Journal of intensive care medicine
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J Intensive Care Med · Oct 2016
Review Case ReportsSpinal Decerebrate-Like Posturing After Brain Death: A Case Report and Review of the Literature.
Criteria for establishing brain death (BD) require absence of all brainstem-mediated reflexes including motor (ie, decerebrate or decorticate) posturing. A number of spinal cord automatisms may emerge after BD, but occurrence of decerebrate-like spinal reflexes may be particularly problematic; confusion of such stereotypic extension-pronation movements with brain stem reflexes may confound or delay definitive diagnosis of BD. We present a case in which we verified the noncerebral (ie, likely spinal) origin of such decerebrate-like reflexes. ⋯ Extension-pronation movements that mimic decerebrate posturing may be seen in a delayed fashion after BD. Verification of lack of any brain activity (by both examination and multiple ancillary tests) in this case and others prompts us to attribute these movements as spinal cord reflexes and propose they be recognized within the rubric of accepted post-BD automatisms that should not delay diagnosis or necessitate confirmatory testing.
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J Intensive Care Med · Oct 2016
ReviewDamage Control and the Open Abdomen: Challenges for the Nonsurgical Intensivist.
As strategies in acute care surgery focus on damage control to restore physiology, intensivists spanning all disciplines care for an increasing number of patients requiring massive transfusion, temporary abdominal closures, and their sequelae. ⋯ Temporary abdominal closure improves outcomes in patients with abdominal compartment syndrome, hemorrhagic shock, and intra-abdominal sepsis but creates new challenges with electrolyte derangement, hypovolemia, malnutrition, enteric fistulas, and loss of abdominal wall domain. Intensive care of such patients mandates attention to resuscitation, sepsis control, and expedient abdominal closure.
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J Intensive Care Med · Oct 2016
The Outcome and Predictors of Mortality in Patients Therapeutically Cooled Postcardiac Arrest.
To review the outcomes of patients postcardiac arrest admitted to a metropolitan intensive care unit (ICU) where therapeutic hypothermia is practiced. ⋯ Patients admitted to ICU postcardiac arrest after therapeutic cooling have a high mortality. An initial rhythm of VT/VF confers a mortality benefit when compared to asystole and PEA.
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J Intensive Care Med · Oct 2016
A 24-Hour Postintensive Care Unit Transition-of-Care Model Shortens Hospital Stay.
Patients discharged early from the medical intensive care unit (MICU) are at risk of deterioration, MICU readmission, and increased mortality. An earlier discharge to a medical ward is desirable to reduce costs but it may adversely affect outcomes. To address this problem, a new model for the MICU transition of care was implemented at our academic center: The MICU team continued to manage all patients transferred from the MICU to the medical ward for at least 24 hours. ⋯ A new model for the post-MICU transition of care, with the MICU team continuing to manage all patients transferred to the medical ward for at least 24 hours, significantly decreased duration of hospital stay after MICU transfer without affecting MICU readmission and mortality rate. The implementation of this model may lower medical costs and make transition of care safer without adverse outcomes.
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J Intensive Care Med · Sep 2016
Low Blood Arterial Oxygenation During Venovenous Extracorporeal Membrane Oxygenation: Proposal for a Rational Algorithm-Based Management.
Venovenous extracorporeal membrane oxygenation (VV-ECMO) is a therapeutic option in the management of the most severe forms of acute respiratory distress syndrome. Oxygenation during VV-ECMO depends on many parameters, and its management is complex. The management of ECMO is still not completely codified. The aim of this study was to rationalize the management of hypoxemia during VV-ECMO. ⋯ If hypoxemia occurs during VV-ECMO, collecting oxygenation parameters and a clear step-by-step algorithm could guide specific intervention to improve oxygenation. This flow diagram is in accordance with current recommendations recapitulated in guidelines or troubleshooting chart but more accurate and complete. Although rational and appealing, it remains to be tested together with a number of still unsolved issues.