Tag: therapy

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This JAMA Clinical Guidelines Synopsis summarizes the American College of Chest Physicians' 2016 recommendations on antithrombotic therapy for venous thromboembolism (VTE). The estimated annual incidence of VTE, defined as DVT of the leg or PE, ranges from 104 to 183 per 100 000 person-years. Compared with those without VTE, the 30-year mortality risk is increased for survivors of an episode of VTE and for survivors of... Read More | Comment
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In a single center’s experience, thrombolytic therapy is used infrequently for the management of cardiac arrest. Thrombolysis during cardiac arrest should be considered on a case-by-case basis and should be utilized only when there is a high suspicion for pulmonary embolism as the cause of arrest and when thrombolytic therapy is readily available. Twenty-six patients were identified. Patients were predominantly male (65%) and Caucasian (89%)... Read More | Comment
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Use of renal replacement therapy (RRT) in sepsis varied widely among nationally sampled hospitals without associated differences in mortality. Improving renal replacement standards for the initiation of therapy for sepsis may reduce healthcare costs without increasing mortality. We identified 293,899 hospitalizations with sepsis and acute kidney injury at 440 hospitals, of which 6.4% (n = 18,885) received renal replacement therapy. After risk and reliability adjustment,... Read More | Comment
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In patients with respiratory failure and metabolic alkalosis, carbonic anhydrase inhibitor therapy may have favorable effects on blood gas parameters. In mechanically ventilated patients, carbonic anhydrase inhibitor therapy may decrease the duration of mechanical ventilation. A major limitation of this finding was that only two trials assessed this clinically important outcome. Six eligible studies were identified with a total of 564 participants. The synthesized data... Read More | Comment
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The majority of respondents reported targeting moderate to deep sedation following cannulation, with the use of sedative and opioid infusions. There is considerable variability surrounding early physical therapy and mobilization goals for patients with acute respiratory failure (ARF) supported by venovenous extracorporeal membrane oxygenation. We analyzed responses from 209 respondents (53%), mostly from academic centers (63%); 41% respondents provide venovenous extracorporeal membrane oxygenation to adults... Read More | Comment
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Patients who develop vasodilatory shock, particularly when caused by an inflammatory condition like sepsis or pancreatitis, have evidence of significant endothelial injury as manifested by coagulation disorders and increased capillary permeability. Endothelial injury during shock may lead to ACE defects, which in turn may cause an increase in vasodilatory mediators that are normally metabolized by ACE and a relative or absolute decrease in ANG-2. These... Read More | Comment
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This article explores the potential role of nutrition and EMS in maintaining muscle health in critical illness. Within this article, we will evaluate fundamental concepts of muscle wasting and evaluate the effects of EMS, as well as the effects of nutrition therapy on muscle health and the clinical and functional outcomes in critically ill patients. We will also highlight current research gaps in order to... Read More | Comment
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Novel use of interactive video games as part of routine PT in critically ill patients is feasible and appears safe in our case series. Video game therapy may complement existing rehabilitation techniques for ICU patients. Of 410 patients receiving PT in the medical ICU, 22 (5% of all patients; male, 64%; median age, 52 years) had 42 PT treatments with video games (median [interquartile range]... Read More | Comment
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Changes in lactate levels after ECMO implantation is an important tool to assess effective circulatory support and it is found superior to single lactate measurements as a prognostic sign of mortality in our study. Based on our results, an early insertion of ECMO before lactate gets high was suggested. Serial changes on lactate levels and calculation of its clearance may be superior to single lactate... Read More | Comment
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It is a longstanding cultural norm to provide supplemental oxygen to sick patients regardless of their blood oxygen saturation. A recent systematic review and meta-analysis has shown that too much supplemental oxygen increases mortality for medical patients in hospital. Patients randomised to liberal oxygen therapy were more likely to die (risk ratio 1.21 (95% confidence interval 1.03 to 1.43)). The increase in mortality was highest... Read More | Comment
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Critical illness can disrupt local and systemic mechanisms that protect against upper gastrointestinal bleeding, a condition that may be associated with increased mortality, particularly among patients receiving extracorporeal life support. On the basis of randomized trials performed over a period of 40 years,3 most guidelines recommend preventive therapy with either histamine H2–receptor antagonists or proton-pump inhibitors (PPIs) for patients in the intensive care unit (ICU)... Read More | Comment
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In adult patients with septic shock and high circulating endotoxin activity, does the use of polymyxin B hemoperfusion therapy significantly decrease 28-day mortality? Among patients with septic shock and high endotoxin activity, polymyxin B haemoperfusion treatment plus conventional medical therapy compared with sham treatment plus conventional medical therapy did not reduce mortality at 28 days. High endotoxin activity is associated with multi-organ failure and increased... Read More | Comment
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In mechanically ventilated patients enrolled in a randomized clinical trial of early mobilization, the use of vasoactive medications was independently associated with the development of ICU-acquired weakness. Prospective trials to further evaluate this relationship are merited. On logistic regression analysis, the use of vasoactive medications increased the odds of developing ICU-acquired weakness (odds ratio [OR], 3.2; P = .01) independent of all other established risk... Read More | Comment
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Following the new ESPEN Standard Operating Procedures, the previous guidelines to provide best medical nutritional therapy to critically ill patients have been updated. These guidelines define who are the patients at risk, how to assess nutritional status of an ICU patient, how to define the amount of energy to provide, the route to choose and how to adapt according to various clinical conditions. When to... Read More | Comment
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Critical care transesophageal echocardiography is feasible, safe, and has clinical utility. It can be safely and effectively performed by fellows within the context of their critical care training with faculty supervision. Pulmonary critical care fellowship training programs should consider introducing critical care transesophageal echocardiography as a useful clinical tool. The examination was feasible in all patients in whom it was attempted, and there were no... Read More | Comment