Journal of critical care
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Journal of critical care · Apr 2018
Case ReportsExamining the role of extracorporeal membrane oxygenation in patients following suspected or confirmed suicide attempts: A case series.
The decision to offer extracorporeal membrane oxygenation (ECMO) is based on a risk/benefit assessment and the likelihood of a treatable underlying condition or the feasibility of destination therapy (durable mechanical support or thoracic organ transplantation) should heart-lung function fail to improve. Patients who present following suspected suicide attempts who fail medical therapy may pose a dilemma for clinicians. An assessment to determine if a patient has a high likelihood of psychiatric recovery such that bridging with ECMO or ultimately destination therapy could or should be offered is not always feasible in the setting of critical illness. ⋯ A discussion of these cases demonstrates the effectiveness of ECMO in supporting this group of patients in the short-term. The self-limited natural history of many psychiatric episodes, poisonings and traumatic injuries makes the use of ECMO a potentially reasonable support strategy. However, careful consideration must be given to psychiatric history and follow-up given the substantial commitment of resources, potential for complications and for stranding patients on extracorporeal therapy without definitive destination therapy.
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Journal of critical care · Apr 2018
Observational StudyInflammatory lung edema correlates with echocardiographic estimation of capillary wedge pressure in newly diagnosed septic patients.
Lung ultrasound is an accurate and accessible tool to quantify lung edema. Furthermore, left ventricle filling pressures (LVFP) can be assessed with transthoracic echocardiography (TTE) by the E/e' ratio (E/e'). The present study aimed to assess the correlation between E/e' and lung edema quantified by a simplified lung ultrasound score (LUS) in newly admitted septic patients. ⋯ In newly admitted septic patients, lung edema is positively correlated with LVFP prior to fluid therapy. This finding might help find future targets for fluid resuscitation in sepsis.
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Journal of critical care · Apr 2018
Observational StudyBedside implantation of a new temporary vena cava inferior filter - Safety and efficacy results of the European ANGEL-Registry.
Pulmonary embolism (PE) is a frequently occurring complication in critically ill patients. Simultaneous occurrence of PE and life-threatening bleeding, may render medical anticoagulation impossible. For these patients, inferior vena cava filters (IVCF) present a valuable therapeutic alternative. The Angel® catheter is a novel IVCF that provides temporary protection from PE and is implanted at bedside. The primary objective of the European Angel® catheter registry is to evaluate the safety and efficacy of this IVCF. ⋯ Data shows that the Angel® catheter is a safe and effective approach to overcome the acute phase of critically ill patients with a high risk for the development of PE or an established PE, when an anticoagulation therapy is contraindicated.
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Journal of critical care · Apr 2018
Exploring the impact of using measured or estimated values for height and weight on the relationship between BMI and acute hospital mortality.
Studies have demonstrated an association between height and weight and mortality among patients in the Intensive Care Unit (ICU) and the optimal body mass index (BMI) might be well above the optimal values in the general population. Most of these studies have relied on estimated values, the validity of which is not known. ⋯ For epidemiological comparisons of mortality among critically ill adults, estimated values of height and weight appear valid.
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Journal of critical care · Apr 2018
Preoperative severe hypoalbuminemia is associated with an increased risk of postoperative delirium in elderly patients: Results of a secondary analysis.
To explore the association between the severity of preoperative hypoalbuminemia and the occurrence of postoperative delirium. ⋯ Preoperative severe hypoalbuminemia (≤30.0g/L) was associated with an increased risk of postoperative delirium and worse outcomes.