Upvote Story 8
Dr. Wung is addressing an important component of critical care nursing: the role of technology in patient care. She has assembled top authors to provide current clinical information in the following areas: Sensory overload and technology in critical care; Alarm fatigue; Nurse-technology Interactions; Safety steps to prevent Infusion errors; Product design and medical devices for nurses; Technologies to assess physiologic parameters (hemodynamics/cardio output); Technologies to... Read More | Comment
Upvote Story 4
Decompressive laparotomy has been advised as potential treatment for abdominal compartment syndrome (ACS) when medical management fails; yet, the effect on parameters of organ function differs markedly in the published literature. In this study, we sought to investigate the effect of decompressive laparotomy on intra-abdominal pressure and organ function in critically ill adult and pediatric patients with ACS, specifically focusing on hemodynamic, respiratory, and kidney... Read More | Comment
Upvote Story 6
Margaret Parker, MD, MCCM, speaks with Joseph A. Carcillo, MD, about the article, “American College of Critical Care Medicine Clinical Practice Parameters for Hemodynamic Support of Pediatric and Neonatal Septic Shock,” published in the June 2017 issue of Critical Care Medicine. Dr. Carcillo the revisions made to the 2014 guidelines and recommendations regarding use of 1) a “recognition bundle” containing a trigger tool for rapid... Read More | Comment
Upvote Story 19
This book describes the pathophysiological significance of the hemodynamic monitoring parameters available to the clinician and their role in providing reliable and reproducible information on the cardiocirculatory status of a patient in shock. It is explained how measurements of these parameters enable the intensivist to understand the patient’s condition and to make more informed treatment decisions in order to optimize the hemodynamic status and improve... Read More | Comment