Journal of intensive care medicine
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J Intensive Care Med · Jul 2017
Case ReportsLeft Heart Decompression in Acute Complicated Myocardial Infarction During Extracorporeal Membrane Oxygenation.
Acute myocardial infarction (AMI) can progress to cardiogenic shock and mechanical complications. When extracorporeal membrane oxygenation (ECMO) is applied to a patient with AMI with cardiogenic shock and mechanical complications, left ventricular (LV) decompression is an important recovery factor because LV dilation increases myocardial wall stress and oxygen consumption. The authors present the case of a 72-year-old man with AMI and LV dilation who developed cardiogenic shock and papillary muscle rupture and who was treated successfully by ECMO with a left atrial venting.
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J Intensive Care Med · Jul 2017
Review Case ReportsAn Unusual Complication With the Administration of a Volatile Anesthetic Agent for Status Asthmaticus in the Pediatric Intensive Care Unit: Case Report and Review of the Literature.
In severe cases of status asthmaticus, when conventional therapies fail, volatile anesthetic agents remain a therapeutic option. When delivered outside of the operating room setting, specialized delivery techniques are needed to ensure the safe and effective use of volatile anesthetic agents. ⋯ This failure occurred as the soda lime compartment filled with water accumulated from circuit humidification and continuous albuterol therapy. The role of volatile anesthetic agents in the treatment of status asthmaticus in the PICU is discussed, options for delivery outside of the operating room presented, and potential problems with delivery reviewed.
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J Intensive Care Med · Jul 2017
ReviewNeurocritical Care of Emergent Large-Vessel Occlusion: The Era of a New Standard of Care.
Acute ischemic stroke continues to be one of the leading causes of morbidity and mortality worldwide. Recent advances in mechanical thrombectomy techniques combined with prereperfusion computed tomographic angiography for patient selection have revolutionized stroke care in the past year. ⋯ Postprocedural critical care issues that might modulate neurological outcome include blood pressure and glucose optimization, avoidance of fever or hyperoxia, fluid and nutritional management, and early integration of rehabilitation into the intensive care unit setting. In this review, we sought to lay down an evidence-based strategy for patients with acute ischemic stroke undergoing emergent endovascular reperfusion.
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J Intensive Care Med · Jul 2017
ReviewKetamine for Analgosedation in the Intensive Care Unit: A Systematic Review.
To evaluate the evidence for the use of intravenous ketamine for analgosedation in the intensive care unit. ⋯ Ketamine use may decrease analgesic consumption in the intensive care unit. Additional trials are needed to further delineate the role of ketamine for analgosedation.
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J Intensive Care Med · Jul 2017
GuidelineRevisiting Ultrasound-Guided Subclavian/Axillary Vein Cannulations: Importance of Pleural Avoidance With Rib Trajectory.
The Centers for Disease Control and Prevention guidelines for the prevention of catheter-related bloodstream infections suggest using "a subclavian site, rather than an internal jugular or a femoral site, in adult patients." This recommendation is based on evidence of lower rates of thrombosis and catheter-related bloodstream infections in patients with subclavian central venous catheters (CVCs) compared to femoral or internal jugular sites. However, preference toward a subclavian approach to CVC insertion is hindered by increased risk of mechanical complications, especially pneumothorax, when compared to other sites. ⋯ This is achieved by directing the needle toward the subclavian vein at a point where it traverses over the second rib, providing a protective rib shield between the vessel and pleura as a safety net for operators. The technique also allows for increased compressibility of the subclavian/axillary vein in the event of bleeding complication.