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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.
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3.
Sarah Morton Alexander Isted Pascale Avery Joe Wang 《The American journal of medicine》2018,131(10):1251-1256.e2
Background
Frailty and acute kidney injury are independently associated with an increased risk of morbidity and mortality. The degree of frailty can be assessed by the Clinical Frailty Score (CFS). This study assessed whether an individual's CFS was associated with acute kidney injury in acute elderly medical admissions and recorded the short-term outcomes.Methods
This was a single-center prospective observational cohort study. All patients aged ≥65 years admitted under an acute medical take over 12 nonconsecutive days were included. Patient demographics, comorbidities, baseline CFS, and renal status on admission were recorded. Outcomes of death, length of stay, and hospital re-attendance were assessed 2 weeks following admission.Results
Of 164 patients (77 males), 19% had acute kidney injury on admission and 22% were considered severely frail. Severe frailty was associated with acute kidney injury (P = .01) and death within 2 weeks (P = .01). Two-week mortality was highest among patients with both (36%).Conclusion
The incidence of acute kidney injury in “severely frail” acutely unwell elderly patients is significantly higher and associated with an increased short-term mortality. The CFS may be useful in acute illness to guide clinical decisions in elderly patients. 相似文献4.
Federica Dellafiore Harleah G. Buck Gianluca Pucciarelli Claudio Barbaranelli Marco Paturzo Rosaria Alvaro Ercole Vellone 《Heart & lung : the journal of critical care》2018,47(6):553-561
Background
Higher patient-caregiver mutuality is associated with improved patient and caregiver outcomes, but no studies have tested the psychometric characteristics of the mutuality scale (MS) in heart failure (HF) patient and caregiver population.Objectives
To test the validity and reliability of the MS.Methods
A cross-sectional design. The MS validity and reliability were tested with confirmatory factor analysis (CFA) and hypothesis testing, and with Cronbach's alpha and model-based internal consistency index, respectively.Results
CFA supported the validity of the MS in the HF patient and caregiver versions. Hypothesis testing showed significant correlations between both versions of the MS and anxiety, depression, quality of life, and self-care. Also, MS caregiver version scores correlated significantly with caregiver preparedness. Cronbach's alphas and the model-based internal consistency index ranged between 0.72 and 0.94 in both versions.Conclusions
The Mutuality Scale showed supportive validity and reliability for HF patients and caregivers. 相似文献5.
Sandra A. Carey Kristen M. Tecson Kyle Bass Joost Felius Shelley A. Hall 《Heart & lung : the journal of critical care》2018,47(4):285-289
Background
Clinical and ethical issues persist in determining candidacy for advanced heart failure (HF) therapies in elderly patients. Selection takes many factors into account, including “activation” (engagement and ability to self-manage).Objective
To investigate effects of age, activation, and depression/anxiety on selection and 6-month survival of participants considered for therapy.Methods
Consecutive people referred for advanced HF therapy completed the Patient Activation Measure and Hospital Anxiety and Depression Scale. We analyzed data from participants by age (≥65 vs. <65 years), stratified by approval for therapy.Results
Among 168 referred, 109 were approved, with no difference in activation between age groups (88% highly activated). Similarly, activation was not associated with age among those not approved. Activation was related to anxiety in older, approved participants, but not to depression.Conclusions
Concerns regarding reduced self-management in the elderly may not be valid. Age alone should not disqualify a candidate for advanced HF therapy. 相似文献6.
7.
Kelly D. Stamp Marilyn Prasun Christopher S. Lee Tiny Jaarsma Mariann R. Piano Nancy M. Albert 《Heart & lung : the journal of critical care》2018,47(2):169-175
Background
Heart Failure (HF) is a public health problem globally affecting approximately 6 million in the United States.Objectives
A tailored position statement was developed by the American Association of Heart Failure Nurses (AAHFN) and their Research Consortium to assist researchers, funding institutions and policymakers with improving HF clinical advancements and outcomes.Methods
A comprehensive review was conducted using multiple search terms in various combinations to describe gaps in HF nursing science. Based on gaps described in the literature, the AAHFN made recommendations for future areas of research in HF.Results
Nursing has made positive contributions through disease management interventions, however, quality, rigorous research is needed to improve the lives of patients and families while advancing nursing science.Conclusions
Advancing HF science is critical to managing and improving patient outcomes while promoting the nursing profession. Based on this review, the AAHFN is putting forth a call to action for research designs that promote validity, sustainability, and funding of future nursing research. 相似文献8.
