Journal of critical care
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Journal of critical care · Oct 2018
Echocardiographic left ventricular diastolic dysfunction predicts hospital mortality after out-of-hospital cardiac arrest.
To determine whether systolic or diastolic dysfunction on transthoracic echocardiogram (TTE) predicts mortality after out-of-hospital cardiac arrest (OHCA). ⋯ Diastolic dysfunction (higher medial mitral E/e' ratio) on TTE independently predicted mortality after OHCA; systolic dysfunction and TTE hemodynamic parameters did not. This reflects a novel use of Doppler TTE to predict outcomes after OHCA.
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Journal of critical care · Oct 2018
Acute respiratory distress syndrome without identifiable risk factors: A secondary analysis of the ARDS network trials.
We examined whether patients with acute respiratory distress syndrome (ARDS) lacking risk factors are enrolled in therapeutic trials and assessed their clinical characteristics and outcomes. ⋯ Patients with ARDS without identifiable risk factors are enrolled in therapeutic trials and may have better outcomes, including a higher proportion of rapidly resolving ARDS, than those with risk factors.
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Journal of critical care · Oct 2018
Case ReportsA novel technique to establish hemodynamic monitoring in patients supported with extracorporeal life support systems (ECLS) for cardiopulmonary resuscitation (ECPR).
Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly used to support conventional unsuccessful resuscitation and it is mandatory to rapidly initiate invasive hemodynamic monitoring, as soon as ECPR therapy is commenced. Commonly, this is achieved by establishing an additional arterial line via the right radial artery for invasive blood pressure measurement, but this can be challenging and risky on the one hand and might lead to erroneous measurements on the other hand. Therefore, a faster, easier, safer and more valid method for hemodynamic monitoring is pressingly needed. ⋯ Invasive hemodynamic monitoring in critically ill patients with VA-ECMO support is easily and rapidly achievable by introducing a pigtail catheter through a modified arterial ECMO cannula. Validation of this method in larger clinical trials is warranted.
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Journal of critical care · Oct 2018
A modified Delphi process to identify, rank and prioritize quality indicators for continuous renal replacement therapy (CRRT) care in critically ill patients.
Continuous renal replacement therapy (CRRT) is a complex and life-sustaining therapy, reserved for our most acutely ill patients, and should be delivered in a safe, consistent and high-quality manner. However valid evidence-based quality indicators (QIs) for CRRT care are lacking. The objective of this study was to develop a prioritized list of QIs for CRRT care that may be used in any CRRT program. ⋯ We developed a prioritized list of 13 QIs for CRRT care. Future work should focus on developing validated benchmarks for these QIs and implementing them into CRRT programs.
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Journal of critical care · Oct 2018
Case ReportsWhen the heart gets the flu: Fulminant influenza B myocarditis: A case-series report and review of the literature.
To describe patients with refractory cardiogenic shock related to influenza B virus myocarditis rescued by venoarterial Extracorporeal Membrane Oxygenation (VA-ECMO). ⋯ Influenza myocarditis is a rare but reversible cause of cardiogenic shock amenable to VA-ECMO rescue. Early antiviral therapy and ECMO support should be considered for patients with fulminant myocarditis during an influenza epidemic.