共查询到20条相似文献，搜索用时 203 毫秒
1.
Christopher Brock Vince Marzano Margot Green Jiali Wang Teresa Neeman Imogen Mitchell Bernie Bissett 《Heart & lung : the journal of critical care》2018,47(4):380-385
Background
Mobilisation of intensive care (ICU) patients attenuates ICU-acquired weakness, but the prevalence is low (12–54%). Better understanding of barriers and enablers may inform practice.Objectives
To identify barriers to mobilisation and factors associated with successful mobilisation in our medical /surgical /trauma ICU where mobilisation is well-established.Methods
4-week prospective study of frequency and intensity of mobilisation, clinical factors and barriers (extracted from electronic database). Generalized linear mixed models were used to describe associations between demographics, clinical factors and successful mobilisation.Results
202 patients accounted for 742 patient days. Patients mobilised on 51% of patient days. Most frequent barriers were drowsiness (18%), haemodynamic/respiratory contraindications (17%), and medical orders (14%). Predictors of successful mobilisation included high Glasgow Coma Score (OR = 1.44, 95%CI=[1.29–1.60]), and male sex (OR = 2.29, 95%CI=[1.40–3.75]) but not age (OR = 1.05, 95%CI=[1.01–1.08]).Conclusions
Our major barriers (drowsiness, haemodynamic/respiratory contraindications) may be unavoidable, indicating an upper limit of feasible mobilisation therapy in ICU. 相似文献2.
Wenjia Guo Tingting Lv Fei She Guobin Miao Yuanwei Liu Rong He Yajun Xue Nang Kham Nu Jing Yang Kun Li Ping Zhang 《Heart & lung : the journal of critical care》2018,47(5):516-524
Background
Heart rate variability (HRV), modulated by cardiac autonomic function, is impaired in obstructive sleep apnea (OSA). However, the effect of continuous positive airway pressure (CPAP) on HRV is debated.Objectives
To investigate the associations between CPAP and HRV in OSA.Methods
Based on literature from five databases published through August 2017, we performed a meta-analysis of cohort studies of OSA treated with CPAP. The change of low-frequency band (LF), high-frequency band (HF) and the ratio between LF and HF (LHR) were analyzed.Results
Eleven studies were included. Decreased LF (SMD = ?0.32, 95%CI: ?0.62,?0.01; P = 0.043) and HF (SMD = ?0.51, 95%CI: ?0.95, ?0.08, P = 0.020) were shown while measured on CPAP. When measured off CPAP, HF was increased remarkably (SMD: 0.31, 95%CI: 0.02, 0.60, P = 0.034).Conclusions
CPAP can improve autonomic activity, which might be one mechanism to reduce the risk of cardiovascular diseases in OSA. 相似文献3.
Jengyuan Wu Chienming Liu Shangsen Lee Yuhung Kuo Tengfu Hsieh 《Heart & lung : the journal of critical care》2018,47(2):157-161
Background
Patients with thoracic empyema have an increased risk of mortality, but their absolute rate of mortality depends on age and comorbidities.Objective
This study seeks to assess the predictive value of the Charlson Comorbidity Index score (CCIS), CHADS2 and CHA2DS2-VASc scores for mortality risk in patients with empyema thoracis.Methods
From Taiwan's National Health Insurance Research Database we identified a total of 484 participants diagnosed with thoracic empyema. The CCIS, CHADS2 and CHA2DS2-VASc scores were used to stratify mortality risk.Results
The incidence rate of mortality in the present study was 20.39 per 1000 person-months. A strong correlation was found between thoracic empyema and CCIS score.Conclusions
Our results show that patients with thoracic empyema have a significantly high incidence rate of mortality and that CCIS can be used as an indicator of risk for mortality. 相似文献4.
