共查询到20条相似文献，搜索用时 31 毫秒
1.
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2.
Background
A clinical trial of extracorporeal membrane oxygenation (ECMO) as an alternative ventilator tool is being performed as a new indication for ECMO. The purpose of this study was to evaluate the feasibility of awake ECMO to increase the success rate of weaning patients from ECMO and ventilator care during treatment of postoperative severe acute respiratory distress syndrome (ARDS).Methods
We retrospectively analyzed the clinical reports of 10 patients who underwent awake ECMO due to postoperative ARDS between August 2012 and May 2015. We analyzed patient history, the partial arterial pressure of oxygen (PaO2)/fraction of inspired oxygen (FiO2) ratio, and patient outcome.Results
Seven patients (70%) were weaned from ECMO without difficulty; one patient failed to maintain awake ECMO, was re-intubated after 2 days of awake ECMO, and was re-tried on awake ECMO after 4 days of ventilator care. We weaned that patient from ECMO 2 days later. We weaned a total of eight patients (80%) from awake ECMO. The ECMO duration of surviving patients was 9.13±2.2 days (range, 6–12 days), and mean ventilator use duration was 6.8±4.7 days (range, 2–16 days). Two cases failed awake ECMO and died due to disease aggravation.Conclusions
Awake ECMO was a useful weaning strategy after severe postoperative ARDS, as it avoids long-duration use of mechanical ventilation. Additionally, it is possible for patients to breathe spontaneously, which might prevents respiratory muscle dystrophy. 相似文献3.
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4.
Jemima Boyd Jenny Paratz Oystein Tronstad Lawrence Caruana Paul McCormack James Walsh 《Heart & lung : the journal of critical care》2018,47(2):81-86
Rationale
Consensus recommendations have been developed to guide exercise rehabilitation of mechanically ventilated patients in the intensive care unit.Objective
This study aimed to investigate the safety of exercise rehabilitation of mechanically ventilated patients and evaluate the consensus recommendations.Methods
This was a prospective, single-centre, cohort study conducted in a specialist cardiothoracic intensive care unit of a tertiary, university affiliated hospital in Australia.Results
91 mechanically ventilated participants; 54 (59.3%) male; mean age of 56.52 (16.3) years; were studied with 809 occasions of service recorded. Ten (0.0182%) minor adverse events were recorded, with only one adverse event occurring when a patient was receiving moderate level of vasoactive support.Conclusions
The consensus recommendations are a useful tool in guiding safe exercise rehabilitation of mechanically ventilated patients. Our findings suggest that there is further scope to safely commence exercise rehabilitation in patients receiving vasoactive support. 相似文献5.
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6.
Melisa R. Chang Neha Chopra David Beenhouwer Matthew B. Goetz Guy W. Soo Hoo 《The American journal of medicine》2019,132(1):110-113
Background
There is limited data suggesting that recovery from severe pulmonary infection with Coccidioides may be hastened by the addition of systemic corticosteroids.Methods
We present a case report of 2 patients with persistent and progressive coccidioidomycosis who demonstrated a dramatic response to adjunctive corticosteroid therapy.Results
Both patients had Coccidioides immitis cultured from respiratory samples. One was a 69-year-old man who had been treated with combination fluconazole and liposomal amphotericin for over 6 weeks, with persistent fever and pneumonia. The other was a 61-year-old man treated with fluconazole and then amphotericin for 3 weeks, with progression to acute respiratory distress syndrome and shock. Both received short courses of intravenous methylprednisolone and recovered to be discharged home.Conclusions
As opposed to associated hypersensitivity, corticosteroid treatment in these cases was directed at modulating the ongoing destructive effects of unchecked inflammation. Rapid improvement was noted in both cases and raises the possibility that the addition of systemic corticosteroids may hasten recovery in patients with severe coccidioidomycosis. 相似文献7.
