Journal of critical care
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Journal of critical care · Feb 2017
Observational StudyDecreased a disintegrin-like and metalloprotease with thrombospondin type 1 motif 13 activity and neurologic outcome in patients with successful resuscitation of out-of-hospital cardiac arrest: A prospective observational study.
The purpose of this study is to investigate the association between a disintegrin-like and metalloprotease with thrombospondin type 1 motif 13 (ADAMTS13) and neurologic outcome in patients with resuscitation of out-of-hospital cardiac arrest (R-OHCA). ⋯ Decreased ADAMTS13 activity was associated with poor neurologic outcome, high mortality, and worsened immune-inflammatory status in patients with R-OHCA. These results suggest that ADAMTS13 may have pathophysiologic relevance in postcardiac arrest syndrome.
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Journal of critical care · Feb 2017
The clinical benefit of a follow-up thoracic computed tomography scan regarding parenchymal lung injury and acute respiratory distress syndrome in polytraumatized patients.
To evaluate the increase of parenchymal lung injury (PLI) volume between the initial and a follow-up computed tomography (CT) scan and to ascertain which of the 2 scans was more appropriate to predict acute respiratory distress syndrome (ARDS). ⋯ The CT scans performed directly after admission are sufficient to define patients at risk for ARDS. Therefore, solely the incidence of PLI does not justify a routine follow-up CT scan.
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Journal of critical care · Feb 2017
Case ReportsPeripartum cardiomyopathy, place of drug therapy, assist devices, and outcome after left ventricular assistance.
Peripartum cardiomyopathy remains a challenging obstetric and cardiologic emergency. We report 5 interesting cases of peripartum cardiomyopathy with different clinical courses, with 3 patients requiring left ventricular assist device implantation. ⋯ Two patients improved with the medical treatment alone without the need of assistance. We will review main important related issues.
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Journal of critical care · Feb 2017
Early fluid resuscitation and volume therapy in venoarterial extracorporeal membrane oxygenation.
For circulatory support, venoarterial extracorporeal membrane oxygenation (VA-ECMO) is dependent on sufficient venous drainage ensured by fluid therapy. Volume overload however is linked to poor prognosis. This study therefore evaluates volume therapy in VA-ECMO. ⋯ Higher fluid balance was consistently linked to poor survival. We found no evidence to support a liberal fluid therapy in VA-ECMO patients, especially not the early after implantation. With a retrospective study, one cannot clarify if lower fluid balance might improve outcomes or represents a prognostic marker.
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Journal of critical care · Feb 2017
Predicting the need for nonstandard tracheostomy tubes in critically ill patients.
Few guidelines exist regarding the selection of a particular type or size of tracheostomy tube. Although nonstandard tubes can be placed over the percutaneous kit dilator, clinicians often place standard tracheostomy tubes and change to nonstandard tubes only after problems arise. This practice risks early tracheostomy tube change, possible bleeding, or loss of the airway. We sought to identify predictors of nonstandard tracheostomy tubes. ⋯ The findings suggest that clinicians should consider using nonstandard tracheostomy tubes as the first choice if the patient is male with an endotracheal tube size ≥8.0 and has a trachea-to-skin distance >4.4 cm on the computed tomography scan.