Konstantinos Z. Vardakas Andreas D. Mavroudis Maria Georgiou Matthew E. Falagas 《The Journal of infection》2018,76(4):321-327
Objective
To evaluate whether intravenous plus inhaled combination (IV/INHCC) compared to intravenous monotherapy (IVCM) was associated with patient outcomes and identify factors influencing study outcomes.Methods
PubMed and Scopus were searched till November 2016. Studies were included if they evaluated adult patients with lower respiratory tract infections due to MDR/XDR Gram-negative bacteria and reported comparative mortality data (adjusted and unadjusted) for patients receiving IV/INHCC versus IVCM. Random effects meta-analyses were performed.Results
Thirteen studies (11 retrospective, 2 prospective) were included. The overall quality of data was low to very low and characterized by the lack of adjusted data. The majority of the studies were designed to evaluate the outcome of the meta-analysis. Both IV and inhaled colistin were administered at variable doses. There was no difference in mortality between IV/INHCC and IVCM when all studies were combined (13 studies, 1115 patients, risk ratio 0.94, 95% confidence interval 0.81–1.08). Only the analysis that included studies with low-dose IV colistin showed significant difference in favor of IV/INHCC versus IVCM (0.65, 0.45–0.94).Conclusions
Overall, low quality data suggest that IV/INHCC did not lower mortality in patients with MDR Gram negative infections unless low IV colistin dose was administered. 相似文献5.
Ayodele Odutayo Christopher X. Wong Rashida Williams Benjamin Hunn Connor A. Emdin 《Journal of cardiac failure》2017,23(1):56-62
Background
Atrial fibrillation (AF) is common among adults with congestive heart failure (CHF). We conducted a meta-analysis to summarize the risk of mortality and cardiovascular disease associated with AF in CHF and stratified our analyses by AF timing and pattern.Methods
We searched MEDLINE and EMBASE for observational studies examining the association of AF with cardiovascular disease and death. Eligible studies had a minimum of 50 participants with AF and 50 participants without AF, and a median follow-up of 6 months.Results
Thirty-three studies involving 114,204 adults (43,549 with AF) were included in this meta-analysis. AF was associated with an increased risk of mortality and this risk varied between incident and prevalent AF (relative risk 2.21, 95% confidence interval 1.96–2.49 vs relative risk 1.19, 95% confidence interval 1.03–1.38, respectively; P?<?.001 for interaction). The risk of mortality associated with incident AF was consistent in adults with CHF with reduced and preserved ejection fraction. The relative risk of mortality did not vary between paroxysmal and chronic AF. Finally, AF was associated with an increased risk of cardiovascular mortality and stroke.Limitation
Use of anticoagulation was infrequently reported in included studies.Conclusions
AF was associated with an increased risk of cardiovascular disease and death and, notably, the risk of mortality varied by AF timing. 相似文献6.
Le Dung Ha Ayman Elbadawi Victor F. Froelicher 《The American journal of medicine》2018,131(1):101.e1-101.e8
Background
Numerous methods have been proposed for diagnosing left ventricular hypertrophy using the electrocardiogram. They have limited sensitivity for recognizing pathological hypertrophy, at least in part due to their inability to distinguish pathological from physiological hypertrophy. Our objective is to compare the major electrocardiogram–left ventricular hypertrophy criteria using cardiovascular mortality as a surrogate for pathological hypertrophy.Methods
This study was a retrospective analysis of 16,253 veterans < 56 years of age seen at a large Veterans Affairs Medical Center from 1987 to 1999 and followed a median of 17.8 years for cardiovascular mortality. Receiver operating characteristics and Cox hazard survival techniques were applied.Results
Of the 16,253 veterans included in our target population, the mean age was 43 years, 8.6% were female, 33.5% met criteria for electrocardiogram–left ventricular hypertrophy, and there were 744 cardiovascular deaths (annual cardiovascular mortality 0.25%). Receiver operating characteristic analysis demonstrated that the greatest area under the curve (AUC) for classification of cardiovascular death was obtained using the Romhilt-Estes score (0.63; 95% confidence interval, 0.61-0.65). Most of the voltage-only criteria had nondiagnostic area under the curves, with the Cornell being the best at 0.59 (95% confidence interval, 0.57-0.62). When the components of the Romhilt-Estes score were examined using step-wise Wald analysis, the voltage criteria dropped from the model. The Romhilt-Estes score ≥ 4, the Cornell, and the Peguero had the highest association with cardiovascular mortality (adjusted hazard ratios 2.2, 2.0, and 2.1, consecutively).Conclusion
None of the electrocardiogram leads with voltage criteria exhibited sufficient classification power for clinical use. 相似文献7.
