Journal of critical care
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Major complications associated with cardiac surgery are still common and carry great prognostic significance. β-Blockers, statins, antiplatelets, and renin-angiotensin system (RAS) blockers are current medical interventions to prevent cardiovascular complications in cardiac surgery. Renin-angiotensin system blockers include angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, and antialdosterones. Several lines of evidence support the cardioprotective effects of RAS blockers: they reduce ischemic events and improve outcome in heart failure independently of their effect on heart function and blood pressure. ⋯ Results from clinical trials and observational studies are conflicting, and they raise more questions than answers. Further studies are needed to examine whether RAS blockers reduce mortality and major complications in patients undergoing cardiac surgery. In this review, we discuss the use of RAS blockers in the setting of cardiac surgery, underlying the potential benefits in reducing postoperative complications.
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Journal of critical care · Jun 2015
ReviewA systematic review of extravasation and local tissue injury from administration of vasopressors through peripheral intravenous catheters and central venous catheters.
The aim of this study was to collect and describe all published reports of local tissue injury or extravasation from vasopressor administration via either peripheral intravenous (IV) or central venous catheter. ⋯ Published data on tissue injury or extravasation from vasopressor administration via peripheral IVs are derived mainly from case reports. Further study is warranted to clarify the safety of vasopressor administration via peripheral IVs.
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Journal of critical care · Jun 2015
Randomized Controlled Trial Observational StudyExercise-based rehabilitation after hospital discharge for survivors of critical illness with intensive care unit-acquired weakness: A pilot feasibility trial.
The aim of this study was to investigate feasibility of exercise-based rehabilitation delivered after hospital discharge in patients with intensive care unit-acquired weakness (ICU-AW). ⋯ Clinical Trials Identifier NCT00976807.
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Journal of critical care · Jun 2015
ReviewAssessment of preload and fluid responsiveness in intensive care unit. How good are we?
Early recognition and treatment of acute circulatory failure and tissue hypoperfusion are paramount for improving the odds of survival in critically ill patients. Fluid volume resuscitation is the mainstay intervention in redistributive and hypovolemic shock. ⋯ The use of dynamic changes in central venous pressure, pulse pressure, and echocardiography for assessment of inferior vena cava diameter variations during respiration allows prediction of fluid volume responsiveness in hemodynamically unstable patients. The use of these bedside approaches and passive leg raising maneuver, which is a reversible and quick fluid volume challenge, allows timely formulation of treatment strategy in patients with shock.
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Journal of critical care · Jun 2015
Multicenter StudyThe prevalance of and factors associated with intra-abdominal hypertension on admission Day in critically Ill pediatric patients: A multicenter study.
To investigate admission prevalence of intraabdominal hypertension (IAH) and to determine clinical and laboratory characteristics on admission day associated with IAH in critically ill pediatric patients. ⋯ Intra-abdominal hypertension seems to affect nearly half of newly admitted critically ill pediatric patients. Lactate level and the presence of hypothermia seem to be the independent predictors of the presence of IAH.