Athanasios Chalkias Theodoros Xanthos Effie Papageorgiou Artemis Anania Apostolos Beloukas Fotios Pavlopoulos 《Heart & lung : the journal of critical care》2018,47(6):616-621
Purpose
To assess the intraoperative initiation and feasibility of a modified NIH-NHLBI ARDS Network Mechanical Ventilation Protocol (mARDSNet protocol) in septic patients with severe ARDS.Materials and methods
This prospective observational study included consecutive adult septic patients with severe ARDS who underwent emergency abdominal surgery prior to intensive care unit (ICU) admission. The primary outcome was survival to hospital discharge and at 90 days. Secondary outcomes were intraoperative adverse events and ICU length of stay.Results
Seven patients were included. A statistically significant difference in lung compliance [ε=0.150, F(1.053, 3.158)=31.098, p=0.010] and driving pressure [ε=0.263, F(1.844, 5.532)=7.042, p=0.031] was observed with time, while plateau pressure did not changed significantly during surgery [ε=0.322, F(2.256, 6.769)=1.920, p=0.219]. Also, PEEP values were constantly increased during surgery [ε=0.252, F(1.766, 5.297)=9.994, p=0.017], with the highest values being observed towards to the end of the procedure. No intraoperative adverse events were observed. Mean (±SD) ICU length of stay was 10.43 (±2.64) days, while all patients survived to hospital discharge and at 90 days.Conclusions
The intraoperative implementation of our mARDSNet protocol is feasible and may increase the survival of septic patients with severe ARDS if initiated prior to ICU admission. 相似文献8.
9.
Bülent Özlek Eda Özlek Oğuzhan Çelik Cem Çil Volkan Doğan Murat Biteker 《Heart & lung : the journal of critical care》2018,47(4):360-362
Background
Allergic myocardial infarction is a rare clinical entity.Objectives
Although a few number of case reports with severe anaphylactic reactions to recombinant human insulin have been reported, allergic myocardial infarction, known as Kounis Syndrome, has not been reported before.Methods
Herein, we report a 57-year-old woman with myocardial infarction, referred for urticarial rash, chest pain, and palpitations developed after the first subcutaneous dose of recombinant human insulin.Results
The patient treated with antihistamines and steroids and discharged from hospital in a good condition.Conclusions
Physicians should be aware of allergic myocardial infarction. The diagnosis of Kounis Syndrome should be entertained when allergic symptoms, electrocardiographic changes, and high cardiac enzymes accompany acute-onset chest pain. All patients admitted to the emergency department with chest pain and ST elevation on electrocardiography should be asked about allergic insults. 相似文献10.
Kyoungrim Kang Leila Gholizadeh Hae-Ra Han Sally C. Inglis 《Heart & lung : the journal of critical care》2018,47(2):142-148
Background
Experience of myocardial infarction (MI) negatively affects different aspects of health-related quality of life (HRQoL).Objectives
This study aimed to examine trends in HRQoL of MI patients and to identify demographic, clinical and psychosocial predictors of HRQoL at three months.Methods
A total of 150 patients in South Korea were completed the study questionnaires at baseline. After three months from discharge, 136 participants completed follow-up questionnaires, including the Korean version of the MacNew Quality of Life after Myocardial Infarction Questionnaire (MacNew).Results
HRQoL significantly improved over three months. Younger age, ST-elevation MI, and higher LVEF, lower level of depression, better understanding of the illness and higher perceived social support at baseline were associated with better HRQoL at three months.Conclusion
Providing adequate information about the illness and social support as well as reducing negative psychological experiences in early days after MI may improve HRQoL of MI patients. 相似文献11.
Chunhua Ma Wei Zhou Qiubo Tang Shuling Huang 《Heart & lung : the journal of critical care》2018,47(4):337-344
Objectives
To test the effects of group-based Tai chi on health-status outcomes among older adults with hypertension.Background
A high-quality study exploring the effects of Tai chi on physical and psychosocial health for older adults with hypertension is needed in China. The long-term effects of group-based Tai chi in Chinese older adults with hypertension remain unclear.Methods
A randomized controlled trial was conducted. The group-based Tai chi training and practice were implemented in older adults over six-month.Results
The Tai chi (TC) group showed significantly lower blood pressure and body mass index than the usual care (UC) group. The TC group participants showed greater improvements in social support, quality of life, and reduction in depressive symptoms over a six-month intervention than UC group. TC group showed significant group-by-time interactions in these variables.Conclusion
Group-based Tai chi is effective in the enhancement of health-status outcomes for older Chinese adults with hypertension. 相似文献12.