Larry A. Weinrauch John A. D&#x;Elia Matthew R. Weir Suphamai Bunnapradist Peter V. Finn Jiankang Liu Brian Claggett Anthony P. Monaco 《The American journal of medicine》2018,131(2):165-172
Objective
Now that long-term survival after successful renal transplantation is no longer limited by excessive cardiovascular risk, the primary care physician should consider that infection and malignancy are leading noncardiovascular causes of death even in the recipient with diabetes.Methods
We accessed the National Institutes of Health–sponsored Folic Acid for Vascular Outcome Reduction in Transplantation (FAVORIT) study population (4010 renal transplant recipients with elevated homocysteine levels) studied to determine whether folate and B12 supplementation would reduce cardiovascular end points. This trial had a null result. Patients were classified as being nondiabetic or having type 1 or type 2 diabetes.Results
We report an excess (cardiovascular and noncardiovascular) 6-year mortality risk associated with the presence of diabetes mellitus. Two thirds of fatal events in our renal transplant recipients were centrally adjudicated as noncardiovascular. The incidence of noncardiovascular death was 70% higher in the diabetic patient cohort than in the nondiabetic cohort.Conclusions
These results demonstrate that infection (but not malignancy) risks are far higher in diabetic than nondiabetic immunosuppressed individuals (although noncardiovascular death rate in nondiabetic individuals also exceeded cardiovascular deaths) and may play a larger role in the excess mortality populations than previously thought. Given that follow-up in this study was 4 to 10 years after allograft surgery, there was a lesser degree of acute rejection requiring high-dose immunosuppression than in the initial postallograft years. This unique perspective allows transplant recipients to return to primary physicians when taking low doses of immunosuppressive agents and provides focus for follow-up care. 相似文献8.
C. De la Calle H.G. Ternavasio-de la Vega L. Morata F. Marco C. Cardozo C. García-Vidal A. Del Rio C. Cilloniz A. Torres J.A. Martínez J. Mensa A. Soriano 《The Journal of infection》2018,76(4):342-347
Objective
Combining a macrolide or a fluoroquinolone to beta-lactam regimens in the treatment of patients with moderate to severe community-acquired pneumonia is recommended by the international guidelines. However, the information in patients with bacteraemic pneumococcal pneumonia is limited.Methods
A propensity score technique was used to analyze prospectively collected data from all patients with bacteraemic pneumococcal pneumonia admitted from 2000 to 2015 in our institution, who had received empirical treatment with third-generation cephalosporin in monotherapy or plus macrolide or fluoroquinolone.Results
We included 69 patients in the monotherapy group and 314 in the combination group. After adjustment by PS for receiving monotherapy, 30-day mortality (OR 2.89; 95% CI 1.07–7.84) was significantly higher in monotherapy group. A higher 30-day mortality was observed in monotherapy group in both 1:1 and 1:2 matched samples although it was statistically significant only in 1:2 sample (OR: 3.50 (95% CI 1.03–11.96), P = 0.046).Conclusions
Our study suggests that in bacteraemic pneumococcal pneumonia, empirical therapy with a third-generation cephalosporin plus a macrolide or a fluoroquinolone is associated with a lower mortality rate than beta-lactams in monotherapy. These results support the recommendation of combination therapy in patients requiring admission with moderate to severe disease. 相似文献9.
Objectives
Early Warning Scores are used to evaluate patients in many hospital settings. It is not clear if these are accurate in predicting mortality in sepsis. We performed a systematic review and meta-analysis of multiple studies in sepsis. Our aim was to estimate the accuracy of EWS for mortality in this setting.Methods
PubMED, CINAHL, Cochrane, Web of Science and EMBASE were searched to October 2016. Studies of adults with sepsis who had EWS calculated using any appropriate tool (e.g. NEWS, MEWS) were eligible for inclusion. Study quality was assessed using QUADAS-2. Summary estimates were derived using HSROC analysis.Results
Six studies (4298 participants) were included. Results suggest that EWS cannot be used to predict which patients with sepsis will (positive likelihood ratio 1.79, 95% CI 1.53 to 2.11) or will not die (negative likelihood ratio 0.59, 95% CI 0.45 to 0.78). Two studies were rated as low risk of bias and one as unclear risk of bias on all domains. The other three studies were judged at high risk of bias in one domain.Conclusion
Early Warning Scores are not sufficiently accurate to rule in or rule out mortality in patients with sepsis, based on the evidence available, which is generally poor quality. 相似文献10.