Mona A. Abed Nidal F. Eshah Debra K. Moser 《Heart & lung : the journal of critical care》2018,47(3):226-230
Background
In developing countries, the number of adults who develop myocardial infarction (MI) at a young age is high. The popularity of waterpipe smoking (WPS) has increased among the same age group. It is unknown if WPS contributes to the incidence of early-onset MI.Objective
To study the association of WPS with early-onset MI, which is defined as first MI occurring in individuals 18 ≥ age ≤ 45 years compared to those older than 45 years.Methods
This was a cross-sectional study. The association of WPS with first-time MI was compared between younger and older adults (N = 225).Results
Twenty-five percent of all participants developed an acute MI before the age of 46 years. Both cigarette and WPS were more common among younger first-time MI patients than older first-time MI patients.Conclusions
WPS is one risk factor that distinguishes the risk profile of young adults with early-onset MI. 相似文献9.
Eda Unal Konstantinos Giakoumidakis Ehsan Khan Evridiki Patelarou 《Heart & lung : the journal of critical care》2018,47(4):351-359
Objective
The aim of this study was to identify, retrieve, critically appraise and synthesize information regarding existing mobile phone text messaging interventions that have been done for secondary prevention of cardiovascular disease (CVD).Methods
A systematic review was conducted. The searching was conducted by using the MEDLINE, EMBASE, PsychINFO, CINAHL, PubMed and ScienceDirect databases. Nine randomized controlled trials (RCTs) were eligible and included.Results
The preventive factors measured among studies varied. While the majority of studies examined medication adherence as a main outcome (4), the other 3 studies focused on CVD risk factors combining blood pressure (BP), smoking, body mass index (BMI), physical activity and dietary habits, only 2 studies examined both medication adherence and risk factor modification of CVD.Conclusion
Even though mobile phone text messaging may be beneficial for the secondary prevention of CVD, reliable conclusions on the effects of text messaging cannot be drawn. 相似文献10.
Nancy M. Albert James F. Bena Denise Buxbaum Linda Martensen Shannon L. Morrison Marilyn A. Prasun Kelly D. Stamp 《Heart & lung : the journal of critical care》2018,47(3):184-191
Background
Research findings on the value of nurse certification were based on subjective perceptions or biased by correlations of certification status and global clinical factors. In heart failure, the value of certification is unknown.Objectives
Examine the value of certification based nurses' decision-making.Methods
Cross-sectional study of nurses who completed heart failure clinical vignettes that reflected decision-making in clinical heart failure scenarios. Statistical tests included multivariable linear, logistic and proportional odds logistic regression models.Results
Of nurses (N = 605), 29.1% were heart failure certified, 35.0% were certified in another specialty/job role and 35.9% were not certified. In multivariable modeling, nurses certified in heart failure (versus not heart failure certified) had higher clinical vignette scores (p = 0.002), reflecting higher evidence-based decision making; nurses with another specialty/role certification (versus no certification) did not (p = 0.62).Conclusions
Heart failure certification, but not in other specialty/job roles was associated with decisions that reflected delivery of high-quality care. 相似文献11.
Amichai Perlman Bruria Hirsh Raccah Ilan Matok Mordechai Muszkat 《Journal of cardiac failure》2018,24(8):533-536
Background
Because neprilysin is involved in the degradation of amyloid-beta, there is concern that the angiotensin-neprilysin inhibitor sacubitril-valsartan could increase the risk for dementia.Methods
We analyzed adverse event cases submitted to the Food and Drug Administration Adverse Event Report System from July 2015 to March 2017. Cognition- and dementia-related adverse event cases were defined with the use of broad and narrow structured medical queries.Results
During the period evaluated, 9,004 adverse event reports (out of a total of 2,249,479) involved the use of sacubitril-valsartan. Based on the broad definition, sacubitril-valsartan was associated with cognition- and dementia-related adverse events in 459 reports (5.1%), but this was lower than the proportion of these reports among other medications (6.6%, reporting odds ratio [ROR] 0.72, 95% confidence interval [CI] 0.65–0.79). Restricting the comparison to cases with age >60 years and with the use of a comparator group with heart failure resulted in no association between sacubitril-valsartan and dementia-related adverse events, with the use of both the broad and the narrow definitions (ROR 0.87, 95% CI 0.76–1.02, and ROR 1.06, 95% CI 0.4–3.16, respectively).Conclusion
Sacubitril-valsartan is not associated with a disproportionately high rate of short-term dementia-related adverse effect reports. Long-term studies assessing cognitive outcomes are required to better establish the medication's cognition effects. 相似文献12.
