Articles: critical-care.
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Diaphragm dysfunction is common in intensive care unit and associated with weaning failure and mortality. Diagnosis gold standard is the transdiaphragmatic or tracheal pressure induced by magnetic phrenic nerve stimulation. However, the equipment is not commonly available and requires specific technical skills. We aimed to evaluate ultrasound guided transcutaneous phrenic nerve stimulation for daily bedside assessment of diaphragm function by targeted electrical phrenic nerve stimulation. ⋯ The SONOTEPS method is a simple and accurate tool for bedside assessment of diaphragm function with ultrasound guided transcutaneous phrenic nerve stimulation in sedated patients with no or minimal spontaneous respiratory activity.
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The prehospital environment is fraught with operational constraints, making it difficult to assess the need for resources such as lifesaving interventions (LSI) for adults with traumatic injuries. While invasive methods such as lactate have been found to be highly predictive for estimating injury severity and resource requirements, noninvasive methods, to include continuous vital signs (VS), have the potential to provide prognostic information that can be quickly acquired, interpreted, and incorporated into decision making. In this work, we hypothesized that an analysis of continuous VS would have predictive capacity comparable to lactate and other laboratory tests for the prediction of injury severity, need for LSIs and intensive care unit (ICU) admission. ⋯ The results from this study suggest that continuous VS obtained from autonomous monitors in an aeromedical environment may be helpful for predicting LSIs and the critical care requirements for traumatically injured adults. The collection and use of noninvasively obtained physiological data during the early stages of prehospital care may be useful for in developing user-friendly early warning systems for identifying potentially unstable trauma patients.
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J Clin Monit Comput · Oct 2024
Time to maximum pupil constriction is variable in neurocritical care patients.
Quantitative pupillometry (QP) use has grown exponentially. Each QP scan captures images of the pupil before, during, and after light exposure to provide component measures of the pupillary light reflex (PLR). This study explores if the time to maximum constriction (tMC) is uniform among neuroscience intensive care unit (NSICU) patients. ⋯ The between-subject mean tMC was 0.97 (0.17) s and ranged from 0.46 s to 1.35 s. The tMC does not occur at a fixed point in time. Clinical applications that seek to characterize pupil health should account for varied tMC and explore relationships to discrete outcomes to determine the clinical usefulness of tMC.
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J. Thorac. Cardiovasc. Surg. · Oct 2024
A Retrospective Multicenter Study of Operating Room Extubation and Extubation Timing following Cardiac Surgery.
In an effort to enhance recovery after cardiac surgery, intraoperative extubation has been targeted as possibly beneficial. This multi-center cohort study aimed to assess this by evaluating the outcomes of OR extubation versus extubation within six hours of intensive care unit arrival (early ICU extubation). Furthermore, we assessed time to ICU extubation and mortality and morbidity. ⋯ Few cardiac surgery patients are extubated in the OR, which is associated with no clinical benefit and with increased morbidity. Cardiac surgery programs should reconsider OR extubation following cardiopulmonary bypass. Additionally, increased intubation time, in particular > 22 hours, is associated with an increase in adverse outcomes.