Connie Schumacher Leslie Hussey Vincent Hall 《Heart & lung : the journal of critical care》2018,47(4):297-303
Objective
To explore the decision making processes undertaken by community-dwelling individuals with heart failure as they experience symptom changes.Background
Heart failure patients are responsible for daily self-management that includes responding to symptom fluctuations between exacerbations. Despite education, some patients fail to seek timely medical intervention when symptoms change.Methods
Semi-structured interviews were conducted with homecare patients after receiving self-management education. Grounded theory methods and qualitative software were used to collect and analyze the data.Results
Five themes were identified: perceiving symptoms, alleviating actions and control, normalizing symptoms, absence of help seeking behaviors, and decreased functional capacity. Normalizing symptoms included actions taken by participants to mitigate symptom fluctuations. Daily fluctuations were assimilated into normal life resulting in desensitization of symptom recognition and decreased functional capacity.Conclusions
Findings support the need to educate on early symptom recognition, the benefits of safe physical activity, and building a system to support self-management patient-physician collaboration. 相似文献11.
James M. Walter Chitaru Kurihara Thomas C. Corbridge Ankit Bharat 《Heart & lung : the journal of critical care》2018,47(4):398-400
Background
Veno-venous extracorporeal membrane oxygenation (VV-ECMO) is increasingly utilized in the management of severe acute respiratory distress syndrome (ARDS). Providers who care for patients on VV-ECMO should be familiar with common circuit complications.Objectives
To provide an example of a common complication, circuit “chugging,” and suggest a management algorithm which aims to avoid excessive fluid administration to patients with ARDS.Methods
We use a clinical case to illustrate chugging and discuss potential management strategies.Results
Our patient received frequent boluses of albumin for intermittent circuit chugging contributing to a net positive fluid balance of roughly 6 liters 4 days after cannulation.Conclusions
Chugging is a common complication for patients on VV ECMO. A thoughtful approach to management may help limit potentially harmful fluid administration for patients with ARDS. 相似文献12.
Gbolahan O. Ogunbayo Le Dung Ha Qamar Ahmad Naoki Misumida Ayman Elbadawi Odunayo Olorunfemi Andrew Kolodziej Adrian W. Messerli Ahmed Abdel-Latif Claude S. Elayi Maya Guglin 《Heart & lung : the journal of critical care》2018,47(4):392-397
Introduction
This study compared inpatient outcomes related to the use of these two devices among patients who developed cardiogenic shock not due to acute myocardial infarction or coronary revascularization.Methods
We extracted admission-level records of patients with a diagnosis of cardiogenic shock who underwent either PVAD or IABP implantation from the National Inpatient Sample (NIS) database from 2010 to 2014. Our outcomes of interest were mortality and length of stay.Results
Inpatient mortality was significantly higher in the PVAD cohort. In multivariate analysis, PVAD use in these patients was associated with higher mortality. There was no difference in the length of stay between both groups among patients that survived to discharge.Conclusion
In our analysis of the NIS database, the use of PVADs in patients with cardiogenic shock of non-ischemic origin was associated with higher mortality when compared to IABP use. 相似文献13.
Zachary L. Cox Pikki Lai Connie M. Lewis JoAnn Lindenfeld Sean P. Collins Daniel J. Lenihan 《Heart & lung : the journal of critical care》2018,47(4):290-296
Background
Nationally-derived models predicting 30-day readmissions following heart failure (HF) hospitalizations yield insufficient discrimination for institutional use.Objective
Develop a customized readmission risk model from Medicare-employed and institutionally-customized risk factors and compare the performance against national models in a medical center.Methods
Medicare patients age ≥ 65 years hospitalized for HF (n = 1,454) were studied in a derivation cohort and in a separate validation cohort (n = 243). All 30-day hospital readmissions were documented. The primary outcome was risk discrimination (c-statistic) compared to national models.Results
A customized model demonstrated improved discrimination (c-statistic 0.72; 95% CI 0.69 – 0.74) compared to national models (c-statistics of 0.60 and 0.61) with a c-statistic of 0.63 in the validation cohort. Compared to national models, a customized model demonstrated superior readmission risk profiling by distinguishing a high-risk (38.3%) from a low-risk (9.4%) quartile.Conclusions
A customized model improved readmission risk discrimination from HF hospitalizations compared to national models. 相似文献14.