Oriana Yu Laurent Azoulay Hui Yin Kristian B. Filion Samy Suissa 《The American journal of medicine》2018,131(3):317.e11-317.e22
Purpose
The magnitude of the risk of severe hypoglycemia associated with sulfonylureas as the initial treatment for type 2 diabetes in the real-world setting is unknown. We assessed the risk of severe hypoglycemia associated with initiating monotherapy with sulfonylurea compared with metformin for the treatment of type 2 diabetes.Methods
By using the UK Clinical Practice Research Datalink and Hospital Episode Statistics linked to the Office for National Statistics, we identified a cohort of patients with type 2 diabetes who initiated sulfonylureas or metformin monotherapy between April 1, 1998, and December 31, 2012, with follow-up until December 31, 2013. Sulfonylurea users were matched one-to-one to metformin users by high-dimensional propensity scores. Hazard ratios (HRs) and 95% confidence intervals (CIs) of severe hypoglycemia, defined as requiring hospitalization, were estimated using Cox proportional hazards models comparing sulfonylureas with metformin monotherapy.Results
The study cohort consisted of 14,012 initiators of sulfonylureas matched to 14,012 initiators of metformin. The mean treated follow-up time was 1.41 (standard deviation, 1.84) years. Use of sulfonylurea was associated with an elevated incidence of severe hypoglycemia compared with metformin as the initiating monotherapy for type 2 diabetes (incidence rate, 2.4/1000 person-years; 95% CI, 1.90-2.90; HR, 4.53; 95% CI, 2.76-7.45).Conclusions
Sulfonylureas, when prescribed as the initiating monotherapy for the treatment of type 2 diabetes, is associated with a 4.5-fold increase in the risk of severe hypoglycemia. Given the negative consequences of this outcome, clinicians should consider alternative hypoglycemic agents when metformin is not tolerated or contraindicated. 相似文献13.
Robyn Gallagher Sue Randall Stella H.M. Lin Janice Smith Alexander M. Clark Lis Neubeck 《Heart & lung : the journal of critical care》2018,47(5):471-476
Background
The mechanisms contributing to the success of cardiac rehabilitation (CR) are poorly understood and may include assessment, monitoring and review activities enabled by continuity of care and this is investigated in this study.Objectives
To identify active assessment components of CR.Methods
A qualitative study using focus groups and individual interviews. CR staff (n = 39) were recruited via professional association email and network contacts and organised into major themes.Results
CR staff assessment strategies and timely actions undertaken provided a sophisticated post-discharge safety net for patients. Continuity of care enabled detection of adverse health indicators, of which medication issues were prominent. Interventions were timely and personalised and therefore likely to impact outcomes, but seldom documented or reported and thus invisible to audit.Conclusion
CR staff assessment and intervention activities provide an unrecognised safety net of activities enabled by continuity of care, potentially contributing to the effectiveness of CR. 相似文献14.
