Journal of intensive care medicine
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J Intensive Care Med · May 2014
ReviewDiastolic heart failure: the current understanding and approach for management with focus on intensive care unit patients.
Multiple recent epidemiologic studies have highlighted the importance of diastolic heart failure (DHF) as a public health problem. Approximately half of patients presenting with symptomatic heart failure (HF) have DHF and they suffer from morbidity and mortality comparable to those with systolic HF. Our understanding of the pathophysiology of DHF has evolved rapidly over the last decade, and the associated echo-Doppler findings that assist with its diagnosis are greatly refined. ⋯ The purpose of this review is to provide an up-to-date summary of the concepts of the pathophysiology of DHF. In addition, we provide an overview of the diagnostic approaches, prognostic identifiers, and associated comorbidities that make DHF more resistant to manage with a focus of the patients admitted to the intensive care unit. The current approach to managing patients with DHF is also reviewed.
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J Intensive Care Med · May 2014
ReviewPatient origin is associated with duration of endotracheal intubation and PICU length of stay for children with status asthmaticus.
To describe intubation practices and duration of mechanical ventilation in children with status asthmaticus admitted from emergency departments (ERs) to pediatric intensive care units (PICUs). ⋯ PATIENTS with status asthmaticus are more likely to be intubated when they are admitted from community hospital emergency rooms, although the duration of intubation and PICU stay is shorter.
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J Intensive Care Med · May 2014
Procedural and educational interventions to reduce ventilator-associated pneumonia rate and central line-associated blood stream infection rate.
Implementing best practice guidelines for ventilator-associated pneumonia (VAP) and central line-associated blood stream infection (CLA-BSI) has variable success. Our institution was concerned with high rates of VAP and CLA-BSI. This retrospective study was undertaken to see whether implementation of the below practices would reduce the rates of VAP and CLA-BSI without resorting to more expensive interventions such as subglottic endotracheal (ET) tube suctioning or silver-impregnated ET tubes. We utilized easily collectable data (standardized infection ratios [SIRs]) to rapidly assess whether interventions already in place were successful. This avoided cumbersome data collection and review. ⋯ Efforts to improve physician, patient, and staff education, and checklist implementation resulted in a decrease in VAP and CLA-BSI. This study confirms the applicability of best practice guidelines and suggests a benefit to the use of checklists. We utilize a practical approach for examining the success of these changes.
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J Intensive Care Med · May 2014
Respiratory perioperative management of patients with obstructive sleep apnea.
Obstructive sleep apnea (OSA) has become a major public health problem in the United State and Europe. However, perioperative strategies regarding diagnostic options and management of untreated OSA remain inadequate. ⋯ Additionally, supplemental oxygen and continuous pulse oximetry monitoring should be utilized to maintain baseline oxygen saturation. Postoperatively patients should remain in a semi-upright position and positive pressure therapy should be used in patients with high-risk OSA.