Dinanibè Kambiré Heidi M. Soeters Rasmata Ouédraogo-Traoré Isaïe Medah Lassana Sangaré Issaka Yaméogo Guetawendé Sawadogo Abdoul-Salam Ouédraogo Soumeya Ouangraoua Lesley McGee Velusamy Srinivasan Flavien Aké Malika Congo-Ouédraogo Absatou Ky Ba Cynthia G. Whitney Ryan T. Novak Chris Van Beneden 《The Journal of infection》2018,76(3):270-279
Objectives
We evaluate early impact of 13-valent pneumococcal conjugate vaccine (PCV13) on pneumococcal meningitis in Burkina Faso.Methods
Nationwide surveillance gathered demographic/clinical information and cerebrospinal fluid (CSF) results for meningitis cases. Pneumococcal cases were confirmed by culture, polymerase chain reaction (PCR), or latex agglutination, and strains serotyped using PCR. We compared incidence (cases per 100,000) in the early post-PCV13 period (2014 and 2015) to average pre-PCV13 incidence (2011–2013).Results
In 2015, age-specific pneumococcal meningitis incidences were 8.7 (<1 year), 2.4 (1–4 years), 6.5 (5–14 years), and 2.6 (≥15 years). Compared to 2011–2013, PCV13-serotype incidence among all ages decreased by 32% (95%CI: 23%–39%), with significant decreases among children aged <1 year (76%; 95%CI: 64%–84%) and 1–4 years (58%, 95%CI: 40%–71%). Among all ages, incidence of PCV13 serotypes besides serotype 1 decreased (68%; 95%CI: 59%–75%), but serotype 1 incidence did not. Incidence of non-PCV13 serotypes also decreased (47%; 95%CI: 29%–60%). Among children aged <1 year, serotypes 12F/12A/12B/44/46 (17%), 1 (12%), and 5 (10%) predominated.Conclusions
Following PCV13 introduction, PCV13-serotype meningitis incidence in young children significantly decreased. PCV13 impact on serotype 1 and disease in older children and adults requires continued monitoring. 相似文献15.
Xue Yu Qin Luo Zhihong Liu Zhihui Zhao Qing Zhao Chenhong An Zhiwei Huang Qi Jin Liu Gao Lu Yan 《Heart & lung : the journal of critical care》2018,47(4):308-313
Objectives
Iron deficiency (ID) prevalence in Chinese patients suffering from pulmonary hypertension (PH) is unclear so far. This study aimed to investigate ID prevalence in different subtypes of PH and its relevant factors.Methods
Hospitalized patients diagnosed with PH from September 2015 to March 2017 were retrospectively enrolled. Patients were grouped based on etiology. Logistic regression analysis was performed to determine factors associated with ID.Results
ID was found in 38.25% of 251 PH patients; with the highest prevalence in connective tissue disease associated pulmonary arterial hypertension (CTD-PAH). Univariate logistic regression analysis showed that female sex, age, CTD-PAH diagnosis and high sensitive C reactive protein (hs-CRP) were associated with ID. After adjusting for age, sex and hs-CRP, the diagnosis of CTD-PAH was still associated with ID (OR = 3.01, 95%CI 1.02–8.90, P < 0.05).Conclusions
ID is common in PH in China. CTD-PAH is independently associated with ID, after adjustment for age, sex, and hs-CRP. 相似文献16.