Tsai-Chung Li Tzu-Yun Yu Chia-Ing Li Chiu-Shong Liu Wen-Yuan Lin Chih-Hsueh Lin Sing-Yu Yang Jen-Huai Chiang Cheng-Chieh Lin 《Journal of diabetes and its complications》2018,32(8):784-790
Aims
The study evaluated associations between 3-year eGFR trajectory patterns and adverse renal event in diabetic patients.Methods
Adverse renal event was defined as sustained eGFR <60 or one ACR >300?mg/g creatinine. Cox proportional hazards models evaluated association between eGFR trajectory patterns and adverse renal event.Results
We detected six clusters. Cluster 1 had a stable but relatively low baseline eGFR level (n?=?823, 20.52%), cluster 2 had a high baseline eGFR level, but slightly decreased afterwards (n?=?1708, 42.59%), cluster 3 had an increasing eGFR during the first 15-month follow-up and then a decline rate (n?=?505, 12.59%), cluster 4 decreased during the first 9-month follow-up and then remained stable (n?=?774, 19.30%), cluster 5 had a sharp decline and then was elevated after 21?months until the end of follow-up (n?=?135, 3.37%), and cluster 6 had an extremely fluctuating eGFR and then a sharp increase at the last 12-month period (n?=?65, 1.62%). Clusters 1, 3, and 4 show increased adverse renal risks compared with cluster 2 (2.24, 1.69–2.97; 2.70, 2.02–3.61; and 2.15, 1.64–2.83, respectively).Conclusions
Patients with sustained low-level renal function, renal decline, or increasing trend in eGFR trajectory encountered an increased CKD risk. 相似文献15.
Chou-Chin Lan Mei-Chen Yang Hui-Chuan Huang Chih-Wei Wu Wen-Lin Su I.-Shiang Tzeng Yao-Kuang Wu 《Heart & lung : the journal of critical care》2018,47(5):477-484
Background and Objectives
Patients with chronic obstructive pulmonary disease (COPD) often have poor health-related quality of life (HRQL), exercise capacity and cardiopulmonary function. Pulmonary rehabilitation (PR) is beneficial to improve exercise capacity and HRQL. However, series changes of these parameters remain unclear.Methods
Forty-three subjects participated in a 3-months PR program. Subjects were evaluated at baseline and at 8, 16, and 24 sessions after PR.Results
After 8 sessions, there were significant improvements in the SGRQ-symptom domain, exertional dyspnea, and oxygen pulse (all p < 0.05). Maximal VO2, SGRQ-activity and SGRQ-impact domains, and respiratory muscle strength were significantly improved after 16 and 24 sessions (all p < 0.05).Conclusions
Eight sessions of exercise training lead to improvement of symptoms and exertional dyspnea. 16 to 24 sessions result in further improvement. We suggest patients receive 16 to 24 sessions of PR. 相似文献16.
Ruprecht Schmidt-Ott Ulf Schutter Jörg Simon Barbara Poulsen Nautrup Alfred von Krempelhuber Kusuma Gopala Anastassia Anastassopoulou Adrienne Guignard Desmond Curran Sean Matthews Emmanuelle Espié 《The Journal of infection》2018,76(5):475-482
Objectives
Herpes zoster (HZ) mainly affects elderly people and immunocompromised individuals. HZ is usually characterized by a unilateral painful skin rash. Its most common complication, postherpetic neuralgia (PHN), may cause chronic debilitating pain. This study aimed to estimate the HZ incidence in individuals aged ≥50 years in Germany, the proportion of PHN and the economic burden.Methods
From 2010 to 2014, HZ patients were recruited when consulting physicians in physician networks covering about 157,000 persons aged ≥50 years. PHN was defined as “worst pain” rated ≥3 on the zoster brief pain inventory persisting or appearing over 90 days after rash onset. Costs were calculated based on medical resource utilization and lost working time.Results
HZ incidence was estimated as 6.7/1000 person-years, increasing with age to 9.4/1000 in ≥80 year-olds. Among 513 HZ patients enrolled, the proportion of PHN was 11.9%, rising with age to 14.3% in HZ patients ≥80 years. Estimated total cost per HZ patient was €156 from the healthcare system perspective and €311 from the societal perspective.Conclusions
The study confirmed previous findings that HZ causes a substantial clinical and economic burden in older German adults. It also confirmed the age-related increasing risk of HZ and PHN. 相似文献17.