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13.
Tariq S. Marroush Andrew R. Boshara Bassent Botros Philip Vendittelli Zohaib Ahmed Luay Dawood Howard S. Rosman 《Heart & lung : the journal of critical care》2018,47(2):131-135
Background
The rupture of sinus of Valsalva aneurysm (RSoVA) is a rare disorder that affects the integrity of the cardiovascular system, disrupting its dynamics and resulting in a variety of manifestations. In this report, we discuss two cases of RSoVA that we encountered and review similar cases reported in the literature.Methods
literature review of reported cases of RSoVA in PubMed and Google Scholar.Results
A total of 223 cases were found and the final analysis included 225 cases, of which 69% occurred in males and the mean age was 38.9 years.Dyspnea was the most common presenting symptom and 76% of the cases described continuous murmur on examination. The right sinus was affected in 61% of the cases and the fistula connected to the right chambers of the heart 73% of the time.Conclusion
RSoVA is a rare condition that is difficult to diagnose, it should be considered in the right context, particularly in young patients with symptoms of heart failure and the presence of continuous murmur on cardiac examination. 相似文献14.
15.
16.
John E. Madias 《Heart & lung : the journal of critical care》2018,47(3):222-225
Background
Hyperactive autonomic nervous system (ANS) is among the postulated pathophysiologic mechanisms of takotsubo syndrome (TTS). Diabetes mellitus (DM) with its associated ANS peripheral neuropathy could exert a “protective” influence for the emergence of TTS.Methods
A patient-based meta-analysis of the data obtained from all patients presented individually was carried out, focusing on age, gender, and history of hypertension (HTN) and DM.Results
The prevalences of HTN and DM for all 2,342 patients, aged 61.1 ± 17.3, 85.1% female, were 37.4% and 9.5%, for patients ≥ 60 years old were 45.8% and 11.7%, and for patients ≥65 years old were 48.2% and 12.3%, correspondingly. The prevalence of DM in patients with TTS is less than half of the world's and USA's elderly populations.Conclusions
Prevalence of DM in patients with TTS is lower than in the general population, suggesting that DM, may have a “protective” effect for the emergence of TTS. 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.
Oronzo Chialà Ercole Vellone Leonie Klompstra Giorgio Alberto Ortali Anna Strömberg Tiny Jaarsma 《Heart & lung : the journal of critical care》2018,47(5):465-470
Background
Symptoms of anxiety, depression, and cognitive impairment are common in heart failure (HF) patients, but there are inconsistencies in the literature regarding their relationship and effects on exercise capacity.Objectives
The aim of this study was to explore the relationships between exercise capacity and anxiety, depression, and cognition in HF patients.Methods
This was a secondary analysis on the baseline data of the Italian subsample (n = 96) of HF patients enrolled in the HF-Wii study. Data was collected with the 6-minute walk test (6MWT), Hospital Anxiety and Depression Scale, and Montreal Cognitive Assessment.Results
The HF patients walked an average of 222 (SD 114) meters on the 6MWT. Patients exhibited clinically elevated anxiety (48%), depression (49%), and severe cognitive impairment (48%). Depression was independently associated with the distance walked on the 6MWT.Conclusions
The results of this study reinforced the role of depression in relation to exercise capacity and call for considering strategies to reduce depressive symptoms to improve outcomes of HF patients. 相似文献19.
20.
Ana C. Paim Larry M. Baddour Bobbi S. Pritt Audrey N. Schuetz John W. Wilson 《The American journal of medicine》2018,131(9):1126-1129