Eamon P. Raith Joshua F. Ihle Jennifer Jamieson Anna Kalff Julian Bosco 《Heart & lung : the journal of critical care》2018,47(4):425-428
Background
Idiopathic capillary leak syndrome (Clarkson's Disease) is a rare angiopathy with a heterogenous phenotype that may present as distributive shock refractory to resuscitative management.Objective
We report a case of idiopathic systemic capillary leak syndrome presenting as septic shock.Methods
Structured case report and review of the literature.Results
A 27-year old man admitted to our institution with coryzal symptoms rapidly deteriorated with presumed sepsis, leading to intensive care unit admission. Following further deterioration, Idiopathic systemic capillary leak syndrome was considered and intravenous immunoglobulin administered, resulting in rapid improvement in the patient's clinical status.Conclusions
Idiopathic systemic capillary leak syndrome is a rare and potentially life-threatening angiopathy that may present as, and should be considered in, refractory distributive shock. Administration of intravenous immunglobulin resulted in rapid recovery in this patient, and has been associated with positive outcomes in previous cases. 相似文献17.
Claire J. Tipping Anne E. Holland Meg Harrold Tom Crawford Nick Halliburton Carol L. Hodgson 《Heart & lung : the journal of critical care》2018,47(5):497-501
Background
The intensive care unit mobility scale (IMS) is reliable, valid and responsive. Establishing the minimal important difference (MID) of the IMS is important in order to detect clinically significant changes in mobilization.Objective
To calculate the MID of the IMS in intensive care unit patients.Methods
Prospective multi center observational study. The IMS was collected from admission and discharge physiotherapy assessments. To calculate the MID we used; anchor based methods (global rating of change) and two distribution-based methods (standard error of the mean and effect size).Results
We enrolled 184 adult patients; mean age 62.0 years, surgical, trauma, and medical. Anchor based methods gave a MID of 3 with area under the curve 0.94 (95% CI 0.89-0.97). The two distribution based methods gave a MID between 0.89 and 1.40.Conclusion
These data increase our understanding of the clinimetric properties of the IMS, improving its utility for clinical practice and research. 相似文献18.
Sim Leng Ooi Betsy Seah Vivien Xi Wu Karen Wei Ling Koh Nana Jiao Hong-Gu He Wenru Wang 《Heart & lung : the journal of critical care》2018,47(4):329-336
Background
Despite the increasing use of implantable cardioverter defibrillators (ICDs) as a preventive approach for high-risk patients with arrhythmias, little is known about the perceptions of ICD recipients regarding these devices and their impact on quality of life.Objectives
To explore perceptions towards quality of life, coping strategies, and learning needs of patients living with ICDs in Singapore.Methods
16 participants (age ranges 52 to 84 years old) were purposively recruited and interviewed individually for this exploratory qualitative study. Data collected was analyzed using thematic analysis.Results
Seven themes emerged: experiencing ICD shocks, ambivalent “love-hate” relationship with ICD, receiving support from healthcare professionals and social networks, attaining acceptance and returning to normalcy, physical coping, emotional coping, and readiness and need for enhanced patient education.Conclusions
With an insight to the perceptions of ICD recipients in Singapore, future practice can focus on addressing their concerns and improve post-implantation quality of life. 相似文献19.
Sikandar H. Khan Michelle Kitsis Dmitriy Golovyan Sophia Wang Linda L. Chlan Malaz Boustani Babar A. Khan 《Heart & lung : the journal of critical care》2018,47(5):489-496
Background
Music listening has been shown to reduce anxiety, stress, and patient tolerance of procedures. Music may also have beneficial effects on inflammatory biomarkers in intensive care and post-operative patients, but the quality of evidence is not clear.Objectives
We conducted a systematic review to evaluate the effects of music on inflammatory biomarkers in intensive care, and post-operative patients.Methods
A comprehensive search of the literature was performed. After screening 1570 references, full text review of 26 studies was performed. Fourteen studies were selected for inclusion.Results
Seven studies showed a significant decrease in cortisol levels, but the level of evidence was low. Three studies had low risk of methodological bias, while 11 studies had high risk of bias.Conclusions
Music intervention may decrease cortisol levels, but other biomarkers remain unchanged. Given the low level of evidence, further research on music effects on inflammatory biomarkers is needed. 相似文献20.
Glenna Schluck Wei Wu James Whyte Laurie Abbott 《Heart & lung : the journal of critical care》2018,47(5):458-464