Hamisu M. Salihu Jason L. Salemi Anjali Aggarwal Beverly F. Steele Ross C. Pepper Mulubrhan F. Mogos Muktar H. Aliyu 《The American journal of medicine》2018,131(1):64-71.e1
Background
Cardiovascular disease remains a leading cause of pregnancy-associated deaths in the United States. The extent to which increasing opioid use among pregnant women contributes to fatal cardiovascular events is unknown. We examined trends in opioid use among pregnant women over the previous decade and the association between changes in temporal trends in opioid drug use and the incidence of acute cardiac events among mothers.Methods
In this retrospective analysis of the Healthcare and Cost Utilization Project, we used a 2-stage stratified cluster sampling of all inpatient hospital discharges from nonfederal hospitals from January 1, 2002 through December 31, 2014. The study population comprised pregnant women aged 13-49 years and related hospitalizations, including delivery. The primary exposure of interest was opioid use during pregnancy. The primary outcome was the occurrence of acute myocardial infarction or cardiac arrest during pregnancy or childbirth.Results
Among the estimated 57.4 million pregnancy-related inpatient hospitalizations, 511,469 (approximately 1%) had documented use of opioids, cocaine, and/or amphetamines. There was a 300% increase in the use of opioids during pregnancy over the study period, whereas cocaine consumption significantly decreased and that of amphetamine remained stable. Over the 13-year period, the rise in opioid use paralleled a 50% increase in the incidence of acute cardiac events among mothers.Conclusion
Over the previous decade opioid use during pregnancy increased significantly, in parallel with the rise in the incidence of acute cardiac events in pregnancy and childbirth. An effective national policy is needed to address this emerging public health challenge. 相似文献18.
Ashish Correa Achint Patel Kinsuk Chauhan Harshil Shah Aparna Saha Mihir Dave Priti Poojary Abhishek Mishra Narender Annapureddy Shaman Dalal Ioannis Konstantinidis Renu Nimma Shiv Kumar Agarwal Lili Chan Girish Nadkarni Sean Pinney 《Journal of cardiac failure》2018,24(7):442-450
Background
Dialysis-requiring acute kidney injury (D-AKI) is a serious complication in hospitalized heart failure (HF) patients. However, data on national trends are lacking after 2002.Methods
We used the Nationwide Inpatient Sample (2002–2013) to identify HF hospitalizations with and without D-AKI. We analyzed trends in incidence, in-hospital mortality, length of stay (LoS), and cost. We calculated adjusted odds ratios (aORs) for predictors of D-AKI and for outcomes including in-hospital mortality and adverse discharge (discharge to skilled nursing facilities, nursing homes, etc).Results
We identified 11,205,743 HF hospitalizations. Across 2002–2013, the incidence of D-AKI doubled from 0.51% to 1.09%. We found male sex, younger age, African-American and Hispanic race, and various comorbidities and procedures, such as sepsis and mechanical ventilation, to be independent predictors of D-AKI in HF hospitalizations. D-AKI was associated with higher odds of in-hospital mortality (aOR 2.49, 95% confidence interval [CI] 2.36–2.63; P?<?.01) and adverse discharge (aOR 2.04, 95% CI 1.95–2.13; P?<?.01). In-hospital mortality and attributable risk of mortality due to D-AKI decreased across 2002–2013. LoS and cost also decreased across this period.Conclusions
The incidence of D-AKI in HF hospitalizations doubled across 2002–2013. Despite declining in-hospital mortality, LoS, and cost, D-AKI was associated with worse outcomes. 相似文献19.
Benjamin Marchandot François Levy Nicola Santelmo Paul-Michel Mertes Olivier Morel 《Heart & lung : the journal of critical care》2018,47(3):248-249
Background
Adequate strategies using either transthoracic (TTE) or transesophageal (TEE) echocardiography in patients receiving cardiopulmonary resuscitation (CPR) is an ongoing area of research.Objectives
As transthoracic point-of-care ultrasound (POCUS) during cardiac arrest resuscitation might result in an increased duration of interruptions in the delivery of chest compressions; the use of TEE has been proposed as an alternative.Methods
No technical complications of either TTE nor TEE are so far being reported in the literature.Results
We report the case of a left intramural atrial hematoma complicating TEE procedure during cardiac arrest. This highlights a unique and to our knowledge, first-in-man, described complicating TEE procedure during CPR.Conclusions
Further research on the safety of transesophageal echo during CRP is mandatory and the question about any potential harm of particular interest. 相似文献20.
Quin E. Denfeld James O. Mudd Wohaib Hasan Jill M. Gelow Shirin O. Hiatt Kerri Winters-Stone Christopher S. Lee 《Heart & lung : the journal of critical care》2018,47(4):281-284