Journal of intensive care
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Journal of intensive care · Jan 2014
Neurological outcomes after extracorporeal cardiopulmonary resuscitation in patients with out-of-hospital cardiac arrest: a retrospective observational study in a rural tertiary care center.
In a rural region with few medical resources, we have promoted the strategy that if an out-of-hospital cardiac arrest (OHCA) patient is likely reversible, he or she should be transported directly from the scene of cardiac arrest to the only tertiary care center where extracorporeal cardiopulmonary resuscitation (ECPR) is readily available. We investigated 1-month survival and neurological outcomes after ECPR in OHCA patients at this center. ⋯ ECPR can be a useful means to rescue OHCA patients who are unresponsive to conventional cardiopulmonary resuscitation in a rural tertiary care center, in a manner similar to that observed in the urban regions.
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Journal of intensive care · Jan 2014
Respiratory support with nasal high-flow therapy helps to prevent recurrence of postoperative atelectasis: a case report.
Postoperative atelectasis should be avoided in surgical patients with impaired pulmonary function. Nasal high-flow (NHF) therapy delivered by the Optiflow™ system (Fisher & Paykel Healthcare Ltd., Auckland, New Zealand) is a new, simple device that supplies heated and humidified oxygen gas at >30 L/min via a large-bore nasal cannula. We herein describe a case in which respiratory support with NHF therapy was useful for the prevention of postoperative atelectasis recurrence. ⋯ In addition, the NHF therapy delivered optimally humidified gas, which improved the bronchial secretion quality. No further atelectasis occurred throughout the remaining stay in the intensive care unit. We conclude that respiratory support with NHF therapy may contribute to the prevention of postoperative atelectasis by delivering CPAP in combination with progressive respiratory rehabilitation.
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Journal of intensive care · Jan 2014
ReviewRole of prothrombin complex concentrate in perioperative coagulation therapy.
Prothrombin complex concentrate (PCC) is a term to describe pharmacological products that contain lyophilized, human plasma-derived vitamin K-dependent factors (F), FII, FVII, FIX, FX, and various amounts of proteins C and S. PCCs can be rapidly reconstituted in a small volume (20 ml for about 500 international units (IU)) at bedside and administered regardless of the patient's blood type. PCCs are categorized as 4-factor PCC if they contain therapeutic amounts of FVII, and 3-factor PCC when FVII content is low. ⋯ There is also an ongoing controversy about plasma transfusion and its potential hazards including transfusion-related lung injury (TRALI). Early fixed ratio plasma transfusion has been implemented in many trauma centers in the USA, whereas fibrinogen concentrate and PCC are preferred over plasma transfusion in some European centers. In this review, the rationales for including PCCs in the perioperative hemostatic management will be discussed in conjunction with plasma transfusion.
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Journal of intensive care · Jan 2014
Effect of a selective neutrophil elastase inhibitor on mortality and ventilator-free days in patients with increased extravascular lung water: a post hoc analysis of the PiCCO Pulmonary Edema Study.
Neutrophil elastase plays an important role in the development and progression of acute respiratory distress syndrome (ARDS). Although the selective elastase inhibitor, sivelestat, is widely used in Japan for treating ARDS patients, its effectiveness remains controversial. The aim of the current study was to investigate the effects of sivelestat in ARDS patients with evidence of increased extravascular lung water by re-analyzing a large multicenter study database. ⋯ Although sivelestat did not significantly affect 28-day mortality, this treatment may have the potential to increase VFDs in ARDS patients with increased extravascular lung water. Prospective randomized controlled studies are required to confirm the results of the current study.
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Journal of intensive care · Jan 2014
Early prediction of acute kidney injury biomarkers after endovascular stent graft repair of aortic aneurysm: a prospective observational study.
Acute kidney injury (AKI) is a common and serious condition usually detected some time after onset by changes in serum creatinine (sCr). Although stent grafting to repair aortic aneurysms is associated with AKI caused by surgical procedures or the use of contrast agents, early biomarkers for AKI have not been adequately examined in stent graft recipients. We studied biomarkers including urinary neutrophil gelatinase-associated lipocalin (NGAL), blood NGAL, N-acetyl-β-d-glucosaminidase (NAG), microalbumin (Alb), and liver fatty acid-binding protein (L-FABP) as prospective early biomarkers for AKI in patients who had received stent graft repairs of aortic aneurysms. ⋯ After stent graft repair of aortic aneurysm, NGAL/Cr is a potentially useful early biomarker for AKI.